Key findings from the UK’s contextualized care roadmap

As costs of veterinary care rise, along with growing economic uncertainty, conversations around access to care and improving affordability have expanded. Most clients consider pets to be family members but face growing financial pressures that affect their ability to provide medical care.¹ One solution that has been widely discussed in the US is implementation of a spectrum of care, which is “a continuum of acceptable care that considers available evidence-based medicine while remaining responsive to client expectations and financial limita­tions.”²

A similar concept has arisen in the UK, called contextualized care, which describes “a way of delivering veterinary care that is adapted to the needs and circumstances of the individual animal, its owner and the wider context.”³ In 2025, the Royal College of Veterinary Surgeons (RCVS) charity partner, RCVS Knowledge, developed a contextualized care roadmap to guide the implementation of this style of care delivery. Key findings from this roadmap were presented at the 2026 VMX by Katie Mantell, chief executive officer of RCVS Knowledge.⁴

Understanding context

Mantell shared that there are 7 contexts that should be considered in each case. These layers expand outward from the patient and become increasingly broad. Applicable contexts include the patient, owner or caregiver, veterinary appointment and team, practice, profession and veterinary industry, wider society, and sustainability (both financial and environmental aspects).

When these contexts are taken into consideration and open discussion is held with the client, patient outcomes improve. Considering the wider contexts outside of the examination room, and even the individual clinic, empowers veterinarians to practice sustainably and ethically while remaining responsive to wider societal pressures. This has been a particular concern for our colleagues in the UK with the recent Competition and Market Authority market investigation into the veterinary sector.⁵

Development and key findings

The roadmap was developed by combining information from a literature review, in-person forum with key stakeholders, surveys of veterinary professionals and clients, online focus groups with pet owners, and interviews with veterinary professionals.

Both clients and veterinary professionals agreed on many benefits of contextualized care for pets, clients, and veterinary teams, including improving trust between clients and veterinary teams, improving quality of care, and reducing rehoming of pets. Additional benefits identified by veterinary teams included fostering openness and support within the team, enabling the practice to operate sustainably, improving job satisfaction, and reducing burnout.

Veterinary professional perspectives on contextualized care

When asked what contextualized care looks like in practice, veterinarians and veterinary nurses, as technicians are known in the UK, highlighted adapting care plans based on clinical judgment, noted the importance of explaining options and potential outcomes to clients, establishing trusting relationships with clients, and embracing a team approach to care in the clinic. Encouragingly, 45% of veterinary professionals report facing very few barriers to providing contextualized care. Perceived barriers to contextualized care varied by position, with veterinary nurses feeling more barriers than veterinarians, and year of qualification, with more experienced veterinarians reporting fewer barriers.

The most common barriers to practicing contextualized care included:

• Lack of continuity of care when patients see multiple team members across visits.
• Client financial constraints that force difficult decisions to be made.
• Difficulty in communicating costs of care to clients.
• Systemic practice pressures, including profits, targets, and protocols
• Feeling most comfortable with providing “gold standard care.”

When asked what would help enable the practice of contextualized care, veterinary professionals noted a need for more emphasis on contextualized care in the literature, better data and research on case outcomes, more accessible information for clients, and changes to veterinary education that would include emphasis on communication skills, confidence building, and exposure to general practice.

Pet owner perspectives on contextualized care

Results were similar for clients, with 45% reporting no barriers to receiving personalized care from their veterinarian. The most common barriers to contextualized care from the pet owner perspective included:

• Being emotional when their pet is unwell, which influences decision-making
• Experiencing guilt around not being able to afford recommended care
• Inability to remember what the vet team said during an appointment
• Discomfort around financial conversations.

When clients were asked what would facilitate contextualized care delivery, they noted the need for access to reliable pet health information, clear communication and transparent discussions around cost and treatment options from the veterinary team, more time and support to process information provided, and having continuity in veterinary team members between visits.

Focused on the future

RCVS Knowledge compiled the data into a full report and published a roadmap to outline strategies that will improve contextualized care delivery. The roadmap encourages unified action in 5 key areas:

1. Professional leadership
   1. Debunk the notion of “gold standard” in veterinary medicine.
   2. Ensure veterinary professionals know that making warranted adjustments based on individual circumstances will not lead to disciplinary action.
   3. Promote and celebrate examples of good, contextualized care.
2. Veterinary education
   1. Explicitly cover a spectrum of evidence-based options, with teaching on how diagnostic and treatment pathways can be adapted to the individual circumstances.
   2. Embed people and communication skills as a key component in veterinary training (for both veterinarians and veterinary nurses).
   3. Teach veterinary professional students how to apply this knowledge.
3. Practice-level support
   1. Foster a team-based approach to care, which includes the pet owner as a part of the team and promotes psychological safety.
   2. Implement systems that encourage continuity of care.
   3. Critically review practice standard operating procedures (SOPs) to ensure they don’t restrict delivery of contextualized care.
4. Evidence and research
   1. Promote widescale engagement in generating evidence on outcomes.
   2. Develop evidence-based tools to support shared decision-making.
   3. Prioritize primary research that compares diagnostic and treatment options that are most relevant to clinical practice.
5. Pet owner empowerment
   1. Provide better transparency on cost and value of veterinary care to pet owners.
   2. Empower pet owners to feel confident and guild-free in selecting the options that are right for them and their pet.
   3. Develop evidence-based, online resources to support decision-making.
   4. Provide support and encouragement around quality-of-life decisions.

Mantell suggested that many of these items can be applied to facilitate the practice of spectrum of care in the United States. Audience members agreed, noting that many of the same challenges and barriers to care are seen in the United States. As the landscape of veterinary care continues to evolve, collaboration between global veterinary communities will only continue to improve access to care for patients and clients, creating better job satisfaction and wellbeing for veterinary professionals.

Boatright, a 2013 graduate of the University of Pennsylvania, is a practicing veterinarian and freelance speaker and author in western Pennsylvania. She is passionate about improving connection with clients and colleagues through spectrum of care practice and mentorship. Outside of clinical practice, Boatright provides consulting services for clinics looking to improve spectrum of care practice and mentorship programs. She is also actively involved in organized veterinary medicine at the state and national levels.

References

1. PetSmart Charities, Gallup. State of Pet Care Study: Pet Parents’ Assessment of American Veterinary Care. Published online April 14, 2025. Available at https://petsmartcharities.org/our-stories/community-impact/52-of-u-s-pet-owners-have-skipped-or-declined-recommended-veterinary-care. Accessed April 9, 2026.
2. Fingland RB, Stone LR, Read EK, Moore RM. Preparing veterinary students for excellence in general practice: building confidence and competence by focusing on spectrum of care. J Am Vet Med Assoc. 2021;259(5). doi:10.2460/javma.259.5.463
3. RCVS Knowledge. Contextualised Care: A Roadmap. Published November 6, 2025. Available at https://www.rcvsknowledge.org/resource/contextualised-care-a-roadmap/. Accessed February 20, 2026.
4. Mantell K. A Roadmap for Contextualized Care – Learnings from the UK. Presented at VMX 2026: Orlando, Florida. January 17, 2026.
5. Competition and Markets Authority. Press release: CMA concludes market investigation with major reforms to veterinary sector. Published March 24, 2026. Available at https://www.gov.uk/government/news/cma-concludes-market-investigation-with-major-reforms-to-veterinary-sector. Accessed April 10, 2026.