Following on from the pandemic pause, the pull of non-invasive cosmetic procedures continues its momentum across the UK, marking a significant surge in their popularity. With this boom in demand comes a need for increased scrutiny regarding the safety and regulations governing these procedures. Historically, the legal framework surrounding them has been somewhat lacking, leaving both patients and practitioners exposed to potential risks.
One key player stepping up to address this gap is Hamilton Fraser. A key partner of the Joint Council of Cosmetic Practitioners (JCCP), focusing purely on medical practitioners. Since 1996 the company has offered tailored insurance that not only provides financial security, but also contributes to the overall safety and professionalism of the non-surgical aesthetic sector.
Insurance in the context of the Government's plans for a new licensing scheme in England
The JCCP and Hamilton Fraser have applauded the Government for taking the first key step to enforce statutory regulation of the non-surgical aesthetics sector in England. It has always been our shared opinion that the adoption of any new system of statutory reform and regulation must be determined within the context of a robust and enforceable licensing scheme. We have previously advised that any new regulatory regime should identify and put in place a national mandated standard for education and training for all aesthetic practitioners who perform invasive procedures as a condition of practice, and should protect members of the public by requiring all practitioners to evidence possession of adequate medical indemnity insurance, complaints procedures, fitness to practice compliance and the provision of consumer access to redress and compensation schemes. The importance of ensuring that all licensed practitioners operate from appropriately licenced hygienic and safe premises is also considered by the JCCP to be essential. The possession of appropriate insurance is a central tenet of the Government's commitment to patient safety and public protection.
The crucial role of insurance in aesthetic practices
Insurance, when approached thoroughly, does not just provide a safeguard for patients and practitioners—it is a fundamental pillar for patient safety and trust within the aesthetic sector. In the realm of non-surgical aesthetic procedures in the UK, insurance is a vital tool for managing risks and making sure that practitioners are shielded from unforeseen complications and legal liabilities. Equally importantly, it is a clear signal to patients of a practitioner's commitment to safety and professionalism.
» The importance of ensuring that all licensed practitioners operate from appropriately licensed hygienic and safe premises is considered by the JCCP to be essential. The possession of appropriate insurance is a central tenet of the Government's commitment to patient safety and public protection «
Insurance conditions and recommendations
The conditions and recommendations surrounding aesthetic insurance are pivotal to ensuring safety and professionalism in the UK's non-surgical aesthetic sector. Indeed, the NHS advises anyone opting to have a non-surgical procedure to make sure that the practitioner they choose has the right standard and level of insurance required to enable them to safely carry out the procedure. However, currently, there is no legal requirement for non-healthcare practitioners, such as beauty therapists, to have medical malpractice insurance cover for non-surgical procedures they provide to members of the public. The position held by the JCCP, and industry leaders is clear: any practitioner undertaking cosmetic or aesthetic procedures should be mandated to purchase and maintain adequate medical malpractice insurance. In our opinion, this must be embedded as a key requirement within the context of the Government's proposed practitioner license standards.
Going further, Hamilton Fraser believes that insurance for invasive procedures involving the use or injection of botulinum toxins and temporary or permanent dermal fillers, should be restricted to those educated and trained to the standards set by the JCCP/CPSA (2018). Suitably qualified and experienced doctors should be the only ones insured to perform hair restoration surgical procedures, which is a CQC regulated and restricted procedure. Hamilton Fraser and the JCCP are supportive of the Government's current proposal to permit non-healthcare regulated practitioners (such as beauty therapists or beauticians) from providing invasive non-surgical procedures, subject only to meeting nationally determined education and training requirements and working under the supervision of suitably qualified and experienced regulated healthcare professionals. These requirements will set a new condition for the provision of insurance cover to these practitioners, highlighting the importance of aligning insurance coverage with the practitioner's qualifications and expertise.
Navigating coverage and limitations
The need to ensure that all practitioners possess sufficient insurance coverage should be a key consideration for all persons who work in the non-surgical aesthetic sector. Exploring the intricacies of coverage and any limitations associated with their insurance cover demands careful attention, and practitioners need to recognise that the repercussions of inadequate indemnity can be far-reaching. Distinguishing between ‘full malpractice insurance’ and ‘treatment insurance’ is essential, but practitioners must also prioritise additional covers for a robust medical malpractice policy that goes beyond bodily injury.
Malpractice versus ‘treatment insurance’
In the dynamic landscape of non-surgical cosmetic procedures, non-medical practitioners often gravitate towards ‘treatment insurance’, primarily covering evidenced bodily injury due to its affordability. However, it is important to be aware of the limitations of this choice, especially when it comes to legal defence costs and broader aspects of professional practice. The ‘treatment insurance’ focus remains on physical harm, potentially leaving practitioners vulnerable to legal and financial challenges that extend beyond bodily injury claims. Without adequate cover, practitioners will be left to defend any allegations personally, which could incur significant legal costs.
