The JCCP was established in 2016 to set standards for non-surgical cosmetic practice, and to consider both the benefits and risks associated with non-surgical, anti-ageing treatments and hair restoration surgery.
The procedures for which we (and our sister organisation the Cosmetic Practice Standards Authority) currently set standards include:
- Botulinum toxin injections
- Dermal fillers
- Skin rejuvenation including micro needling and skin peels
- Laser and light therapy
- Hair restoration surgery.
In recent years both the JCCP and the CPSA have witnessed a growing number of harmful complications arising from such procedures, many of which have been the result of sub-standard practice, administered by inappropriately qualified and poorly trained practitioners. We are also seeing an exponential increase and gross misrepresentation of the benefits of treatment, not least on social media and other online platforms.
The recent explosion in cosmetic procedures has been fuelled by social media, the proliferation of high street beauty outlets and a dramatic increase in the range of cosmetic procedures, including those involving botulinum toxins, dermal fillers, chemical peels, vitamin injections or infusions, plasma replacement therapy, laser treatments and breast and buttock augmentation surgery using dermal fillers. All of these procedures carry the risk of serious harm if they are not administered by suitably trained and relevantly experienced professionals operating from clean and hygienic premises.
At the heart of the problem is a serious lack of concern for public safeguarding. In addition to this, a lack of evidence-based information and advice to enable members of the public to make safe and fully informed choices. The simple fact is that this is an area that requires statutory regulation.
Realising the objectives for a new system of licensing in England (as determined by the Health and Care Act 2022)
As we proceed into 2024 we are becoming increasingly aware that the Westminster Government is engaging actively to consult on how best to design and implement a new system of licensing laws across England for non-surgical cosmetic procedures. This commitment represents the biggest shake up in a generation for the cosmetic treatments industry. The JCCP has publicly declared its commitment to supporting this development.
» In recent years both the JCCP and the CPSA have witnessed a growing number of harmful complications, many of which have been the result of sub-standard practice, administered by inappropriately qualified and poorly trained practitioners «
The new licensing regime is designed to safeguard people who access invasive cosmetic treatments, and follows earlier legislation that made it illegal to administer dermal fillers and injectable toxin treatments to under 18s. The new scheme will involve a practitioner licence and a premises licence, and will make it an offence for anybody to carry out non-surgical cosmetic treatments without the relevant licenses. It will also extend the range of treatments that may not be administered to those under the age of 18.
The scheme seeks to ensure that people who administer cosmetic procedures are properly experienced, trained and qualified, have the necessary insurance cover and operate from premises that are clean, hygienic and suitably licensed. The scheme will be administered by local authorities across England.
In September 2023 the government launched a major public consultation to seek the views of practitioners, patients, stakeholders and members of the public on this new licencing scheme. In response to this consultation the DHSC has received over 11,800 responses which are currently being reviewed and analysed.
We anticipate a response from the Government in late spring this year to determine which procedures will be within the scope of the new license, along with recommendations regarding how the provision of such procedures will be implemented (including initial proposals on whether new standards of supervision and oversight will be required for some practitioners).
The JCCP continues to work closely with the Government and regulatory authorities to achieve legally enforceable governance arrangements for the cosmetic sector.
The Government consultation is the result of our long-term work and collaboration to co-design a new, sustainable system of regulation to protect and safeguard members of the public.
The JCCP is also committed to honouring its commitment to members of the public and to its registrants in Northern Ireland, Scotland and Wales. It will continue to work with politicians and Government officials in each of the three Devolved Administrations to identify and promote opportunities for UK wide collaboration and standardisation of regulation for the non-surgical sector where the considered to be desirable, relevant and feasible.
Matters pertaining to supervision, oversight and remote prescribing
The Government's consultation for a cosmetic licensing scheme proposes that certain procedures, denoted within their ‘Amber’ category, should only be provided under the oversight of a named regulated healthcare professional who has gained an accredited qualification to prescribe, administer and supervise aesthetic procedures. These procedures are denoted in this way based on an understanding of the risk they present to members of the public due to their relatively invasive and complex nature. Some of the procedures involve, either directly or indirectly, the use of injectable prescription only medicines (POMs).
