Building Your Dog's Care Team

Your primary care vet is the most important member of your dog's care team. Not because they do the most clinical work directly, but because they're the coordinator. They know your dog. They hold the medical history. They prescribe medications. They monitor for changes. They coordinate referrals when needed.

For chronic disease management to work well, you need a good primary care relationship. This is the foundation everything else builds on.

What you want from a primary vet for chronic disease management:

Continuity. Seeing the same vet (or two specific vets in a practice) for ongoing care. Continuity dramatically improves chronic disease outcomes because the vet builds knowledge of your individual dog over time.

Interest in chronic disease. Some vets are particularly engaged with chronic conditions; others are more focused on acute medicine. For an arthritic dog, a vet who genuinely enjoys long-term management is valuable.

Willingness to coordinate. A good primary vet welcomes input from other team members. They communicate with specialists, accept reports from physiotherapists, and incorporate the broader picture into your dog's management plan.

Realistic time allocation. Chronic disease appointments often need more than the standard 10-15 minutes. A practice that can accommodate this, either through longer appointment slots or through nurse-led follow-up consultations, serves chronic patients better.

Clear communication. You should leave consultations understanding what was discussed and what comes next.

If your current primary vet relationship isn't delivering these things, it's worth considering whether to address it. We covered this in our companion article on getting the most from vet appointments.

For arthritis specifically, the situations where specialist referral becomes appropriate include:

• Diagnostic uncertainty (when the underlying structural problem isn't clear)
• Surgical decision-making (when a specific orthopaedic procedure is being considered)
• Pain management that isn't working adequately on standard approaches
• Complex cases with multiple joint involvement
• Atypical presentations that don't fit standard patterns
• Second opinion when significant decisions are being made

The main specialty relevant to arthritis is orthopaedic surgery, but pain management specialists, internal medicine specialists, and rehabilitation specialists all sometimes contribute.

How specialist referral works

Specialist veterinary care in the UK works through a referral system. Your primary vet sends a referral letter to a specialist or referral centre with relevant history, examination findings, and imaging. The specialist arranges an appointment, conducts their assessment, and provides recommendations both to you and back to your primary vet.

Most pet insurance policies cover specialist referrals when they're appropriately initiated by a primary vet. Pre-authorisation is often available and worth using for higher-cost procedures.

Finding the right specialist

The UK has a significant number of qualified orthopaedic specialists, both at university teaching hospitals (RVC, Cambridge, Edinburgh, Liverpool, Glasgow) and private referral centres (Fitzpatrick Referrals, Davies, Eastcott, Anderson Moores, North Downs, and many regional centres).

What to look for in a specialist:

Recognised qualifications. RCVS Recognised Specialist in Small Animal Surgery (Orthopaedics), EBVS European Specialist, ACVS Diplomate, or equivalent. The terms "specialist" and "orthopaedic surgeon" aren't legally protected; specific qualifications are.

Volume of practice. Specialists who perform high volumes of specific procedures tend to achieve better outcomes. A surgeon who does 200 TPLOs per year is different from one who does 20.

Geographic accessibility. Recovery involves multiple appointments. A centre several hours away may not be practical for ongoing care.

Insurance compatibility. Some centres have direct claim arrangements with major insurers, easing cash flow significantly.

Multidisciplinary support. Centres with in-house anaesthesia specialists, rehabilitation services, and imaging facilities offer more comprehensive care than standalone services.

Communication. A good specialist communicates clearly with both owners and referring vets, supports continuity of care after the procedure, and is available for follow-up questions.

The PetCare Atlas catalogues UK referral hospitals, specialist practices, RCVS specialists, and advanced practitioners with their specialisations and locations, which we'll cover in detail later in this article.

Veterinary physiotherapy is one of the most underutilised resources for arthritic dogs. A qualified veterinary physiotherapist assesses your dog's movement, identifies areas of muscle tension, compensation, and dysfunction, and provides treatment to address them. They're particularly valuable for arthritic dogs because arthritis creates secondary compensation throughout the musculoskeletal system that's often missed in standard veterinary examination.

What they do

Veterinary physiotherapists provide hands-on treatment including manual therapy, massage, soft tissue work, joint mobilisation, and therapeutic exercise prescription. Many also offer modalities like laser therapy and therapeutic ultrasound. They typically work through veterinary referral and report back to your primary vet.

