Approved Tuberculin Testers in England

Approved Tuberculin Testers (ATTs) are para-veterinary professionals with the authority to carry out statutory TB skin testing of cattle. ATTs have been used in Great Britain by the Animal & Plant Health Agency (APHA) since 2005. A small number of suitably trained technical staff (animal health officers) carry out TB testing under APHA veterinary direction. Although ATTs can conduct skin tests, responsibility for interpretation of their test results rests with an APHA vet.

A public consultation on extending the use of ATTs into private veterinary practice was conducted in summer 2018. APHA completed an ATT pilot study which ran from December 2018 to February 2020 and involved a selection of Veterinary Delivery Partner (VDP) practices across England. The pilot study tested the methods and procedures involved with using ATTs including registration, theoretical and practical training, veterinary supervision, authorisation and quality assurance.

Outcome of the APHA pilot

During the pilot, extensive feedback was gathered from participating ATTs, their veterinary supervisors, veterinary practices and farmers, to test the effectiveness of the system. Feedback during the pilot was overwhelmingly positive from all parties, particularly farmers. ATTs were praised by farmers for their high quality TB testing, professionalism and cattle handling skills. This was reflected in an overall higher than expected response rate to the feedback survey.

The results of monitoring and various surveys during the pilot indicates that the level of veterinary supervision of ATTs during training was very high, and has been maintained subsequently as required. Positive feedback was received from ATTs on the quality of the training and veterinary supervision. All issues identified during the pilot study were resolved and action taken to reduce future risk of recurrence.

Following a successful pilot, from 2 November 2020 ATTs will be rolled out in private veterinary businesses in England. APHA will continue to support and monitor the further rollout of ATTs.

Q&A

An ATT is a para-veterinary professional with the authority to carry out statutory TB skin testing of cattle. ATTs have been used in Great Britain by APHA since 2005. In England only, ATTs are now also permitted to be used by private veterinary practices.

ATTs will be rolled out into private veterinary businesses in England from 2 November 2020. From this date candidates will be able to register and enrol onto the Official Controls Qualification (Animal Health Paraprofessional) – Approved Tuberculin Tester (OCQ(AHP) – ATT) training. Veterinary businesses can recruit potential ATTs in advance of the rollout date, but no training can start before 2 November 2020.

No. ATTs are only being rolled out in private veterinary practices in England, and are not currently permitted to carry out TB testing in Wales and Scotland. Skin tests completed by ATTs in England are recognised by Wales and Scotland e.g. for cross border pre-movement testing purposes. ATTs employed by APHA, however, are authorised to TB test in England, Scotland and Wales.

No. ATTs can be used by private veterinary practices in England that are not part of the VDP network, as well as VDP practices. ATTs don’t need to be directly employed by the practice for which they are carrying out TB testing. Subcontracted or ‘locum’ ATTs will be permitted, but all ATTs must work within a veterinary led team and meet the strict veterinary supervision requirements.

No. ATTs are only permitted to carry out tuberculin skin testing of cattle.

ATTs can carry out all statutory and private TB skin tests apart from those for export purposes, including the testing of animals for export of ova or semen. This applies both to ATTs employed by APHA and those in private veterinary practice. Cattle keepers must bear this in mind when using statutory and private TB tests for export purposes. If there is a chance that the keeper may be exporting within 60 days of the injection day of a TB test, they must notify the testing practice when the test is booked.

Use of ATTs in private veterinary practice has a number of potential benefits:

  • help VDPs to increase their capacity in order to deliver projected increases in TB testing as part of Defra’s bovine TB eradication strategy
  • enable and support vets to focus more on tasks requiring veterinary judgement or certification
  • provide contingency for any potential drop in the number of vets TB testing in England, or diversion of vets in the event of an exotic disease outbreak
  • enable veterinary businesses to continue to provide a cost-effective service to their commercial and government customers whilst maintaining standards

Candidates applying for the ATT role must meet a range of criteria including a minimum amount of previous livestock experience, qualifications, and identification and security checks.

The minimum qualification requirement is either:

  • three GCSEs or equivalent qualifications in Mathematics, English and in a Science subject or Food Production, or
  • three years performance in a government regulatory role e.g. Local Authority (LA) inspector or Environmental Health Officer

 Candidates also require at least six months previous livestock handling experience.

Once accepted for the ATT role, candidates are allocated to a supervising vet within the practice who is qualified as an official veterinarian (OV) to perform TB skin testing. This vet is known as the Approved Veterinary Supervisor (AVS) and is responsible for training the ATT and ensuring that they achieve the necessary requirements to a high standard. ATTs must undertake a comprehensive training package consisting of both theoretical and practical on the job training. The Official Controls Qualification (Animal Health Paraprofessional) – Approved Tuberculin Tester (OCQ(AHP) – ATT) qualification must be gained before authorisation to carry out any TB testing

An online theory training course is provided by APHA’s contracted training provider, Improve International, a company specialising in veterinary continuous professional development (CPD). The candidate must pass an exam at the end of the course and this must be invigilated by a vet, a Registered Veterinary Nurse (RVN) or an online invigilator appointed by the training provider.     

Following successful completion of the theory training course, conditional authorisation to skin test is granted for a maximum of six months, to allow the candidate time to complete their practical training. The ATT is directly supervised throughout their practical training by their AVS. This means they cannot perform any TB testing unless their AVS is physically present at the test. They carry out TB skin testing of cattle during this period of conditional authorisation until they meet the requirements for the numbers of animals tested and skin reactions seen, and are considered competent by their AVS. During this time the AVS checks all their TB test results and submits them to APHA on their behalf. On successful completion of the practical assessment (see below), full authorisation to TB test is granted. The ATT cannot TB test alone until their authorisation is received. Once they are fully authorised to test, the ATT no longer has to be directly supervised when TB testing, however they are periodically audited, and continue to receive support from their AVS.