We at the JCCP consider the Government's proposal for regulated professional oversight to be an essential and key feature of any new licensing framework and have commissioned a specific work programme to be undertaken by the JCCP's Clinical Advisory Group (CAG). The working group has assumed (as its initial hypothesis) that those procedures that have been currently ascribed an ‘Amber’ classification in the in the DHSC's consultation paper should be the subject of detailed consideration for the Government to determine if supervision or oversight should be applied to these procedures. It is an assumption founded in the principles of oversight, accepted as part of the Health Education England qualifications framework (2015). It is a key issue requiring review and further development as part of the new proposed framework of licensing. However, it is understood that the procedures that currently reside within this category may change in response to the consultation and as such, we must await a final decision for the DHSC before making further recommendations.
The JCCP has already advised in its response to the first DHSC Consultation process (2023) that it does not wish to place an unnecessary or disproportionate supervisory or oversight burden on practitioners where procedures are considered to have self-limiting controls to mitigate potential harm, such as failsafe mechanisms, which are commonplace within the cosmetics industry (e.g. devices that administer laser and light). In order to avoid potentially negative unintended consequences that might be set down within any future proposed scheme of ‘tiered’ supervision, the JCCP has advised that further research and consultation is required regarding certain procedures with clinicians, regulators, manufacturers, and industry (e.g. to further consider risk factors, potential for complications, the use of certain technological devices/machines etc.).
It is our current position that for a framework of supervision to be adequate, it must achieve a number of objectives in achieving its goal:
- It should recognise that public protection is its primary goal.
- It should be proportionate, such that it facilitates access to appropriate procedures from appropriate practitioners.
- It should be flexible enough to permit the inclusion of new procedures and make allowance for the varying needs of customers and the practitioners performing them. However, it should not be so flexible as to be open to undue interpretation or abuse.
- It should encourage transparency.
- It should define accountability.
- It should be enforceable.
The JCCP is also clear in its opinion that any non-surgical procedure that involves the use of a prescription-only medicine must be provided either by a prescriber/independent prescriber or under the direct supervision of a prescriber, if the practitioner does not possess a regulated prescribing qualification. In our opinion this will necessitate the provision of clinical oversight by a named and designated prescriber on a case by case basis.
Clinical oversight describes the responsibilities of all regulated healthcare professionals, as set down by their respective statutory professional regulator. This is to protect public safety through their activity when delegating procedures, along the chain of events from consultation to aftercare.
The following list is indicative but not exhaustive. It highlights the key factors in securing public safety.
- Assessment of competence, including the ongoing competence of the practitioner to whom the procedure is delegated.
- Face to face consultation with the consumer, with approval and direction to proceed with the procedure as appropriate.
- Assessment of outcomes, including the intervention in the case of adverse outcomes and compliance with reporting mechanisms.
- Where delegation is directed to a professionally unregulated individual, oversight may extend further to include, for instance, confirmation of appropriate record keeping, assurance of legitimate sourcing of products and responsibilities towards ethical and legal advertising.
We also affirm that in line with advice provided by professional statutory regulators that both remote prescribing and the provision of remote supervision for the oversight of POMs used either directly or adjunctively for cosmetic procedures, should not be an available option where prescription medicines are concerned.
Furthermore, it is our position that remote prescribing for elective cosmetic procedures is inappropriate. All cosmetic procedures that are delegated to others to perform on a third party basis must conform to professional regulatory standards, including the requirement for in-person assessment; a procedure requiring a prescription-only medicine will always require delegation and clinical oversight when it is not performed by the prescriber.