A typical physiotherapy session lasts 45-60 minutes. Initial assessment is usually longer. Subsequent sessions focus on specific treatment based on the assessment findings.

When they matter

For arthritic dogs, physiotherapy is particularly valuable:

• After diagnosis to assess movement patterns and develop a baseline
• Following any acute flare-up or sudden worsening
• After orthopaedic surgery as part of structured rehabilitation
• For ongoing maintenance to manage secondary muscle compensation
• When home exercise programmes need to be designed for specific dogs

Qualifications

In the UK, look for:

ACPAT (Association of Chartered Physiotherapists in Animal Therapy). Chartered Physiotherapists who've completed specific animal physiotherapy training. The highest qualification level, requiring HCPC registration as a human physiotherapist plus additional specialist training in animal work.

IRVAP (Institute of Registered Veterinary and Animal Physiotherapists). Another recognised register with specific animal physiotherapy qualifications.

NAVP (National Association of Veterinary Physiotherapists). Smaller register with specific qualifications.

Approximately 1,047 veterinary physiotherapists are catalogued across the UK in the PetCare Atlas, making this one of the more accessible parts of the care team for most owners.

Realistic costs

UK veterinary physiotherapy costs typically £45-80 per session, with initial assessments often £60-100. A typical course of 4-6 sessions costs £200-400 total. Insurance coverage varies; many policies include physiotherapy when veterinary-referred.

For cats

Veterinary physiotherapy for cats is less common but increasingly available. Some physiotherapists specialise in feline patients. Home visits are often preferable to clinic visits for cats, given transport stress. If your cat would benefit from physiotherapy, ask for cat-experienced practitioners specifically; not all dog physiotherapists are equally comfortable with feline patients.

We've covered hydrotherapy in detail in its own dedicated article. The summary version: hydrotherapy is one of the most evidence-supported complementary interventions for canine arthritis, offering controlled exercise with reduced joint loading through either pool or underwater treadmill modalities.

For care team purposes, hydrotherapy practitioners are:

Qualified hydrotherapists with a minimum Level 3 Certificate in Canine Hydrotherapy, ideally with additional Level 4 qualification for underwater treadmill work.

Members of professional bodies including CHA (Canine Hydrotherapy Association), NARCH (National Association of Registered Canine Hydrotherapists), or ICH (Institute of Canine Hydrotherapists).

Often combined with physiotherapy at rehabilitation centres that offer integrated care.

The PetCare Atlas catalogues approximately 412 hydrotherapy providers across the UK including hydrotherapists, hydrotherapy centres, and rehabilitation centres.

How they fit with the rest of the team

Hydrotherapy works well alongside other team members. Sessions typically happen weekly or fortnightly during active rehabilitation, monthly for maintenance. Communication back to the primary vet documents progress. Combination with veterinary physiotherapy (often at the same centre) provides comprehensive movement-focused care.

For cats, dedicated feline hydrotherapy is rare. Most centres focus exclusively on dogs. Some progressive centres are exploring cat-specific hydrotherapy but it remains a niche service.

Acupuncture has emerged as one of the most valuable additions to the chronic pain care team. The mechanisms are well-characterised and the response rate in arthritic dogs is approximately 80%. We covered this in detail in our complementary therapies overview.

For care team purposes, acupuncture practitioners must be:

Veterinary surgeons with specific acupuncture training. UK law restricts veterinary acupuncture to qualified veterinarians.

Members of ABVA (Association of British Veterinary Acupuncturists) or holders of equivalent qualifications.

The ABVA directory at abva.co.uk lists qualified members across the UK.

When they matter

Acupuncture is particularly valuable for:

• Dogs whose pain isn't fully controlled by standard medications
• Dogs unable to take NSAIDs (kidney disease, GI sensitivity)
• Dogs with central sensitisation features (chronic pain that's become entrenched)
• Multi-joint or spinal involvement
• Older dogs with concurrent conditions complicating medication choices

Coordination

Veterinary acupuncturists typically work in collaboration with primary vets. They communicate about treatment plans, medication adjustments, and progress. Some primary vets practise acupuncture themselves, which simplifies coordination considerably.

For cats, veterinary acupuncture is offered by some practitioners and increasingly recognised as useful for chronic pain. The handling considerations are different (cats need particularly gentle technique), and some acupuncture practitioners specialise in feline patients.

