The cosmetic treatments industry faces its biggest shake up in a generation according to the Joint Council for Cosmetic Practitioners (JCCP). A major consultation, launched by the Scottish Government on Friday 20th December seeks the views of members of the public on a new scheme of licencing and regulation for non-surgical cosmetic procedures such as breast and buttock augmentation, liposuction, vitamin infusions, weight loss injections, ablative lasers botulinum toxin injections, chemical peels and dermal fillers etc.
The proposals outlined in the consultation paper for a new scheme of licensing and regulation would require both a premises and practitioner licence to undertake lower risk procedures, with higher risk procedures restricted to a regulated setting will involve possession of both a practitioner licence and a premises licence and will make it an offence for anybody to carry out non-surgical cosmetic treatments without a license (and/or in the absence of proposed systems of regulatory control and professional oversight).
The Scottish Government is also seeking public views on the degree to which children and young people should be able to access non-surgical cosmetic procedures and whether to put in place any age restrictions for such procedures.
The scheme of regulation 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 regulated.
The JCCP has worked closely with colleagues at the Scottish Government and regulatory authorities in the UK to achieve legally enforceable governance arrangements for the cosmetic sector. The Scottish Government's new consultation document is the result of long-term work and collaboration to co-design a new, sustainable system of regulation to protect members of the public.
Context
The Scottish Government has advised that ‘the number of non-surgical cosmetic procedures (NCSPs) being carried out across Scotland and the UK has risen considerably over the years and continues to do so. Alongside the growth of this industry there has been increased concern about the safety of these procedures, especially, but not only, where they take place outwith a traditional healthcare setting. The Scottish Government believes that consumers should be able to receive these procedures with confidence and with minimal risk of harm, wherever they access them. We also believe that providers of these procedures should have a framework within which they can operate safely and responsibly’.
The Scottish Government has set out a series of specific questions as part of its consultation. The consultation questions may be accessed at https://consult.gov.scot/healthcare-quality-and-improvement/regulation-of-non-surgical-cosmetic-procedures/.
The consultation paper acknowledges that NSCPs ‘are sometimes carried out by regulated healthcare professionals, including doctors, nurses or dentists, who must be adequately trained and are subject to professional standards of competence and to investigation if concerns are raised. NSCPs can also be carried out by beauty therapists who may be highly skilled and have voluntarily registered with professional organisations such as the British Association of Beauty Therapy and Cosmetology (BABTAC). However, we know that sometimes individuals carry out NSCPs with no adequate training or oversight, using unlicenced, unsuitable or low-quality products leading to a heightened risk of harm to clients’.
‘NSCPs are sometimes carried out in clinical settings such as hospitals and clinics, which are subject to regular inspection. They are also carried out in beauty salons, which are not subject to inspection or external scrutiny, or sometimes in hotels, mobile vehicles or someone's home. While again some of these non-regulated settings may be kept to a good standard of hygiene, in the absence of regulation these premises are not subject to any external standards, verification or monitoring of cleanliness and safety’.
» The scheme of regulation 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 regulated «
The previous 2020 consultation in Scotland
In 2020 the Scottish Government ran a public consultation on the further regulation of non-surgical cosmetic procedures (that pierce or penetrate the skin) and proposals to introduce a licensing scheme. The majority of respondents (98% to the consultation and 90% to a citizen survey) supported the principle of further regulation of procedures led by those who are not qualified healthcare professionals.
Responses to the 2020 consultation also demonstrated support for certain procedures to be restricted to appropriate medical professionals; such as where injectable substances (such as Botox® and dermal fillers) are used. Advice received by the Scottish Government highlighted that LA licensing may not be the appropriate level of regulation for all procedures. The current therefore consultation sets out an alternative model to managing the risks of these procedures by restricting them to delivery by certain regulated health care professionals, or to settings with medical oversight. This would bring the settings into the scope of HIS regulation and inspection as independent clinics.
The 2024 Scottish Government's proposal
The Scottish Government propose that private, non-surgical cosmetic procedures (NSCPs) should only take place either:
- In an independent clinic, or other healthcare setting regulated by Healthcare Improvement Scotland (HIS): or
- In a business premises that is licensed by the local authority.
