Aesthetics Regulation - The First Open Consultation
In the last decade or so, non-surgical cosmetic procedures have become more prevalent due to social media, accessibility, and technological advancements. When these treatments first became available to the public, over 20 years ago, the government failed to introduce any legislation relating to who can administer aesthetic treatments, the training and qualifications required and the products used.
This lack of standardisation has led to competent practitioners who operate to high standards of best practice in relation to training, health and hygiene finding themselves in competition with practitioners and businesses with low levels of competence and who lack appropriate training in the procedures they offer.
The aim of the licensing scheme is to ensure that aesthetic practitioners, regardless of whether they are healthcare professionals or not, have to adhere to the same consistent standards and protect individuals from the potentially harmful physical, emotional and psychological impacts of poorly performed non-surgical cosmetic procedures.
The aesthetics industry is estimated to be worth in excess of £3bn and is predicted to grow 10% annually. The government recognise that any licensing scheme for non-surgical cosmetic procedures must strike a balance between protecting the public and building confidence in the safety of the aesthetic industry, while respecting consumer choice and encouraging innovation. Equally, the government won’t want to stifle the growth of this sector.
What does the licensing scheme aim to achieve?
The government hopes that the licensing scheme will:
identify the procedures that present a risk to the public
consist of 2 interlinked components: a practitioner licence and a premises licence
be administered and enforced by local authorities, who will work with a range of partners such as environmental health officers, trading standards officers and the Health and Safety Executive
make it an offence for an individual to carry out non-surgical cosmetic procedures without a licence
require those people who offer procedures to:
be suitably trained and qualified
hold appropriate indemnity cover
operate from premises which meet the scheme’s standards of hygiene, infection control and cleanliness
introduce a minimum age of 18 for those people seeking to receive the procedures licensed under the scheme
What does this particular consultation focus on?
This is just the first consultation on the licensing scheme.
In this consultation, the government are seeking the views of practitioners, the public and anyone who has any interest/involvement in the aesthetics sector.
This consultation focuses only on the following things:
the procedures in scope
restrictions on which practitioners should be permitted to perform procedures
age restrictions for those undergoing such procedures
Further consultations will be needed to determine the other aspects of the proposed licensing scheme, including education and training standards, infection control and cleanliness, indemnity requirements and licensing fees to be paid.
What are the key points within this consultation?
There are three aspects to this consultation.
Allocating treatments into RAG rated categories
Determining who can administer which treatments
Determining the minimum age of those having non-surgical cosmetic treatments
In essence, this consultation focuses on the treatments, the practitioners permitted to deliver them and to whom. The next consultation will focus on training, standards of hygiene, infection control and cleanliness for premises, and indemnity requirements.
A RAG rating (Red, Amber, Green) will apply to non-surgical aesthetic procedures and the risk rating will determine who can administer the treatment
Green: procedures with the lowest risk of complications. All practitioners are eligible to perform licensed procedures where they meet agreed standards.
microneedling
mesotherapy
intense pulsed light (IPL) and light emitting diode (LED) therapies
chemical peels that involve destruction only into viable epidermis (the outermost layer of the skin)
‘no-needle’ fillers including pneumatic devices that use intense pressure to pass substances through the epidermis
micropigmentation (semi-permanent make up), including microblading and nanoblading
non-ablative laser hair removal
photo rejuvenation (the use of a laser to treat skin conditions including wrinkles, acne scarring, sun damage)
Amber: procedures with medium risk of complications. Non-healthcare professionals must be licensed and have relevant oversight by a named regulated healthcare professional (who has gained an accredited qualification to prescribe, administer and supervise aesthetic procedures). Qualified and regulated healthcare professionals are eligible to perform these procedures without oversight where they meet agreed standards.
botulinum toxin injections
semi-permanent dermal fillers injected into the face only
biorevitalization injections and/or any injection of hyaluronic acid
vitamin and mineral injection procedures
platelet rich plasma (PRP) therapy for cosmetic purposes and Biofiller
injection microsclerotherapy (spider vein treatment)
weight loss injections
carboxytherapy and/or the infusion of gases under the skin
cellulite subcision
injection lipolysis with a POM
cryolipolysis
high intensity focused ultrasound (HIFU), including intimate use
radiofrequency treatments
plasma ablation or plasma fibroblast
non-ablative lasers (excluding photo rejuvenation and laser hair removal)
medium depth peels that involve full thickness destruction of entire epidermis into upper dermis (the inner layer of the 2 main layers of the skin)
POM treatments applied topically for cosmetic purposes, such as prescription strength vitamin A and hydroquinone for the treatment of pigmentation problems or for skin whitening
electrocautery
the combination of 2 or more technologies to create a hybrid device. For example, the combination of radiofrequency and microneedling to treat lines, wrinkles, sagging skin, acne scars and stretch marks
cryotherapy and/or any cryocautery procedure that freezes the skin in order to remove skin lesions such as skin tags, age spots and warts
Red: procedures with the highest risk of complications. This proposal brings specified high-risk procedures into CQC regulation, so that they fall outside of the scope of the licensing scheme. The government propose restricting these procedures to qualified and regulated healthcare professionals only.