The PetCare Atlas catalogues approximately 624 manual therapy practitioners across the UK including massage therapists, chiropractors, osteopaths, and acupuncturists. This is a category where I want to be transparent about a divergence between PetCare Atlas (which lists what's available) and PetsLikeMine's editorial stance (which weighs evidence quality).

The Atlas is a comprehensive directory of what UK practitioners exist and are accredited. PetsLikeMine's role is to give evidence-weighted guidance about which interventions are most worth your time and money.

Therapeutic massage

Massage is the manual therapy with the most plausible mechanism and least controversy. Therapeutic massage can address secondary muscle tension and compensation that's common in arthritic dogs, supports circulation, and provides positive physical contact that many dogs enjoy.

The evidence base for therapeutic massage as a standalone intervention for arthritis is weaker than for hydrotherapy, physiotherapy, or acupuncture, but the safety is excellent and many dogs benefit visibly.

UK costs: £35-65 per session typically. Look for practitioners certified by the Canine Massage Therapy Centre, the Canine Massage Guild, or similar recognised bodies.

Chiropractic and osteopathy

These are more controversial. The evidence base specifically in canine arthritis is weak. The risks are real if performed by unqualified practitioners. Many of the benefits attributed to these therapies (improved range of motion, reduced muscle tension, pain relief) can be achieved through safer, better-evidenced modalities like physiotherapy or acupuncture.

That said, some dogs do appear to respond well to chiropractic or osteopathic treatment, and for those owners who have access to a genuinely qualified practitioner working in collaboration with veterinary care, it can have a place.

If considering these modalities, the practical guidance is:

• Use practitioners with recognised qualifications (McTimoney, the Royal College of Chiropractors animal certification, registered osteopaths with animal training)
• Insist on veterinary diagnosis before treatment begins
• The practitioner should communicate with your primary vet
• Avoid practitioners making strong claims about treating systemic disease through manipulation

My honest editorial position: I wouldn't make chiropractic or osteopathy a centrepiece of arthritis management for most dogs. The evidence-based pathway (medication, weight, exercise, environmental modification, hydrotherapy, physiotherapy, acupuncture) generally serves dogs better. But if you have access to a well-qualified practitioner and find your dog responds, it can be a reasonable adjunct.

For dogs whose weight management isn't progressing despite owner effort and standard veterinary support, a pet nutritionist can add real value. Qualified pet nutritionists develop tailored feeding plans based on the individual dog's situation, calorie requirements, body condition goals, and any concurrent conditions.

In the UK, qualified pet nutritionists are uncommon (the PetCare Atlas lists around 78), partly because the qualification standards are evolving. Look for:

• BSc or MSc in animal nutrition
• Veterinary nutrition certifications (residency-trained veterinary nutritionists are the gold standard but rare)
• Working with veterinary input rather than in isolation
• Evidence-based approach rather than fashion-driven (raw vs kibble debates often signal less rigorous practitioners)

For most arthritic dogs, the standard approach (calculating calorie needs, using therapeutic joint diets, working with the primary vet on weight management) is sufficient without specialist nutrition input. Where weight loss has stalled despite genuine effort, or where complex multi-condition feeding plans are needed, specialist input adds value.

For dogs whose arthritis progression eventually contributes to end-of-life decisions, dedicated end-of-life care services have grown significantly in recent years. These services include:

Home euthanasia services. Veterinary professionals who provide euthanasia at home in familiar surroundings rather than at the clinic. For arthritic dogs whose travel is difficult and stressful, this is often the kinder option. UK costs typically £200-400 plus aftercare costs.

Hospice and palliative care services. Dedicated services focused on comfort and quality of life in the final stages of chronic disease.

Quality of life assessment services. Professional input on quality of life evaluation when decisions are being weighed.

The PetCare Atlas catalogues end-of-life service providers across the UK. We have a dedicated article on the quality of life conversation in our Stage 6 cluster.

A common owner concern about building a care team is communication: how do all these practitioners stay informed about each other's input? Who's coordinating? How do you avoid your dog being managed by separate practitioners working in isolation?

The primary vet as coordinator

Most well-functioning care teams have the primary vet at the centre as coordinator. Specialists, physiotherapists, hydrotherapists, and others communicate with the primary vet through reports and letters. The primary vet maintains the overall view of the case and adjusts the management plan accordingly.