In contrast, practitioners should prioritise additional covers maintained under a full medical malpractice policy that ensures comprehensive protection. This includes support for professional body tribunals, offering a safety net in case of disputes or complaints, as well as ‘good samaritan’ cover for decisions/procedures made under the context of medical emergencies, extending protection beyond bodily injury to include psychological and emotional injury to, and financial loss of, the patient thereby acknowledging the holistic impact of aesthetic procedures on patients/members of the public.
Policy limits: a critical factor in comprehensive coverage
Understanding policy limits is integral to gauging the extent of protection offered by insurance policies. ‘Treatment insurance’ policies commonly provide aggregate limits of indemnity ranging from £100,000 to £2,000,000 per policy year. Yet, these limits may fall short, particularly for practitioners involved in more complex or experimental procedures that carry higher litigation risks.
By comparison, medical malpractice policies set higher standards. Starting with limits of £2,000,000, these policies extend up to £10,000,000 for invasive or experimental procedures. Hamilton Fraser recommends a minimum cover of £2,000,000, with the standard for practitioners offering toxins, fillers, and laser treatments beginning at £5,000,000. These elevated limits reflect the escalated risks associated with certain procedures, emphasising the necessity for more extensive coverage. It is not beyond the realms of the imagination to consider the impact of a future class action against an unsuspecting practitioner or business.
Understanding policy excess: the practitioner's contribution
The policy excess remains a pivotal aspect of insurance coverage, representing the amount practitioners contribute to a claim, including defence costs. For lower risk treatments such as toxins or temporary fillers, average excess amounts range from £250 per claim, with higher risk treatments, for example laser and light procedures, commanding excesses of £1,500 or higher. More invasive or experimental procedures may incur significantly higher excess amounts, ranging from £5,000 to £20,000.
The perils of performing uninsured treatments
Performing uninsured treatments not only leaves the patient without recourse against the practitioner in the event that something might not go to plan, but it can also risk financial ruin for the practitioner. In the absence of appropriately sourced and underwritten insurance covers, the consequences of unforeseen complications become a shared burden between the practitioner and the patient, often resulting in legal and financial quagmires which many proceed for a long period of time, and which could have been averted if adequate coverage had been purchased.
» Performing uninsured treatments not only leaves the patient without recourse against the practitioner in the event that something might not go to plan, but it can also risk financial ruin for the practitioner «
Importance of adequate education and training
Beyond insurance, the bedrock of a responsible aesthetic practice lies in the practitioner's education, training, proven experience and competence. It is not merely about possessing a certificate, but about ensuring that practitioners undertake nationally recognised and competent training courses. These courses should provide comprehensive theoretical learning, hands-on practical training and assessment, and robust after-course support.
The provision of adequate education and training ensures that practitioners are equipped with the knowledge and skills required to perform procedures safely and effectively. Recognised courses, accredited by industry bodies, offer a guarantee of quality education, covering the latest advancements and adhering to industry standards. However, it's not just about theory; practical training is equally important. The ability to apply practical knowledge in a controlled and supervised clinical setting is what sets apart a well-trained practitioner from the rest.
Good after-course support is the linchpin that ensures ongoing competence and confidence. It's not uncommon for practitioners to encounter challenges or have questions after completing a course. A training programme that offers robust support mechanisms, whether through mentorship, online forums, or continued education, empowers practitioners to navigate the complexities of aesthetic procedures with due diligence, confidence and expertise.
Looking ahead: future requirements and independent redress systems
Anticipating future industry requirements, practitioners must recognise the growing importance of belonging to a recognised complaints redress scheme. Proactively taking this step not only aligns practitioners with evolving regulatory standards, but also demonstrates a commitment to transparency and accountability. Independent redress systems, in particular, play a pivotal role in ensuring that there are fair and unbiased resolution mechanisms available for service-related consumer complaints.
The important features of an independent redress system include impartiality, accessibility, and the ability to provide structured and fair resolutions to customer grievances. As the aesthetic sector continues to advance, these systems contribute to enhancing overall standards and reputation, fostering a climate of trust between practitioners and consumers. The Cosmetic Redress Scheme (www.cosmeticredress.co.uk) has been operational in the UK since 2017 and is designated a Competent ADR Authority by Trading Standards and is approved by the Government under the Alternative Dispute Resolution for Consumer Disputes (Competent Authorities and Information) Regulations 2015.
The UK's non-surgical aesthetic sector is heading towards a future where insurance requirements are not only more stringent and mandated within the context of aesthetics, but also more aligned with industry advancements, regulatory changes, and consumer expectations, ensuring the continued safety, sustainability, and professionalism of the sector. It is imperative for practitioners to recognise the evolving landscape, secure adequate insurance coverage, and invest in comprehensive training to navigate the complex terrain of aesthetic practices responsibly and with excellence. Hamilton Fraser, in conjunction with the JCCP, has created a best practice charter in anticipation of the forthcoming licensing regimes currently under discussion.