Once the ATT is considered competent to TB test by their AVS and they have met the criteria for the number of animals tested and skin reactions seen, they are eligible to take the practical assessment. The assessment is carried out by an independent assessor via APHA’s contracted training provider. ATTs are assessed both on the injection day (TT1) and reading day (TT2) of the TB test. The AVS must be present at the practical assessment, as the ATT is not permitted to test alone at this stage whilst only conditionally authorised. On passing the practical assessment, the ATT is granted full authorisation by APHA to TB test. They can test unsupervised once fully authorised, however they are still monitored and supported by their AVS. 

As part of their practical training, ATTs are required to observe a certain number of skin reactions of both types (circumscribed and oedematous). APHA recognises that this is difficult in some areas e.g. the Low Risk Area. ATTs are permitted to observe a proportion of reactions in cattle TB tested by another authorised tester, as long as they have seen and recorded them. If required, ATTs are also permitted to move to another practice under the supervision of another AVS to observe the required number of skin reactions.

If an ATT has not completed their practical assessment within the six month period of conditional authorisation, it will automatically lapse and they must reapply to APHA. Prior to the deadline, the ATT can apply to APHA to seek an extension to their conditional authorisation. ATTs are not permitted to carry out TB tests unless they are conditionally authorised.

Once an ATT is fully authorised, they can carry out TB testing alone without direct supervision, however they are still monitored and supported by their AVS. Between four and six months after gaining full authorisation, all ATTs must complete an on farm assessment by their AVS on both the injecting day (TT1) and reading day (TT2) of the TB test. Failure to complete the assessment will result in suspension of the ATT’s authorisation. Additionally, an on farm audit must be carried out for all ATTs in the first twelve months following full authorisation by the VDP, APHA or training provider. Failure to complete this audit will result in suspension of the ATT’s authorisation. Subsequently, ATTs must complete a VDP, APHA or training provider audit at least once every two years, and provide evidence to APHA that they have tested a minimum number of cattle.

Yes. ATTs are required to complete revalidation of the OCQ(AHP) – ATT (theory only) course two years from their initial date of full authorisation, and thereafter every four years.

Yes, as long as you meet the criteria. Candidates must also declare any conflicts of interest as part of the application process. As for vets, ATTs are not permitted to TB test their own cattle, or operate where there is a potential conflict of interest.

An AVS is the vet responsible for training the ATT and ensuring that they achieve the necessary requirements to a high standard.

AVSs must nominate a deputy AVS so that they can provide cover in the event of the AVS being unavailable. A second deputy AVS is also permitted if required. The deputy AVS must meet the same eligibility criteria as the AVS.

The AVS must be an authorised official veterinarian (OV) and hold the Official Controls Qualification (Veterinary) Tuberculin Testing – OCQ (V) – TT. The AVS must have had a fully compliant VDP, APHA, or training provider audit within the two years prior to accepting the AVS role. The practical assessment that completes the training for an OV is not accepted for this purpose. Subsequently, the AVS must comply with OV audit requirements. The same criteria applies to any nominated deputy AVSs. AVSs and deputies must inform APHA of any change in circumstances.

On accepting the AVS role, the vet completes a short online course outlining their role and responsibilities, along with a series of declarations confirming that they meet the eligibility criteria for the AVS role and understand their responsibilities. They must also nominate one or two deputy AVSs.

The AVS has accountability for ATTs under their supervision and must ensure that they meet the criteria for the role. The main responsibilities of the AVS are to:

  • ensure that the ATT meets the criteria for enrolment
  • ensure that the ATT is aware of and understands their responsibility regarding conflicts of interest and carrying out TB testing on behalf of government
  • provide health and safety (H&S) training and ensure that the ATT understands the requirements of H&S on farm and when TB testing
  • provide support and guidance to the ATT throughout their training
  • direct supervision of the ATT carrying out TB testing once conditional authorisation has been granted i.e. whilst training
  • provide confirmation to APHA that the ATT has met the training requirements regarding the number of animals tested and number of skin reactions observed
  • interpretation of TB test results for reactors and inconclusive reactors whilst the ATT remains on farm (either in person or over the phone)
  • check and sign off all TB tests carried out by the ATT and submit the results to APHA
  • carry out audits of the ATT once fully authorised to test
  • attendance on farm as required to support the ATT and to try to resolve any issues e.g. in the event that a TB test result is challenged, animal disease or welfare concerns are identified or H&S issues arise
  • advise APHA immediately of any conflicts of interest or other risks that compromise the ability of the ATT to perform their role

The number of ATTs under the supervision of any single AVS is capped at one ATT in training at any time, and no more than two ATTs at any given time. This means that at any given time, an AVS could supervise one ATT in training plus one authorised ATT, or two authorised ATTs. The AVS is also permitted to act as a deputy for other ATTs simultaneously.

Yes. APHA will continue to support and monitor the rollout of ATTs. A specific review group will be maintained to monitor implementation for at least the first two years post-rollout.

APHA will monitor the performance of ATTs (and OVs) in terms of numbers of reactors, inconclusive reactors and skin reactions identified against that expected. This will enable audits to be targeted to any outliers.

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