The Government should make dermal fillers prescription-only devices or provide legislation that restricts the currently unregulated supply
In 2018, the Joint Council for Cosmetic Practitioners (JCCP) was created as a Professional Standards Authority (PSA)-accredited voluntary register for non-surgical cosmetic practitioners (including healthcare practitioners and beauty therapists) in the UK. Since its inception, the JCCP has gathered firm and convincing evidence to confirm that voluntary registration does not act as an incentive to require individuals who practise in the sector to seek to register against a nationally agreed set of practice, competence and knowledge-based standards.
The JCCP is of the opinion that compulsory or statutory registration is required to provide members of the public with the assurance that registered aesthetic practitioners have demonstrated their compliance with the standards set by the JCCP (which were endorsed by the professional regulators, the PSA and by NHS England via Health Education England (HEE) in 2016). The JCCP was charged with the responsibility to ‘own’, enhance and implement the HEE standards in June 2018 (as agreed by HEE at that time). Such standards require practitioners to practise competently, safely and ethically against a declared code of practice and competency frameworks/standards. Such registered practitioners would also be accountable for their practice and would be aware that sanctions could be applied should they fail to meet the safe practice standards required in just the same way as can be imposed by a healthcare professional statutory regulator through the application of their fitness to practice rules (the PSA requires the JCCP to operate to the same fitness to practice rules as those used by the healthcare statutory regulators).
As Executive Chair of the JCCP, I presented oral evidence to the All-Party Parliamentary Group for Beauty, Wellbeing and Aesthetics on 16 September 2020 and reinforced the JCCP's position that nothing less than statutory registration for all practising cosmetic practitioners should become a legislative requirement in the UK, so as to afford public protection and patient safety. Registration and regulation would afford the public the assurance that they require to confirm that their practitioners are ethically safe, knowledgeable, competent, accountable and capable professionals. Our position is based on the premise that:
- There is an urgent need for the Government to consider how best to address the fragmented nature of the aesthetics industry, which is characterised by professional dissonance and antagonism, and conflicts relating to commercial interest
- This fragmentation and lack of control drives the need to introduce a robust and effective system of governance, regulation and control within the sector
- The lack of a legitimately empowered co-ordinating body to oversee the sector and to represent its multiple interests has resulted in the proliferation of multiple professional associations and interest groups, some of which are diametrically opposed to regulation, public safety and effective evidence-based practice.
Therefore, there is a need for ‘one voice’ to represent the multiple interests that exist in the sector, focusing on patient safety and public protection to create a fair and equitable regulatory environment for all practitioners. This body has to have the confidence of all stakeholders in the sector and be independent of any commercial interests.
Manifesto for change
The JCCP has reviewed the many developments that have taken place over the last 3 years. It believes that to formulate a coherent policy response in this area, as a matter of priority, the UK Government should focus on the following.
Statutory regulation
Introducing statutory regulation within the aesthetics sector to create a fair and equitable regulatory environment for all practitioners, which is based on statutory regulation as a core principle (this is a critical matter and is a primary aim of the Council's strategic objectives). Statutory registration is required as a priority for all practitioners who perform non-surgical aesthetic treatments at and above Level 5.
Mandating education and training requirements for practitioners
Mandating that education and training requirements should be prescribed for all practitioners linked directly to agreed standards and competencies set down by HEE (2016), the JCCP (2018) and the Cosmetic Practice Standards Authority (2018).
Educating the public
Requiring all aesthetic services to publish (in plain English format) a summary of the procedures that they provide, the risks associated with such treatments, the cost of such procedures, a summary of their practitioner qualifications, their insurance certificate and details of their redress scheme. This should be compulsory so as to ensure that members of the public are appropriately informed and are able to make risk-assessed choices about safe and effective treatment options.
Defining what is a ‘medically related aesthetic service’
The publication of a clear definition of what is a ‘medically related’ service and what is an elective ‘cosmetic’ procedure/service should be sought. These issues are not clearly defined in UK law and, as such, pose a continued threat to public protection and patient safety with regard to the provision of regulatory oversight provided by the Care Quality Commission and the Medicines and Healthcare products Regulatory Agency. Clarification is also required to confirm what constitutes a ‘cosmetic surgical’ treatment (for example, threads and cogs are now classified as being surgical procedures, but are performed in a range of beauty salons and clinics, etc), as opposed to a cosmetic ‘non-surgical’ procedure. Therefore, all aesthetic treatments should be be licensed by a national co-ordinating centre/body, with each treatment being risk-assessed with regard to patient harm and the impact on public protection.
Identifying risk as part of the consultation process
Ensuring that the risk of potential physical and psychological harm and the impact associated with each defined cosmetic treatment area is identified should be a requirement in all aesthetic treatment assessments and pre-treatment consultations.
Restricting treatments to adults only
Making a move to legislate that elective, non-medically related aesthetic procedures should be restricted for use only for those who are over 18 years old.
Providing accessible information to patients
The information needs of patients/clients who are considering or having the ‘higher risk’ treatments should always be provided in an accessible format to ensure that they are able to make an informed choice with regard to their proposed treatment journey.
Mandating premises standards
The introduction of specific premises standards in England for beauty salons and non-CQC registered clinics (many of which are not currently required to comply with specific premises standards in England, unlike in Scotland where this is now statutory regulatory requirement) should be guaranteed. The JCCP considers this essential in ensuring public safety and health protection compliance (particularly in regard to the hygiene standards that are now required to protect against COVID-19). This will require standardisation and mandatory enforcement through the provision of new secondary legislation.
Introducing licensing requirements and standards
Nationally agreed and consistent regulatory and licensing standards for the aesthetics and beauty sector should be introduced with the aim of removing some of the anomalies that exist between various counties and London Boroughs (which have their own Act) and the rest of the UK.
Tighten up the rules around advertising aesthetic treatments and training programmes
The imposition of greater regulation and oversight to reduce the significant number of false and exaggerated advertising (including social media) claims that provide misleading information to both members of the public and to practitioners about the standard, type and effectiveness of the administration of safe procedures.
Dermal fillers to be made prescription-only devices
Requiring the UK Government to move immediately to make dermal fillers prescription-only devices (or to provide alternative legislation to restrict the currently unregulated supply of these devices).
Enforcement by regulatory bodies of JCCP remote prescribing guidelines
Reinforce the need for all aesthetic practitioners to adhere to the guidance set down by the healthcare professional statutory healthcare regulators and by the JCCP for ‘responsible prescribing’ should be reinforced.
Insurance
Require all practitioners to hold adequate and robust medical indemnity insurance cover and to be members of redress schemes to protect the public.
Establishment of a national database on complications
The Government can work with the MHRA to design and implement a coordinated approach to the reporting and analysing of complications. The MHRA occupy a central role in assisting in the design, production and implementation of a national database.
Coordinated approach to data collection and research within the sector
Plugging the evidence-based gap that exists in regard to the lack of data, and research relating to the non-surgical sector should be addressed as a priority, such as the size of sector, the number and type of practitioners who operate in the UK (including details of their professional backgrounds and training) and the value of the industry to the UK economy. Additionally, data is required on the number, type and extent of complications that occur as a result of aesthetic treatments, how these adverse events are reported and the cost to the NHS of correcting such complications.