This works best when:

• All practitioners agree on the coordinator role
• Communication is timely (reports within 2 weeks of appointments)
• The primary vet has capacity to integrate the information
• The owner facilitates by making sure their primary vet receives reports

When you need to coordinate yourself

Sometimes the formal coordination doesn't work as well as it should. Reports get delayed. Information falls through gaps. The primary vet doesn't always have the time to actively integrate input from multiple sources.

When this happens, the owner becomes the practical coordinator. This means:

• Keeping copies of all reports and bringing them to each appointment
• Telling each practitioner what the others are doing
• Asking each practitioner whether they need information from another
• Following up when reports haven't arrived
• Being the consistent thread that holds the picture together

This isn't ideal but it's often realistic. A well-organised owner with a folder of reports and a clear understanding of their dog's overall management plan is sometimes the best coordinator the team has.

The PetsLikeMine pet card

For platform members, the pet profile within PetsLikeMine helps consolidate this picture. Treatment history, current medications, care team contacts, recent observations, and shared discussions all live in one place that you can reference across practitioners. This is particularly useful when you're seeing multiple team members at different times.

Sometimes the care team you have isn't the team you need. Two specific situations come up.

When a second opinion is appropriate

Second opinions are reasonable in many situations:

• Major surgical decisions
• Significant cost decisions
• Cases where the clinical picture seems borderline
• Diagnosis uncertainty
• Treatment not producing expected response
• When you feel rushed in the original consultation

Reputable veterinary professionals welcome second opinions. If your vet seems threatened by the suggestion, that's information worth noting.

How to seek a second opinion:

• Ask your primary vet to refer you specifically for a second opinion (most will support this)
• Request that records and imaging are forwarded to the second opinion provider
• Bring your own notes about what you've observed
• Be open to either confirmation of the original plan or a different recommendation

Two professional opinions in agreement give you more confidence. Two professional opinions in disagreement give you information about which approach is more contested and worth thinking about further.

When to change vets

Sometimes the primary vet relationship isn't working. This can happen for various reasons:

• Communication has broken down
• The vet seems too rushed for chronic disease management
• You don't feel your concerns are being heard
• Clinical approaches don't match what you're learning from elsewhere
• The practice has changed (different ownership, staff turnover, service quality)

Changing vets is a significant step but sometimes the right one. Practical considerations:

Start by trying a different vet in the same practice. If your concern is about a specific clinician rather than the practice generally, this often solves the problem with less disruption.

Talk to the practice manager. Practice management can sometimes address specific issues you've identified.

Consider whether the issue is the practice or the specialty. Some general practices struggle with complex chronic disease cases. Referral to specialists may be the answer rather than changing the primary vet.

If you decide to change practices, request that your records be transferred. This is your right, though there may be a small administrative fee. The new practice handles much of the practical work of obtaining records.

Don't burn bridges. Even when changing practices, courteous communication serves you better than expressed grievance. You may need to return for emergencies; veterinary networks are smaller than you might think.

Changing vets isn't failure on anyone's part. Sometimes the fit just isn't right for the long-term partnership chronic disease requires.

Throughout this article I've referenced the PetCare Atlas, which is a comprehensive UK directory of veterinary and allied pet care providers, available at vetdirectory.conciergevet.co.uk. It's worth explaining what it is and how to use it as part of building your team.

The Atlas catalogues:

• 5,700+ vet practices
• 247 referral hospitals and specialist practices
• 1,583 RCVS specialists and advanced practitioners
• 1,047 veterinary physiotherapists (ACPAT, IRVAP, NAVP accredited)
• 412 hydrotherapy providers (CHA, NARCH, ICH accredited)
• 624 manual therapy practitioners (massage, chiropractic, osteopathy, acupuncture)
• 218 clinical animal behaviourists
• 1,432 dog trainers
• 78 pet nutritionists
• 53 end-of-life care services

Total: over 12,000 UK pet care providers, structured and updated weekly.

Two ways to navigate

The Atlas offers two main lenses:

Grid view. Every provider catalogued, filterable by type, accreditation, and geography. Useful when you know what kind of practitioner you're looking for and want to find one near you.

Map view. Geographic visualisation of provider density and specialisation across the UK. Useful for understanding what's available in your area or when planning travel for specialist appointments.