It is also proposed that certain procedures should only be carried out in a HIS regulated setting, either by an appropriate healthcare professional or under their supervision.
Under this proposal practitioners in a licensed premises would be able to carry out lower risk, less invasive procedures, with more invasive, higher risk procedures carried out only in a HIS regulated setting.
Wherever procedures take place we propose to establish standards (unless these are already established by virtue of the existing HIS regime) for:
- Training and qualifications;
- Insurance and indemnity;
- Premises' hygiene and equipment;
- Materials, for instance disposable needles and consumable products used in procedures.
The Scottish Government has followed the approach adopted in England and has a proposed three groupings of procedures (based on a proportionate approach to clinical risk management):
- ‘Group 1 procedures are the least invasive and lowest risk procedures. We propose that these can take place in a licensed premises by licenced individuals. Adherence to the standards referred to above will be a condition of obtaining and retaining a licence’.
- ‘Group 2 procedures are more invasive and higher risk. This category includes any procedure that uses a prescription-only medicine, or where such medicines are likely to be required as part of management of any complications arising from the procedure. We propose that these be restricted to HIS regulated premises, therefore meeting any standards set by HIS, and that there must be supervision by an appropriate healthcare professional, including a prescriber where prescription-only medicines are in use’.
- ‘Group 3 Procedures are those procedures which by virtue of either the complexity of the procedure, or the risk profile, we propose should only be undertaken by the appropriate healthcare professional’.
The consultation also advises that ‘it will not be possible for procedures to be carried out by practitioners working in hospitality venues, a client's own home or any other location outwith a licensed premises or HIS regulated clinic. It may be possible for practitioners to work out of their own homes, but in that case the space will require a local authority licence, or to be regulated by HIS, meeting all the relevant requirements’.
Proposals for licensing
The Scottish Government propose that procedures listed in Group 1 of the annex must be undertaken:
Either
- By a practitioner with a practitioner licence issued by the local authority in which they are practicing; and
- In a premises which is also licensed by the relevant local authority. or
- In a HIS regulated setting.
Under the Scottish Government's proposals Group 2 and 3 procedures ‘cannot take place under this licencing scheme. These procedures must only take place within a HIS-regulated setting (see below), it will also be possible for group 1 procedures to be carried out in a HIS-regulated setting’. It is also proposed that premises licences will be linked to practitioner licences.
It is proposed that the Practitioner License ‘will list the procedures the practitioner is qualified to undertake. In obtaining the licence the practitioner will be required to demonstrate that they have met an agreed standard of training, for instance an SCQF NVQ at the appropriate level for the relevant procedure. CPD courses will not be an appropriate form of qualification in themselves. It will be a condition of licence that practitioners either hold appropriate insurance or that any procedures they undertake are insured through the premises they are operating in’.
The JCCP is supportive of the principle of mandating a UK four country standard of education and training that should be provided by suitably qualified and approved education providers within the United Kingdom. The JCCP considers that the actual standard, kind, content and academic-related level of future education and training standards should equate as far as possible to those set dow#n in 2015 by Health Education England and by the JCCP/CPSA in their ‘Competency Framework for Non-Surgical Procedures (2018).
The JCCP is also particularly pleased to note that the Scottish Government's assertion that ‘in determining an application for a practitioner licence, LA officers will review evidence provided by the applicant to ensure they meet the relevant training and qualification standards for the procedures they will undertake’ and that ‘the LA would be required to conduct a fit and proper person check and take steps to identify whether the individual has been disqualified from obtaining a licence’.
Proposals for regulation
Importantly the consultation advises that it is proposed ‘that the procedures listed in Group 2 and Group 3 must only take place in HIS-regulated settings’ and that ‘these settings may also offer Group 1 procedures, as well as non-cosmetic services’. It is also recommended ‘that where NSCPs are being provided by any GP or dental surgery they must be registered with HIS, even if this would not otherwise be a requirement, regardless of any overlapping regime of inspection or regulation which is in place.
