All roads lead to Rome

How the voluntary registers are moving towards a common goal for all MSK professionals

For musculoskeletal practitioners looking to join a register, there are currently two to choose from. So, what does each voluntary register offer and how do you decide which one’s for you? Stephanie Bateman finds out.

With a myriad of animal therapy courses on offer in the UK, the world truly is a budding animal practitioner’s oyster. But there’s a tiny snag – not all courses are equal and while some qualify you to join one of the two registers currently available, others don’t.

Currently, there are two voluntary registers - Register of Animal Musculoskeletal Practitioners (RAMP) and Animal Health Professions Register (AHPR).

RAMP is open to Veterinary chiropractic, osteopathic and physiotherapy professionals, while AHPR is open to Veterinary chiropractic and manipulation, hydrotherapy, veterinary physiotherapy, animal sports therapy and animal massage professionals.

Which one you can join depends on your qualifications and clinical training.

So, why were the registers created in the first place?

“After years of differing of opinions between select members, it was music to the ears of hundreds of qualified therapists that all the associations were getting together to create one register, raising the level of education and getting an equal level of recognition from animal owners and other professionals,” explains Animal Physiotherapist Hannah Ashton.

“To hear the talks had failed and two registers were going to be established was so disappointing as it didn't feel like the original goal would be met.”

Dr Vav Simon is President of RAMP and says that protection of title was the key issue when discussions between the two registers began in 2009.

“There were a lot of courses springing up that were training people, but the titles of chiropractic, osteopathy and physiotherapy were not protected,” she says. “Effectively, Joe Blogs the dustman could do a weekend course on animal physiotherapy and call himself an animal physiotherapist and there was no one to stop him.”

The confusion grew to a place where DEFRA were being asked questions from both the public and vets as to who these new people were.

“Members of various bodies from the industry gathered together to see what could be done to protect the title, not knowing at that point that it wasn’t possible,” says Vav. “The next best thing was to ask the vets what they wanted. Their answer was someone they would feel happy to refer to who were giving the same level of care and quality treatment and professionalism to the animals that they would expect themselves. So, we set about trying to raise standards.”

"RAMP was created to “govern the practice of MSK treatment, protect the public and be able to reassure the vets and animal owners that if they ask for a practitioner, the person they are going to get is properly trained, qualified, keeps up CPD, has insurance and is being evaluated and monitored on a regular basis.

Because RAMP set up to the same level as human practitioners, many people thought that they only accepted human-trained practitioners.

“That isn’t the case,” adds Vav. “As long as you meet the criteria you are allowed onto the register. We wanted to make it a much wider and more accessible register to be on.”

RAMP are also in talks with the RCVS who are currently discussing regulating all paraprofessionals, however, this is a road RAMP seem less keen to go down for various reasons.

Why two registers?

Veterinary surgeon Carole Brizuela is acting chair of AHPR and manages the veterinary physiotherapy programmes at Harper Adams University. She explains how and why AHPR was set up.

“The review of minor procedures for the veterinary surgeons act started off talks between big groups of MSK professionals, and for two years, we discussed the best route coming up with training standards and trying to decide how to do things,” she says. “Then RAMP was set up and many of the MSK members were not eligible to join such as the canine hydrotherapists and sports massage therapists, so we set up AHPR in 2018 with the aim of being more inclusive and ensuring that other people who work in the industry were supported.”

AHPR has different subgroups within the register including vet physio, sport therapy and massage, animal chiropractic and manipulation and small animal hydrotherapy.

“Those groups were made up of the major associations and representatives from the main governing bodies plus some other people like myself, who are involved in education to come together to develop the training standards for each different sub group. The main board then put together CPD documentation, a code of conduct and all the documents you’d expect from a voluntary regulatory body. We wanted to make sure that the training standards were what you’d expect from a professional.”

AHPR accredits courses and those courses have to meet certain standards such as being university validated or on the regulated qualification framework (RQF) so they are being correctly validated and accredited by external bodies.

“We look at the training and whether it meets the day one competencies and the clinical training hours that we expect,” says Carole. “It’s also externally validated, and quality controlled by whichever university or RQF they are on at that point in time.”

As with RAMP, AHPR agrees that registers are there for protection of the public rather than people on the register.

We’re very much behind the idea that we are a group of practitioners who are overseen by a vet but are still very knowledgeable in their own right,” says Carole. “Our aim is to provide a register for a wide range of professionals working within the animal health industry so that the public and vets can be assured that the people on the register have been properly trained and are accountable, and they follow a code of conduct and do CDP etc.”

The RCVS’s view

Eventually, both registers would like to reach a point where they can work together but much of the power on this lies in the hands of the RCVS. Ben Myring is head of the Policy & Public Affairs Manager in the Communications Department at the Royal College of Veterinary Surgeons. Here, he shares his thoughts on voluntary registers and where he sees the industry heading.

“I’d start by pointing to the merits of regulation in general – by setting and upholding standards of education and conduct we protect animal health and welfare and public health and provide assurance and clarity to the public,” he says.

“We do this for veterinary surgeons, but also for one paraprofession – veterinary nurses – who by virtue of being Associates of the RCVS are termed an ‘allied profession’. The RCVS’s Royal Charter allows us to add additional paraprofessions as Associates – i.e. we would keep the register for that paraprofession and be responsible for setting and upholding their standards.

“It has already been agreed by RCVS Council that those paraprofessions whose work can amount to an act of veterinary surgery need to have their work properly underpinned by legislation (the existing Exemption Orders being insufficient for this purpose) and that one way to do this would be to add them to the Veterinary Surgeons Act (VSA) alongside veterinary nurses. Alternatively, a new Veterinary Surgeons Act could achieve the same aim. “The VSA requires the RCVS to ‘hold the list’ of individual paraprofessionals directly, rather than accredit a separate body that then holds the register. It is also arguably appropriate that groups who carry out acts of veterinary surgery be directly regulated, regardless of the legislative technicalities. There are also benefits - both of coherency and cost - to sharing one system of regulation.

“As is usual for paraprofessionals there are already a number of groups representing and/or holding voluntary registers for the various musculoskeletal paraprofessional groups, and we have been in discussions with these groups as we develop our policies. Voluntary regulation schemes are a common and essential step on the path to statutory regulation.

“At the moment we are not in a position to regulate musculoskeletal therapists because of the prior requirement for legislative reform noted above. Because of that we have not considered the application criteria or regulatory standards for those paraprofessionals, and so we don’t yet take a view on which forms of training are appropriate.”