In February 2022, a significant development in the realm of non-surgical cosmetic procedures occurred with an amendment to the Health and Care Bill. This amendment granted the Secretary of State the authority to establish a licensing scheme for aesthetics treatments in England. Following the receipt of royal assent in April 2022, the specific framework and details of this licensing scheme are currently in the process of being defined through extensive engagement, including a public consultation.

It is estimated that 900,000 Botox procedures alone take place in the UK annually raising concerns about the existing regulatory framework. Currently, there are minimal restrictions on who can perform these procedures. In an effort to ensure public safety and enhance standards in the aesthetics industry, the government has initiated the process of regulating non-surgical cosmetic procedures. ‘Non-surgical’ or ‘non-invasive’ procedures are treatments that do not involve the skin being cut with a scalpel or instruments being inserted in the body. This does not mean that these procedures work magically from the surface, these treatments are often injected solutions including as dermal fillers, Botulinum toxin (Botox) or laser technologies and micro needling that target the epidermis of the skin.

At present, anyone can practise aesthetics in the UK. You do not have to demonstrate any level of medical training or hold any particular level of qualification to administer non-surgical treatments and non-medical injectors are able to work with prescribers to allow the administration of Botox treatments. Training usually consists of a 1-day course per treatment, but more often we are seeing aesthetic crash courses, some just a day or two long with no entry requirements as a way to compete in an oversaturated market.

Stage 1: Public Consultation

On September 2nd, 2023, the Department of Health and Social Care embarked on an open consultation to gather feedback from individuals and businesses regarding the proposed licensing scheme for practitioners offering non-surgical cosmetic procedures, including Botox, fillers, and laser treatments.

The proposed scheme will make it a criminal offence for practitioners to conduct procedures under the following conditions:

• Without a Practitioner's License or Premises License: Practitioners must hold the appropriate licenses to perform these procedures or operate from licensed premises.
• Without Suitable Training and Qualifications: Practitioners must demonstrate the necessary training and qualifications for their respective procedures.
• Without Premises Inspection: All premises must be inspected to ensure they meet the scheme's requirements for infection control, hygiene, and cleanliness before any treatment is administered.
• Without Appropriate Indemnity Cover: Practitioners must have adequate professional indemnity coverage to protect patients' interests.
• On Patients Under the Age of 18: The scheme proposes introducing a minimum age of consent for individuals seeking aesthetic treatments, ensuring that no procedures are performed on those under 18.

This scheme seeks to identify procedures that pose risks to the public, establish a minimum age requirement for patients, and guarantee that practitioners operate from premises that adhere to stringent standards for infection control, hygiene, and cleanliness.

Administration and Enforcement:

Local authorities will play a pivotal role in administering and enforcing this scheme. Collaborating with various partners, including trading standards officers, environmental health officers, and the Health and Safety Executive, they aim to address the widespread concerns within the industry effectively.

Questions Posed by the Consultation:

The consultation, scheduled to run for eight weeks, solicits responses to the following questions:

• Which Procedures Should Be Included in the Scheme? The scheme primarily focuses on "cosmetic procedures," encompassing a range of non-surgical treatments such as injections, applications, and other aesthetic practices.
• Who Will Be Eligible to Perform Each Procedure? Procedures are categorized based on complexity and invasiveness, with practitioners required to meet specific standards for each category:

Green: Low-risk procedures that all practitioners can perform upon meeting agreed standards.

Examples include:

• Microneedling
• Intense pulsed light (“IPL”) and light emitting diode (“LED”) therapy
• ‘No needle fillers’
• Micropigmentation including microblading and nanoblading.

Amber: Medium-risk procedures that require non-healthcare professionals to work under the oversight of regulated healthcare professionals.

Examples include:

• Botox injections
• Semi-permanent dermal fillers
• Weight loss injections
• Radiofrequency treatments

Red: High-risk procedures reserved for qualified and regulated healthcare professionals.

Examples include:

• Thread lifting procedures.
• All intravenous injections
• Hair restoration surgery
• Hay fever injections
• Deeper chemical peels

Age Restrictions:

The Botulinum Toxin and Cosmetic Fillers (Children) Act 2023 already prohibits the administration of Botox or filler injections for cosmetic purposes to individuals under 18 in England. The proposed licensing scheme is poised to uphold these age restrictions, ensuring that no procedures are performed on those under 18, except when approved by a GMC registered doctor and carried out by a specified healthcare professional.

Level 7 Qualification:

There have been many rumours circulating as to what qualification requirements may arise from the new regulations, the most talked about being the Level 7 Certificate. Following the 2012 PIP breast implant scandal, the Department of Health appointed Health Education England (HEE) to conduct a full review of the regulatory framework in the cosmetic industry. This review included treatments such as dermal fillers, Botox and micro- needling so that appropriate recommendations could be made. HEE suggested that an appropriate qualification to practise aesthetics would be the Level 7 Certificate, the equivalent to a master’s degree which would follow a suitable medical undergraduate degree such as medicine or nursing. This would result in an industry where you would not be able to practise aesthetics unless you were a qualified medic or able to demonstrate that you had an existing client base prior to the new regulations coming into force. As for now, this remains a rumour and no specific qualifications have been cemented.

Taking Action:

The consultation period is set to conclude at 11:59 on October 28, 2023. We strongly encourage anyone with an interest in this field to actively participate and share their views. In our opinion, sensible regulation and a professional approach on the part of practitioners ensures public confidence. This is vital in developing an industry where the consequences of negligence can be far reaching and sometimes life threatening. From a practitioner’s perspective, they want to offer services for a premium where quality is assured. Insurers will only offer reasonable terms for professional indemnity policies if they know the risk has been properly managed. Regulation helps in both respects, but it has to be proportionate and responsive to the need for change as a young industry develops. If sanctions are to be imposed for breaches of rules and principles, the guidance needs to be clear, and this is an issue across other regulated sectors.

At JMW, we are committed to upholding the highest standards in legal advice for those with an interest in aesthetics. Our services incorporate all regulatory and professional standards requirements, as well as industry-specific best practices. If you require guidance or assistance, JMW is ready to equip you with the practical tools and resources necessary to meet these evolving requirements.

Please share your views here: The licensing of non-surgical cosmetic procedures in England - GOV.UK (www.gov.uk)

The Joint Council for Cosmetic Practitioners (JCCP) have collaborated with Aesthetics CPD to produce a video explaining the proposed scheme.

https://drive.google.com/file/d/1b7fhSlFdhqLYWhbtvPaN_bxlwvy-d3Su/view?usp=sharing

This blog was co-authored by Jonathon Enston and Georgia Hughes.