Practitioner related issues and queries
Answers to frequently asked questions relating to practitioners
In this chapter we will cover the frequently asked questions relating to practitioner related issues.
The DHSC advises that ‘many practitioners who carry out, oversee or prescribe medicines for use in non-surgical cosmetic procedures are regulated healthcare professionals, such as nurses, designated allied health professionals, dentists, doctors and pharmacists.
The UK healthcare professional statutory regulators are responsible for ensuring that those professionals on their registers have the necessary skills and knowledge to be registered and function within their prescribed scope of practice.
The regulators expect that individual registrants choosing to undertake non-surgical cosmetic procedures should ensure that they have the skills and knowledge required to do so and should follow the requirements of any relevant legislation.
Regulatory bodies can investigate and take action in line with their fitness to practise processes’.
There are many such regulated professions, but the JCCP considers that only those regulated professionals who are considered by their regulators to be ‘fit for purpose’ to deliver a range of cosmetic procedures should be included in this definition.
The determination of such professionals will require further definition and determination.
No. The intention is that all practitioners, including registered all 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.
The license will apply to all those wishing to offer cosmetic procedures including those currently unregulated and those with professional health care registration, such as doctors, dentists, nurses, allied health professionals and pharmacists.
This is a central and key issue that is set out in the consultation paper. The Government advises that it recognise that there are ‘concerns about the serious risks associated with certain non-surgical procedures.
The Governement propose that there are different oversight categories depending on the risk associated with the procedure. The oversight categories are as follows:
1. all practitioners eligible to perform licensed procedures where they meet agreed standards (Green – procedures with the lowest risk of complications)
2. non-healthcare professionals must be licensed and overseen by a nominated regulated healthcare professional (who has gained the accredited qualification to prescribe, administer and supervise aesthetic procedures), based on the clinical oversight model recommended within the 2013 Keogh review and by the HEE Qualification Requirements for the Delivery of Non-Surgical Education and Training (2015) (Amber – procedures with medium risk of complications)
3. in line with section 3, restrict certain procedures to regulated healthcare professionals, potentially bringing high-risk procedures into CQC regulation, so that they fall outside of the scope of licensing scheme (Red – procedures with the highest risk of complications)
The Government also proposes that ‘any procedure that requires a Prescription Only Medicine (POM) must, at the very least, be overseen by a regulated healthcare professional.
This includes any procedure that uses a POM directly, for example, injectable toxins; and/or any adjunctive procedure that uses a POM alongside the primary procedure to assist or complement it, for example, lidocaine for anaesthetic purposes, or hyaluronidase for managing complications of dermal fillers’.
Please note: Examples of the procedures that will be allocated to each of the ‘green’, ‘amber’ and ‘red’ categories noted above are set out in detail in the consultation paper.
We believe that this will be a key standard to be included in the new licence and have endorsed this approach.
Further work is required with the Professional Statutory Regulators to confirm their endorsement of this requirement.
We anticipate that, to obtain a license, an element of supervision/oversight will be required for certain practitioners performing specified procedures. Having a supervisor will not be a substitute for a license. At this this stage we are unable to clarify what the DHSC intends regarding the definition of the concept of ‘under supervision’ or ‘working under clinical oversight’.
Further information will be provided by the DHSC over the next 12 months to confirm some of the details underpinning this response. The JCCP will be giving serious consideration to this matter in the coming months.
No. At this stage of the process, we are unable to confirm whether this will be a legal requirement. This will be dependent on the outcome of the Government's consultation. However, you may wish to register with the CQC.
The new non-surgical cosmetic license will most likely require you to register with your local authority environmental health team in order to obtain both a premises and a separate practitioner license.
We are working with the CQC and the DHSC to make recommendations to avoid an overlap in evidencing the requirements for a license between various agencies. However, you will still need a license.
We anticipate that there will be a transition period. We anticipate a transition period and await detail on this. The JCCP are recommending a two-year transition period.
Both the premises and personal licenses will specify the procedures that are included in the scope of each practitioner’s license.
Yes, we expect this to be the case although each ‘site’ will need to have its own individually assigned premises license.
Yes, if the home clinic meets the standards set down in the anticipated new premises license. Home based clinics will also have to be inspected by local authority Environmental Health Officers in just the same way as they inspect salons and clinics.
We anticipate that it will not be acceptable to provide the procedure in the client’s home or from a mobile vehicle.
This will depend on the procedures being offered and remains subject to review and approval. The JCCP’s current premises standards may help give an indication of what may be required.
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.
A later stage in drafting legislation will be to define and provide the powers that local authorities will be given (and require) to enable them to enforce the license.
It is likely that an EHO would serve a ‘prohibition notice’ which, in the absence of compliance, would then result in court proceedings and legal sanctions (yet to be determined).
It is too early in the process to respond purposefully to these important questions.
We will share the question with DHSC and licensing colleagues to alert them to need to consider and respond to these matters as part of their ongoing deliberations.
This will be made explicit in future regulations. However, a failure to meet the required standards of competence, practice proficiency and premises would provide a basis for refusal to issue a license.
License holders will also need to meet a ‘fit and proper person’ test with regard to ‘good character’. A license may also be withdrawn for persistent breaches of the terms of the license or other illegal activity.
Most definitely – this will be a key condition for the granting of a practitioner license.
It will definitely be a requirement for you to advise members of the public of their right to make a complaint should they be dissatisfied with the service you provide.
You will need to publish your complaints procedure and make it accessible to members of the public.
It is our hope that the DHSC will also make recommendations of the need for you to provide members of the public with access to a redress scheme.
The latter has yet to be determined.
We recognise the potential risks associated with any delay to requiring all practitioners to meet all of the conditions set down and prescribed in the new license.
We expect however that there will be period ‘grace’ of up to two years to enable practitioners to evidence that they meet and satisfy all of the conditions set down in the license. It will be for Environmental Health Officers to apply their judgement to risk assess and (if necessary) apply conditions/sanctions at any time if they consider that there is a real risk of harm to members of the public.
