What remote veterinary triage learned the hard way

A veterinary surgeon in Britain may not prescribe a prescription-only veterinary medicine on a hunch, a photograph or a form. Schedule 3 of the Veterinary Medicines Regulations 2013 requires that the prescriber must first carry out a clinical assessment of the animal, and the animal must be under that veterinary surgeon’s care. Everything commercially interesting about remote animal care in this country follows from how those two phrases are read.

For most of the last decade they were read conservatively, and a video consultation could not lead to a prescription. That changed on 19 January 2023, when RCVS Council voted, by twenty to three, to adopt new guidance on what “under care” means. The College published the decision the following day and the guidance came into effect on 1 September 2023.

The change was not a green light. It was a carve-out with a hole in the middle of it, and the hole is where the money was.

The rule that shapes the market

Under the guidance, a clinical assessment is defined as any assessment that gives the veterinary surgeon enough information to diagnose and prescribe safely and effectively, and whether a physical examination is needed before prescribing is stated to be a matter of professional judgement. That is the permissive half.

The restrictive half is a list. A physical examination is required where a notifiable disease is suspected, when prescribing controlled drugs, and, unless there are exceptional circumstances, when prescribing antibiotics, antifungals, antiparasitics or antivirals.

Consider what that removes. Flea and worm treatment is the single highest-volume repeat purchase in companion animal practice, and it is antiparasitic. Antibiotics are the commonest acute prescription in first-opinion work. A remote-first provider is therefore permitted to prescribe in the categories where volumes are lower and clinical certainty is harder, and is excluded from the categories that make a conventional practice’s dispensary profitable. Any business model built on remote prescribing has to solve that, and the two available solutions are a partnership with a physical practice or an entirely different revenue line.

There is a second obligation that shapes company structure rather than product. A veterinary surgeon who has an animal under their care must be able, on a 24/7 basis, to physically examine it. The College permits that duty to be discharged by another veterinary service provider on the surgeon’s behalf, provided arrangements are made in advance and confirmed in writing with the client. A telemedicine platform, by definition, cannot examine anything. Its 24/7 obligation is therefore a contract with somebody who can, and the quality of that contract is the real regulatory surface of the business.

Consider what that requires operationally. Coverage has to exist wherever the client is, not wherever the platform is, which means a national network rather than a partnership. It has to be confirmed in writing with the client in advance, which means it is a step in the sign-up journey rather than a clause in a supplier agreement. And it has to hold at three in the morning on a bank holiday, which is precisely when a physical practice’s capacity is least elastic and most expensive. A remote-first veterinary business is, in regulatory terms, a company whose principal fixed obligation is to a service it does not provide.

That is the part of the model that does not scale in the way software scales, and it is the reason the sector’s growth has been slower than the technology press expected in 2019. Adding a thousand users to a video platform costs almost nothing. Adding a thousand users to a 24/7 physical examination commitment costs whatever the local market charges for out-of-hours capacity.

What is on the record about Vet-AI

Vet-AI is a real company and a useful worked example, so it is worth being precise about which claims can be checked and which cannot.

VET-AI LTD is registered at Companies House with company number 11343174, incorporated on 3 May 2018, with a registered office in Leeds and SIC codes covering veterinary activities and other professional, scientific and technical activities. Its filing history shows accounts filed under the total exemption regime available to small companies, share allotments in 2024, and confirmation statements up to May 2026.

Its consumer product, Joii Pet Care, publishes its own regulatory position. The service states that it operates as a registered RCVS Vet Practice (7499851), that prescription-only veterinary medication is dispensed for Joii by VioVet Ltd under a separate practice registration, and that it is registered as an internet retailer of veterinary medicines with the Secretary of State for Environment, Food and Rural Affairs. Published pricing shows video consultations at no charge for customers insured with partner insurers, and £28 for a consultation otherwise.

That structure repays a second look. The consulting entity and the dispensing entity are separate registered practices. Prescribing and supply have been deliberately decoupled, which is exactly what the prescribing rules push a remote provider towards, and it is also the arrangement the competition authorities have spent two years examining across the whole sector.

