Sharon Bennett 
Anything treated with botulinum toxin and dermal filler is classified to be a disease
It is with great joy that I can say that the British Association of Cosmetic Nurses (BACN) reached 1000 members, for the first time ever, in May 2021, and membership has continued to grow since. We have put this down to a number of reasons, including the success of the support and guidance that the BACN provided during the COVID-19 pandemic, as well as the incredible work of the head office team on the development of the monthly virtual sponsored webinars, peer group meetings and the Instagram live interviews. In addition to this, we have a hugely experienced management committee of nurses and regional leads, who are scholars and experts in particular fields and are so giving and generous in their time and knowledge.
The 10-point plan
In March 2021, the Joint Council for Cosmetic Practitioners (JCCP) published a 10-point plan (JCCP, 2021), laying out the goals it seeks in terms of regulating the aesthetics sector, and the BACN submitted a response, which can be found in the members section of the BACN website.
The BACN welcomes the 10-point plan produced by the JCCP in terms of it articulating many of the issues affecting non-surgical aesthetics that stakeholders have been highlighting in recent years.
Here, I am highlighting one of the JCCP action points that I believe is key: ‘The definition of medical and cosmetic treatments’. This is particularly relevant, as, during the UK lockdowns, nurses were challenged by whether they could work in their clinics and whether their insurance would cover them. They were equally challenged by dogged environmental health officers across the country.
We responded to the Health Inspectorate Scotland (HIS) consultation in 2020, and I thank Constance Campion for her valuable input in our response, some of which I used for our JCCP response.
Medical versus aesthetic
The practice of medical aesthetics is derived from a well-established element of the specialism of plastic, reconstructive and aesthetic surgery, and it has evolved and developed in other medical disciplines, such as dermatology. Only medical and nursing practitioners can practise within these specialisms, and medical aesthetics patients require optimum levels of care from the initial time when they require a consultation to the point of aftercare, due to the risks that can lead to complications, some of which can be complex secondary problems and include sepsis. There is a worrying trend to align medical aesthetics practice with beauty, due to the fact that a far greater emphasis is being placed on the cosmetic result, rather than on the medical significance required to safeguard patients and the public.
The regulation of all non-surgical cosmetic procedures, within the scope of medical aesthetics practice, should not be confined to a given set of treatments that reflect a beauty menu, but, rather, constitute a level of patient care, which is commensurate with the continuity of care that patients undergoing medical aesthetics treatments require. This includes, but is not confined to, comprehensive consultation and assessment, informed consent and an array of non-surgical treatments, including botulinum toxin therapeutic injections, dermal fillers, insertion of absorbable and non-absorbable threads and sutures, injection lipolysis and laser and intense pulsed light (IPL) treatments resulting in the destruction or alteration of skin lesions, etc.
Patients who present seeking medical aesthetics treatments may have underlying conditions and diseases, which makes them vulnerable. The Government must be able to ensure that patients can consult medical professionals to have their physical and mental needs placed at the heart of their care, as is commensurate with the reasonable standard of care, safety and effectiveness expected in healthcare settings.
Any procedure using a prescription-only medicine or a class three implantable medical device is medical. The words medical device is the indicator.
A procedure may also be cosmetic insofar as the expected outcome or results of that procedure, but the two are not mutually exclusive, and to try and set such distinction is too simplistic and is therefore biased. As a comparison, we would point out that the majority of breast augmentation surgeries (using an implantable medical device) are for cosmetic reasons but are also self-evidently medical. The recently published World Health Organization (WHO) International Classification of Diseases (ICD)-11 (2019) classifies everything treated with botulinum toxin and dermal filler to be a disease.
It is accepted that medicine is not an exact science and patients are entitled to a reasonable standard of care. Medical aesthetics is a medical process, and while it may be allied with beauty therapy in a working environment, where therapists operate within their remit in scope, the overriding fact is that appropriate educational and training structures are not in place to widen the remit of therapists into medicine and nursing. They are unable to determine which medical and care needs are appropriate.
Code of conduct
Moving on, the BACN has undertaken an extensive review and update of its code of conduct. It will enable BACN members to understand their responsibilities. An aesthetic nurse conducting medical aesthetic treatments is required to exercise a unique and multifaceted clinical judgement and skillset, often in complex scenarios that are unique to the aesthetic specialism. In light of the paucity of a robust, recognised medical model within the aesthetic specialism, it is our intention that the principles within the code underpin the broad scope of practice and clinical skillset that aesthetic nurses are required to develop. We have included contemporaneous references to current legislative and statutory guidance. The code will be sent to all members and will be available on the members' resource section of the website.
On a lighter note, the BACN's regular monthly digital webinars are approaching, as well as our monthly ‘In conversation with…’ (on Instagram live) and, of course, our regular monthly peer reviews. In June, we had the pleasure of holding a sponsored session by Merz, which focused on a new treatment for early onset photodamage, and, in July, we are focusing on the topic of upskilling to enhance your brand. Additionally, I will be speaking with Alice Hart-Davis for the Instagram live ‘In conversation with…’, so I am looking forward to receiving questions from members that they would like to pose to Alice for that session. Please look out for the posts and emails regarding dates.
It is often a surprise to people that the term ‘nurse’ is not a protected job title, as it means that anyone can describe themselves as a nurse. The same is not true of paramedics, chiropodists, physiotherapists and a host of other health practitioners. ‘Registered nurse’ is a protected title, but ‘nurse’ alone is not.
In 2018, the former Chief Nursing Officer of England said that she would work with other nursing officers to ensure that those only registered as a nurse could use the title. Unfortunately, this requires Government legislation, which, at the time, was not forthcoming. Now, Professor Alison Leary, a nursing workforce expert and editorial advisory board member for the Nursing Times, has set up a petition that requires 100 000 signatures to be considered for Government debate in Parliament. I urge you to sign and share this petition with your colleagues and friends: https://petition.parliament.uk/petitions/587939.
Working from dawn until dusk
Like many others, I found that the reopening of the clinic in April 2021 had me working from dawn until dusk and longer, squeezing in patients desperate to have a treatment. The Zoom Boom exploded onto the scene. After 6 weeks of not doing anything except eat, work, sleep and work as part of the vaccination programme during weekends, I finally emerged to some semblance of normality, hence being able to write the BACN column here!
So, a word of advice: we cannot be superheroes for long. Create some you time, factor breaks into the day, be firm about your hours, enjoy family time, see friends and find time for exercise and leisure. These were all things that I forgot to do. Now, I have joined a new gym, visited restaurants with friends and family, pulled my bike out of the shed and have diary dates planned and I feel better.
I look forward to seeing you at the next BACN virtual event and even at the next real-time live event soon.