Scope of the proposed licensing
Answers to frequently asked questions relating to the proposed licensing scheme
In this chapter we will cover the frequently asked questions relating to the proposed licensing scheme and what this means for practitioners.
The Government advises that their intention is that the licensing scheme will: • be administered by Local Authorities in England, who will work with a range of partners to operate and enforce the scheme, such as Environmental Health Officers, Trading Standards Officers and the Health and Safety Executive• consist of two interlinked components: a practitioner licence and a premises licence• make it an offence for an individual to carry out non-surgical cosmetic treatments without a license
• operate from premises which meet the scheme’s standards of hygiene and cleanliness• require those people who offer procedures to: - be suitably trained and qualified - hold appropriate indemnity cover
In the wording of the Health and Care Act law passed in April 2022, a cosmetic procedure is defined as a procedure, other than a surgical or dental procedure, that is carried out for cosmetic purposes. It includes:(a) the injection of a substance(b) the application of a substance that is capable of penetrating into or through the epidermis(c) the insertion of needles into the skin(d) the placing of threads under the skin(e) the application of light, electricity, cold or heat
However, the exact procedures within this definition will be defined as the licensing law is drafted.
The current Government consultation seeks to inform and answer this question and will determine exactly which procedures will be included in the scope of the new licence.
At this time, it is not possible to confirm which procedures will be included within the scope of the new licensing regime but the current Government consultation on this subject sets out the Government’s current proposals for the scope of the new practitioner license.
This will be the central focus of this wide reaching public consultation exercise, to which we have all been invited to contribute with regard to those procedures that you consider should more obviously be included within the new license and other procedures that are currently unregulated and which you would prefer to be regulated as part of the overall licensing scheme.
The Government has advised that it considers that there are ‘certain non-surgical cosmetic procedures that are of sufficient complexity and invasiveness that they should only be performed by healthcare professionals and that providers of these procedures should be overseen by the CQC.
To better protect individuals who choose to undergo high-risk non-surgical cosmetic procedures, we propose amending the CQC’s regulations to add certain cosmetic procedures to its ‘regulated activities’ and to specify that these may only be undertaken by regulated healthcare professionals. Anyone else carrying out these CQC regulated procedures in the future would then be committing an offence. Such procedures would not be included within the LA licensing scheme.
Examples of the types of treatment that the Government is considering adding to the CQC’s scope of regulation are:
• Procedures aimed at augmenting any part of the body, in particular the breast, buttocks and genitals• Hair restoration surgery• Any injectable procedures – such as dermal fillers - undertaken to intimate areas of the body• The combination of ultrasound and large bore cannula for the purposes of liposuction, as used in procedures • PDO Cogs and Threads to CQC registered providers only• All intravenous injectables and infusions • Dermal micro-coring • Lasers which target the deeper layers of the dermis e.g C02 lasers when used for ablative resurfacing
Yes, questions are included in the consultation document to enable you to respond to these matters.
Some procedures will not be within scope of the license and therefore a license will not be required.
However, we are aware that some high-risk procedures may fall through this gap in regulation, and that regulation is still needed for those procedures. We are currently discussing ways of achieving this with various regulatory bodies, Royal Colleges and professional organisations.
Practitioners may be interested to review the precedent set by the Dr Evil case in relation to performing surgical procedures.
The precedent highlights the issues (and consequences) surrounding competence, premises, management of emergencies and ability to consent.
Yes, we anticipate that the license will detail each of the procedures that an individual is licenced to perform.
We are not sure at the present time. This is a matter for ongoing consultation.
However, some of the requirements for the cosmetic license may inform other licenses required by tattooists and others, for instance in the use of medicines.
The intention is that all practitioners, including registered health care professionals, will have to have a specific licence to carry out any of the procedures included within the future legislation. Wherever possible we know that the government will seek to remove duplication of inspection regimes.
However, what is clear is that the new national licensing standard for aesthetic practice will be applied to all providers and practitioners, regardless of their professional background. In addition, all registered healthcare professionals who perform procedures that are defined for inclusion within the scope of the new licence will also need to continue to satisfy all requirements set down by their Professional Statutory Regulator.
At the present time all persons who provide non-surgical cosmetic procedures that are meant for inclusion within the scope of the new license will be required to evidence that they meet all of the conditions set out within the practitioner license and as such to be in possession of a practitioner license.
There are a range of conversations taking place with regard to the provision of ‘equivalence’ requirements relating to education and training standards that form a condition for the issue of a license e.g. possession of a GMC Specialist Register qualification in applied areas of practice.
The premises license is expected to be generic in form, but we expect will certainly identify whether there are any exceptions, with regard to specific procedures that can or cannot be carried out as part of the conditions of the premises license.
We expect there to be one practitioner license. We expect the license will state and specify which procedures it has been issued for.
The legislation, and the advice that we have offered the DHSC and regulators, is designed to ‘future proof’ as far as possible. New procedures may be assessed as they arise but should fall into one of the five categories stated in Section 180 of the Health and Care Act (2022):
(1) the injection of a substance(2) the application of a substance that is capable of penetrating into or through the epidermis(3) the insertion of needles into the skin(4) the placing of threads under the skin(5) the application of light, electricity, cold or heat
This is something to be considered.
There has been no suggestion that a national public register system will be mandated or implemented.
We consider that there has to be a public facing register system to evidence, approved education and training providers and their qualifications.
The latter would provide local authority officers with a frame of references against which to determine where the applicants actually meet these required standards for education and training included in the new license.
This is expected to be the case.
As with existing licensing schemes, failure to meet the requirements of the licence can lead to practitioners and premises being prevented from operating.
The exact details of the sanctions that will be applied to those practitioners who fail to meet the required standards set down for the new licence have yet to be legally determined. As with current practice, it is anticipated that EHOs will have the power to implement immediate or emergency enforcements notices.