all thread lifting procedures, including PDO thread and cog lifts
hair restoration surgery
procedures aimed at augmenting any part of the body, in particular the breast, buttocks and genitals, typically using autologous fat or dermal fillers
dermal micro-coring
hay fever injections for reducing redness or blotches on the skin
the combination of ultrasound and large bore cannula for the purposes of liposuction
deeper chemical peels such as phenol peels
lasers which target the deeper layers of the dermis. For example, CO2 lasers, where used for extensive fully ablative resurfacing
the provision of any green or amber procedure where the circumstances of the provision meet the criteria for the procedure to be classed as the CQC regulated activity of treatment of disease, disorder or injury (TDDI)
all intravenous injectables and infusions
Red rated procedures are to be classified as regulated activities by CQC and are restricted to qualified and regulated healthcare professionals only operating from CQC registered premises. This would mean non-healthcare professionals would not be able to carry out these procedures.
There will be a minimum age requirement for those seeking treatment
The government propose that all licensed procedures should be restricted to those above the age of 18 unless approved by a doctor and carried out by a healthcare professional.
Does this mean that non-healthcare practitioners won’t be able to administer Botox & fillers?
No.
Aesthetic practitioners who aren’t regulated healthcare practitioners will still be able to administer treatments in the amber treatment category, but they must be licensed and have relevant oversight by a named regulated healthcare professional (who has gained an accredited qualification to prescribe, administer and supervise aesthetic procedures).
The required training, qualifications and what “relevant oversight” entails hasn’t yet been determined.
What’s NOT included in this consultation?
During this consultation, no feedback was requested on:
restriction of non-surgical aesthetic treatments to healthcare professionals only - this element is not up for discussion. The government are looking for a way to make the practice of non-healthcare practitioners safer.
what “relevant oversight” means
minimum training and qualification requirements
cleanliness, hygiene and infection control standards
indemnity requirements
Do I need to be a prescriber? Do I need a Level 7?
The vast majority of treatments most healthcare practitioners carry out fall into the green or amber rated categories.
The report states:
For green rated treatments, the report states, “All practitioners are eligible to perform licensed procedures where they meet agreed standards.”
For amber rated treatments, the report states: “Qualified and regulated healthcare professionals are eligible to perform these procedures without oversight where they meet agreed standards.”
There is no explicit mention of needing to prescribe or have a Level 7 qualification in this report. But this initial consultation is not relating to these aspects of the licensing scheme.
What “agreed standards” are is yet to be determined.
The next consultation should provide more information, clarity, and the opportunity to provide feedback on training and qualification standards.
How long will it be until the licensing scheme is introduced?
A long time!
This initial consultation runs for 8 weeks, ending on 11:59pm on 28 October 2023, after which will follow a period of analysis and consideration of the information provided to us.
From the date the consultation closes and throughout 2024 and 2025, the government state they will work with expert groups on the elements that will underpin the licensing scheme, including education and training standards, insurance, infection control and hygiene qualifications and a fees model.
They will then need to draft and document the full licensing proposals to be presented in Parliament, to then be agreed and made law.
Given that it’s taken 16 months, from the Health and Care Act giving the Secretary of State for Health and Social Care the power to introduce a licensing regime for non-surgical cosmetic procedures in England, to having this first open consultation, it’s highly likely that we can expect the implementation of the full licensing scheme to take years, not months.
What about in Wales and Scotland?
The licensing scheme, this consultation period and the proposals are specific to England.
Scotland currently has its own regulations relating to aesthetic practice in place.
Wales is yet to announce any plans regarding the regulation of non-surgical aesthetic procedures.
Where can I read more?
You can read the whole report here: https://www.gov.uk/government/consultations/licensing-of-non-surgical-cosmetic-procedures/the-licensing-of-non-surgical-cosmetic-procedures-in-england
Where can I give my feedback?
You can complete the online survey here: https://www.gov.uk/government/consultations/licensing-of-non-surgical-cosmetic-procedures