Three entry points

The Atlas can also be approached three ways depending on what you're starting with:

By symptom. If you've noticed something specific (limping, drinking more, lump, behaviour change, coughing), the Atlas can guide you to the right care pathway. Useful when you're not sure what kind of practitioner you need.

By pathway. If you're managing a known condition, the Atlas's care pathways show the typical journey across multiple practitioners. The musculoskeletal pathway (relevant for arthritis) maps the route through GP vet, specialist referral, physiotherapy, hydrotherapy, chiropractic/osteopathy, and ongoing maintenance.

By practitioner type. If you know specifically what kind of help you need (a hydrotherapist within 30 miles, an orthopaedic specialist for second opinion, an ABVA-registered acupuncturist), filter directly.

Why this matters

The fundamental challenge in chronic disease management is that the right care isn't all in one place. Your primary vet may not know which hydrotherapy centre 20 miles away has Level 4 underwater treadmill qualification. Your physiotherapist may not know which orthopaedic specialist takes your insurance. The information that connects these pieces lives in multiple registers, websites, professional bodies, and informal recommendations.

The Atlas brings it together. For complex chronic disease management, having one structured map of UK pet care provision is a meaningful resource. We use it ourselves in clinical practice when making referrals, and we encourage you to use it for building your dog's care team.

Let me show what a real care team looks like over the years of an arthritic dog's life.

Year one of diagnosis. Primary vet manages diagnosis, starts NSAIDs, agrees weight management plan. Refers to hydrotherapist for initial assessment and weekly sessions. Owner does home physiotherapy and environmental modification independently. Total care team: 2 active practitioners.

Year two. Pain control needs enhancement. Primary vet adds acupuncture to the plan, referring to an ABVA-qualified veterinary acupuncturist for monthly sessions. Hydrotherapy reduces to fortnightly maintenance. Total care team: 3 active practitioners.

Year three. Acute deterioration. Primary vet refers to orthopaedic specialist for assessment. Specialist confirms progression but recommends conservative management given dog's age. Returns to primary vet care with adjusted medication regime. Veterinary physiotherapist added for soft tissue work. Total care team: 4 active practitioners.

Year four and beyond. Stable management. Primary vet for routine reviews and medication adjustments, hydrotherapist for maintenance sessions, acupuncturist for periodic treatment, physiotherapist as needed for flares. The team has stabilised.

End-of-life stage. Quality of life conversations. Decision is made for home euthanasia given the dog's mobility difficulties. Local home euthanasia service contacted through Atlas listings. Primary vet, hydrotherapist, and acupuncturist all informed and able to support the family through the transition.

This is what good chronic disease care looks like over years. Not five practitioners simultaneously from day one, but a thoughtfully built team that grows and adjusts as needs change.

If you're a new arthritis owner thinking about your care team:

1. Make sure your primary vet relationship is solid. Continuity, communication, capacity for chronic disease care. If not, consider whether to address this first.

2. Consider hydrotherapy referral within the first 3-6 months. Most arthritic dogs benefit, and adding this practitioner early establishes the team mentality.

3. Keep a record of practitioner contacts. Names, addresses, phone numbers, what each has done. Our care team tracker is a printable one-pager built for this.

4. Bookmark the PetCare Atlas. You'll likely need it as the journey develops.

5. Build the team gradually. You don't need every practitioner from day one. Add as needs emerge.

6. Maintain the coordination. Whether your primary vet does it actively or you do it practically, someone needs to hold the picture together.

The owners whose arthritic dogs do best over many years aren't the ones with the most expensive care or the most famous specialists. They're the ones who've built a thoughtful team of practitioners around their dog, with good communication, mutual respect, and a clear sense of who does what.

Your primary vet is the foundation. Beyond them, the team grows organically as needs emerge. The hydrotherapist who knows your dog's normal water tolerance. The physiotherapist who notices small changes month to month. The acupuncturist who's been treating them for three years. The orthopaedic specialist available when bigger decisions arise.

This is what professional chronic disease care looks like. It's collaborative rather than centralised, distributed rather than concentrated, and built around the individual animal rather than the specific practitioner.

Your arthritic dog deserves the benefit of that kind of team approach. With deliberate effort, supported by tools like PetCare Atlas to find the right practitioners, you can build it.