The consultation also asserts that ‘under this proposal Group 2 procedures must be undertaken either by an appropriate healthcare professional or by a trained practitioner who is being supervised by a healthcare professional who will remain responsible for the procedure. The healthcare professional would be responsible for ensuring that the practitioner's training and competence is appropriate to the procedure. HIS would consider the training and competence of both healthcare professionals and non-healthcare practitioners as part of their inspection. By supervision we mean that an appropriate healthcare professional must be present on site and undertake an initial face to face consultation for each procedure, including prescribing any prescription-only medicine for the procedure. The supervising professional will remain responsible for the safety of the procedure, satisfying themselves that the client is an appropriate candidate, is able to consent and understands any risks that may be associated with the procedure. They will also be required to be on site and available to answer any questions, or in the event of complications which require medical management, or if the practitioner undertaking the procedure requires support’. This accords with the JCCP's extant policy and is warmly welcomed!
» The JCCP has worked closely with colleagues at the Scottish Government and regulatory authorities in the UK to achieve legally enforceable governance arrangements for the cosmetic sector «
The JCCP is very supportive of the Scottish Government's proposal to limit the administration of all Group 3 procedures ‘by an appropriate healthcare professional themselves and not delegated to a non-healthcare-professional practitioner’. The JCCP had advised the Scottish Government that further work is required to define who can be identified as ‘an appropriate healthcare professional’. We specifically agree with the proposal that ‘whether undertaking or supervising a procedure the healthcare professional will need to be working within their scope of practice and have appropriate training and experience both in the procedure itself and in the management of any complications that may arise. The complexity of group 3 procedures is such that they will usually require advanced anatomical and medical knowledge so that we expect the appropriate professional to usually be a doctor or a nurse prescriber with advanced training, we will engage with professional bodies and HIS in establishing this in detail’.
The JCCP is of the firm opinion that the inclusion of the more complex, invasive and potentially harmful procedures included in Groups 2 and 3 should fall within the scope and purview of HIS as a regulator. Such inclusion will provide for the provision of a well-tested and aligned scheme of regulation, the uniform enforcement of nationally determined standards, objective monitoring and evaluation of service delivery and will ultimately lead to service improvement and the removal of unwarranted and unsafe variation in treatment practice. We also recognise that there will be an increasing number of procedures that will enter the market over the next few years, which would need to be included within the concept and principles of the practitioner license, and as such ‘future proofing’ will be essential’.
» The JCCP is firmly of the opinion that all procedures contained within Groups 2 and 3 should be restricted to younger people of the age of 18 (unless specific medically diagnosed conditions apply) «
Age restrictions
The Scottish Government is also seeking public views ‘on the degree to which children and young people should be able to access NSCPs’. The JCCP is firmly of the opinion that all procedures contained within Groups 2 and 3 should be restricted to younger people of the age of 18 (unless specific medically diagnosed conditions apply). The JCCP also considers that all Group 1 procedures should be considered on a case-by-case basis but always with ‘parental consent’ for persons under the age of 18.
Professor David Sines CBE, Chair of the Joint Council for Cosmetic Practitioners, said:
‘In recent years we have seen a massive growth in the number and types of non-surgical cosmetic procedures. Alongside this growth we have seen a dramatic increase in the number of complaints about substandard treatments, unregulated cosmetic products and unsuitable treatment premises.
All too often it is the NHS – and therefore the taxpayer – that has to pick up the pieces when a cosmetic procedure goes wrong. The Joint Council for Cosmetic Practitioners has seen a 400% increase in complaints in the last year alone, so we warmly welcome this important step towards proper regulation. Nothing is more important than public protection and patient safety.
I warmly welcome the Scottish Government's decision to consult on this new, proposed scheme of regulation and licensing. In my opinion the proposals included in this consultation document will dramatically improve consumer safety and reduce the risk of injury and harm arising from improperly performed cosmetic treatments. Nothing is more important than public protection and patient safety.
I would urge everybody to support this move towards sensible and proportionate regulation in this important sector.’