Consider this tricky scenario: Tom, a local moggy, is a regular and persistent visitor to your practice, but he isn’t owned by your team. He’s fed regularly and is much loved. Some patients even say that having Tom in the surgery is “great” and “lovely therapy” for them.

However, one day, a young child is scratched and badly injured by a grumpier-than-usual Tom, and when you look at your public liability insurance, you get a sinking feeling.

As Tom isn’t your pet, you realise that your public liability insurance may not cover something that doesn’t belong to you. And there may not be an acceptable, or reasonable, industry standard relating to non-assistance animals being allowed in the waiting room… so is the practice compromised?

Back to basics

But let’s not get ahead of ourselves. We should be asking, firstly, which kinds of animals should be allowed in the surgery, and secondly, what classes as an “assistance animal” anyway?

This is an interesting subject and one I’ve delved into as part of updates to the Assistance Dogs and Other Animals Policy [PLUS]. This policy considers various areas including infection prevention control and other measures such as the legal requirement that needs to be considered to keep you compliant.

On the surface, it seems to be quite a simple subject – that is, practices are obliged to have assistance dogs on the premises as we must comply with both the Disability Discrimination Act 1995 and the Equality Act 2010.

But what exactly is an “assistance dog”?

The Equality Act 2010 s173(1) outlines the legal definition: assistance dogs are usually those that have been trained by a charity such as Guide Dogs for the Blind. As such, you’d hope that any animal coming into the premises would be clearly identified as a working dog and that it would have been trained to support their owner who has a specific need.

However, this isn’t always the case! While there is an official training standard, there is no legal requirement for an assistance dog to have been trained by a charity, or even for the owner to carry any specific identification to prove that it’s a working animal. But without proof that can be requested, or any confirmation of training, how can we be sure that dogs entering the practice are really assistance dogs?

This is the guidance from the Equality and Human Rights Commission, highlighting why assistance dogs should be welcomed inside business premises. In fact, if the canine is refused entry, the consequences of disability discrimination litigation may become a possibility. It should be noted that there are many cases of companies being fined for not allowing assistance dogs into their premises or taxi; as such, these companies have fallen foul of the requirements of the DDA.

Of course, it’s vital that we all ensure we don’t make life harder for those who need an assistance dog – but, surely, having evidence, such as the dog being listed on a national register, would be sensible? Perhaps the dog’s status and details of its training could be included on a plastic ‘credit card’ or small tag placed on the dog’s lead or collar? Having this kind of evidence would make life easier for the owner if they ever had to explain to a restauranteur, shopkeeper or GP receptionist that the dog had a right to be there.

Recent poll – Do you allow animals?

In a recent poll on the Practice Index forum, a significant majority of members stated that, apart from assistance dogs, they don’t allow animals into their practice, and some practice managers insisted on seeing proof of training for dogs. They believed that no proof of training meant that the dog must be a pet and not an assistance dog. Whilst this is a pragmatic approach, I would urge caution as we already understand that there’s no requirement to prove the status of the animal. As such, you could find yourself falling foul of the legislation.

Some surgeries do allow all dogs into the reception area, but this is each practice’s choice. Please remember that we must consider all of our patients. Some patients will have an allergy to animals, some will be immunosuppressed, and others will be frightened or have a phobia of dogs. We must also think about the potential increased IPC risk posed by canines. Even dogs that are tied up outside the practice for a while may leave something smelly for people to tread in!

Therefore, having some guidelines in place, so that staff members know the recommended procedures, is advisable.

Are animals allowed in other healthcare settings?

Therapy dogs are often seen in children’s hospitals or care homes. These canines are an essential part of Animal Assisted Therapy (AAT), and their handlers work alongside healthcare professionals as part of a care plan. Of course, these dogs receive specialist training.

Also, there is Animal Assisted Activity (AAA), where a handler may bring in a dog for general interaction; these dogs are usually the handler’s pet, so wouldn’t be in the same category as AAT dogs. Then there are other animals, such as Shetland ponies, cats and more, that may be introduced into a healthcare setting to allow people to stroke or interact with the animals.

However, as our patients make only fleeting visits to our practices, it’s unlikely that any type of therapy animal would be used in a GP practice setting.

Back to Tom the moggy

When it comes to deciding which animals should be allowed into the surgery, a useful RCN document can be found at Appendix 1 – an agreement for a dog owner to take full responsibility for their pet. The document also has many other requirements including ensuring that the animal is bathed and brushed and kept on a lead. It should be noted, though, that this is a form for a hospital setting and for a dog. As far as I can see, there is no standard for other types of animals. Therefore, with no best practice examples, I would assume that Tom, the local cat, should never have been allowed into the surgery in the first place.

But I wonder where the ‘Tom scenario’ would leave the Partners?

As I’m not a lawyer, and I’m not from an insurance background, I’ve given this scenario to both groups of experts for their advice.

• The legal team from Hempsons have agreed that this is a very interesting point of law and have suggested that any agreement to have animals (other than assistance dogs) in the practice must be purely based upon the findings of a risk assessment.
• From an insurance perspective, it was suggested that any such public liability claim for the above scenario would likely result in the claim being declined as it would be unusual to have a non-pet or visiting animal on the premises, and that there was no way of ascertaining its health or temperament. This was even following raising a risk assessment.

Whilst this is simply their opinion, given their responses, surely the probable outcome to a similar scenario would be that the partners would likely be sued at their personal expense?

Risk management

Hempsons did further advise that any employer must have a policy in place if they permit pets or other animals in the workplace. Furthermore, they reminded us that as the employer has a duty to take reasonable care of the health and safety of their employees, they should consider all the risks involved and take any reasonable precautionary steps.

Therefore, it’s suggested that if you allow animals into your practice then, as a bare minimum, you should complete a risk assessment. Secondly, I’d advise discussing this issue with your insurer to find out exactly where you stand.

To support risk management, there’s a risk assessment template at Annex A to the Assistance Dogs and Other Animals Policy [PLUS].