What is not on the public record is as important. Because the company files under the small companies exemption, its revenue, margin and consultation volumes are not disclosed in its statutory accounts. No published clinical outcome data for the service exists that could be checked against an independent source. Figures for registered pets, consultation counts, funding rounds and user satisfaction circulate widely in trade coverage, and none of them can be verified against a filing, a regulator or a peer-reviewed study, so none of them appear here.

The evidence base is thinner than the sector’s confidence

For a subject that has been commercially active since 2019, the published evidence on veterinary teleconsultation remains slight. The British appraisal usually reached for is not a systematic review, and the difference matters in a field this thin. It is a Knowledge Summary, the critically appraised topic format Veterinary Evidence runs, published in 2022 by researchers at the Royal Veterinary College. It examined eight studies comparing teleconsultation with in-person consultation, six of them cross-sectional, one a randomised controlled trial and one a case report, and concluded that all eight provided weak evidence of similar levels of clinician and / or client satisfaction, the weakness arising from the subjectivity and varied methods of measuring satisfaction. The authors also placed a boundary around applicability, noting that teleconsultation remains suited to specific scenarios: emergency triage, remote locations, routine postoperative checks and behavioural work.

Note what that appraisal measured. Satisfaction, not diagnostic accuracy, and not outcome. The question a regulator or an insurer would want answered, which is whether remote triage sends the right animals to a clinic quickly enough, is not settled by eight satisfaction studies, and the sector has not funded the trial that would settle it.

The design of that trial is not mysterious, which makes its absence more conspicuous. It would need a cohort of presentations triaged remotely, an independent physical assessment of the same animals within a defined window, and a comparison of the disposition each route produced, with under-triage and over-triage reported separately because they carry entirely different costs. Under-triage harms the animal. Over-triage sends healthy patients into a system with no spare capacity and converts a cheap consultation into an expensive one. Any provider holding data of that kind and choosing not to publish it is making a commercial decision, and it is a reasonable one. It is also the reason an academic reader will find the veterinary telemedicine literature thinner than the market’s confidence would suggest.

Two structural factors keep it thin. There is no equivalent of a clinical trials register for companion animal services, so nothing compels publication of a negative result. And the funding that exists flows to product development rather than to evaluation, because a platform’s competitive advantage lies in the former and its regulatory exposure has so far not depended on the latter.

This is where the sector’s language does itself damage. Symptom checkers are routinely described as artificial intelligence when the checkable description is a structured questionnaire with a triage rule set behind it, which is a perfectly respectable thing to build and a considerably easier thing to assure. The distinction matters to anyone assessing risk, and it is the same distinction that runs through the rest of the category, which Foundry4 covers in its AI and automation section and in its work on intelligent automation.

The competition remedies change the ground under all of it

On 24 March 2026 the Competition and Markets Authority published the final report of its market investigation into veterinary services for household pets, and the remedies land during 2026 and 2027. Two of them bear directly on remote providers.

A cap on written prescription fees sets the maximum at £21 for the primary prescription and £12.50 for each additional medicine prescribed in the same consultation, with large businesses given six months to comply and smaller ones twelve. A separate remedy requires firms to reduce barriers to buying medicines elsewhere and to provide a written prescription in hard copy by the end of the consultation or digitally within 48 hours.

Read those together and the effect is to make the prescription itself a cheap, portable, digitally delivered object. That is straightforwardly good for a business whose model is a low-cost consultation followed by online supply, and straightforwardly hard for a practice that has been cross-subsidising a consultation fee with a dispensary margin. The CMA was not regulating telemedicine. It has nonetheless done more to shape the addressable market for remote veterinary care than any guidance the profession has issued.

The lesson generalises past pets. A service built on a regulated professional judgement does not compete on interface quality. It competes on where the regulator has drawn the line around the judgement, and on what the competition authority has done to the price of everything on the other side of it. Vet-AI’s structure, two registered practices with prescribing and supply held apart, reads as an answer to those constraints rather than to a design brief. That is usually the sign of a company that has been paying attention.