A cosmetic procedure is elective and, by definition, one where there is no medical need or imperative, and where any other benefit is unlikely to be urgent. On this basis alone it is clear that there can be little justification for remote prescribing, since benefits cannot outweigh risk.
The following are the common risks associated with remote prescribing that the JCCP finds through its experiences, particularly in the complaints it receives:
- ‘Remote’ is taken to the extreme. There is frequently no contact (for instance via telephone or video), with the patient, only a review of a medical history form.
- Prescribers fail to consider or implement risk mitigation measures.
- Prescribers fail to account for their personal interests, including commercial interests and decisions based on time constraints.
- Prescriber fails to assess the psychological component of the presenting individual.
- Prescriber fails to identify the ‘cosmetic shopper’, prone to abusing prescribed medicines and further avoids referring or communicating with appropriate healthcare professionals.
- Prescribers delegate to unregulated practitioners without allowance for the additional risk where these individuals hold no accountability.
- The prescriber is unknown to the person performing the procedure because a 3rd party intermediary is used.
- Prescribers seek to avoid accountability through lack of traceability.
- Prescribers are frequently unavailable to assess outcomes and intervene in complications.
- Prescribers fail to provide the necessary directions, required in medicines legislation for the provision of all ‘parenteral’ prescription medicines.
- Prescribers fail to ensure that appropriate records are maintained.
- Prescribers frequently delegate to individuals with an evident lack of competence.
Next steps on the journey to regulation in 2024
This article has set out some of our key and shared priorities that we consider to be essential if we are to realise a new mandated and legally enforceable scheme of licensing for cosmetic practice by the proposed date for implementation in England in 2026. To achieve this aim the JCCP remains committed to working collaboratively with colleagues, regulators and stakeholders throughout the forthcoming year to assist in the co-design of the new licencing scheme in England.
To assist us to achieve aim we have agreed the following objectives:
- The JCCP will continue to be actively and fully engaged in the DHSC public consultation licensing process.
- The JCCP will continue to operate its PSA approved Practitioner Register under the same terms and conditions as currently used (free membership and agreed auditing arrangements with the Practitioner Register Committee and the PSA).
- The JCCP will further develop and extend its Education & Training Register for providers and approved qualifications in association with DHSC proposals for the design and implementation of a new licensing scheme in England.
- The JCCP's Clinical Advisory Group will continue to work with the CPSA and key partners to develop new and revised standards to assist in the design of a new and responsive model for licensing, and to identify emerging procedures that may warrant inclusion in the Government's new licensing system.
- The JCCP will continue to engage with research partners to contribute to the evidence base to inform safe and effective aesthetics practice and governance.
- The JCCP will continue to build on those areas where it is seen as having a major strategic role in the sector – influencing members of the public, government, regulators and other stakeholders, complaints handling, standard setting, licensing and education and training.
- The Council will expand and develop its JCCP&me consumer/public facing website to further raise consumer awareness of risk associated with the higher level/invasive procedures.
- The Council will continue to develop and promote its consumer complaints platform in the interests of public protection and patient safety.
- The JCCP will also continue its quest to work collaboratively with the Advertising Standards Authority (ASA) and the Committees of Advertising Practice (CAP) to radically reduce (and where possible remove) false, exaggerated, improper and illegal advertisements wherever they appear (including social media channels).
- The JCCP will call for a clearer definition regarding medical, medically related and cosmetic procedural interventions.
- The JCCP's Clinical Advisory Group will develop and publish proposals for supervision and clinical oversight and proposals for the safer manufacture, supply and distribution of medicines and devices used for cosmetic purposes; we will also produce guidelines for the safer distribution and application of dermal fillers.
- The JCCP Board of Trustees will work with key stakeholders to design and publish standards and recommendations for ‘Good Practice in Insurance’.
- Priority will be given to grow and develop the JCCP Corporate Membership Scheme for commercial partners in the aesthetics sector.
- The JCCP will pursue its work with regulators to ensure that the highest standards are adopted within the proposed licensing scheme in England.