Scotland proposes to regulate injectables for non-medics
In January, the Scottish Government announced a proposal that could see non-medics have to carry a licence in order to perform injectables such as fillers and botulinum toxin.
Public health minister Joe FitzPatrick said Scotland would be the first in the UK to introduce the licensing scheme. A consultation has been initiated for the public to share their views until the end of April.
“We are committed to patient safety and want to ensure that all those who carry out non-surgical procedures, such as dermal fillers or lip enhancements, are competent and that the treatments take place in safe and hygienic premises,” said FitzPatrick.
“We plan to introduce regulations later this year and invite members of the public and interested parties to give their views as part of the consultation on our proposals.”
The licences would be akin to those required in tattoo parlours, where a licence will show that the practitioner has been adequately trained and has both the experience and skills to perform the treatment.
Clinics run by medical professionals who provide non-surgical cosmetic procedures have been regulated by Healthcare Improvement Scotland (HIS) since 2016. However, there is no regulation around who can practise injectables in locations such as aesthetic clinics, beauty salons, pharmacies and hairdressers. In addition to a rise in the number of traditional beauty salons offering injectable treatments, the proposed legislation was also launched in reaction to the increasing number of pharmacists entering the field of aesthetic medicine.
The proposal
In the plans, non-healthcare practitioners providing treatments that pierce or penetrate the skin, including injectables, skin needling and possibly light and energy-based devices like laser, would be regulated by a licence under Part 1 of the Civic Government (Scotland) Act 1982.
The scheme is being modelled somewhat on the regulatory requirements that tattoo parlours and piercing shops are required to adhere to, whereby local authority Environmental Health officers (EHOs) visit the premises and assess them against the specified conditions before a licence is granted.
When it comes to what these conditions would be, the proposal consultation paper reads: “Conditions could include that services are provided in a clean and safe environment, individuals would be 18 years of age or older, cooling off periods would be offered and sharps etc. would be disposed of appropriately.”
It also says, “We intend to make it a requirement that an applicant’s knowledge, skill, training and experience is taken into account when determining whether they are a fit and proper person to hold a licence.” Further details are likely to be discussed and decided upon after the consultation process when responses have been reviewed.
Environmental health officers would be required to refuse a licence if they didn’t deem the applicant as a “fit and proper person”. It would be a requirement that an applicant’s “knowledge, skill, training and experience” would be taken into account. Whether or not the Government would specify certain qualifications or course certificates from recognised education providers is yet to be determined.
To address the legislative gap where pharmacists are concerned, the Government is also proposing amending the definition of “independent clinic” so that it covers pharmacy professionals. This would mean that non-surgical cosmetic procedures provided by pharmacy professionals would be regulated by HIS in the same way as aesthetic businesses run by medical professionals.
Not far enough
Despite the Government’s intention to bring some level of regulation to an area that is essentially a free market, the proposals haven’t been met with much positivity from some Scottish clinicians who don’t think the proposed legislation is the right approach. “I am completely against the Scottish Government’s proposal to introduce a licensing scheme – this will effectively legitimise non-medical people performing medical procedures,” says Helena Collier, co-founder and clinical director of Skintalks Medical Aesthetics in Musselburgh, East Lothian. She adds, “Some may argue that a licensing system – similar to that of tattooists – is better than no regulation, but the Government implying that injecting a dermal filler is similar to getting a piercing clearly shows it has been misguided with regard to the level of knowledge, skill and expertise required to deliver medical aesthetic care.”
Following the 2013 Keogh Report, the Scottish Cosmetic Interventions Expert Group (SCIEG) was established to examine the provision of cosmetic surgery and interventions in Scotland and analyse the report’s recommendations for implementation. The group recommended that regulation should be extended so that only healthcare professionals (regulated by HIS) could provide non-surgical procedures, or else hold overall responsibility if the procedure was performed on their behalf. These recommendations are addressed in the current consultation paper, with the Government stating: “…there is currently a lack of evidence of harm from all activities and therefore we do not want to cause undue financial difficulties for reputable small businesses, if this can be avoided by the introduction of other appropriate regulation. We consider that a blanket ban on non-medical professionals carrying out non-surgical cosmetic procedures could be difficult to enforce and might drive unregulated providers underground.”
Dr Sam Robson, medical director at Temple Clinic in Aberdeen, believes the proposed legislation undermines aesthetics as a medical profession. She says, “This is an attempt by the Government to obfuscate the issue – non-medics should just not be injecting. They do not have the experience or the knowledge to recognise or manage a complication and they do not have insurance. Aside from anything else this trivialises the whole procedure.”
Collier agrees: “The Government refuses to acknowledge that the practice of medical aesthetics is a specialist field of medicine. If lay people can be licensed by Government to perform these treatments, then how can the procedures be of a medical nature?” The consultation paper describes its proposed scheme as “a way forward that ensures the visibility of all services and licensing backed with rigorous implementation guides to ensure best practice in all circumstances.” However, Collier argues that “there is only one acceptable approach – only registered healthcare professionals with an appropriate healthcare degree should be practicing within the field of aesthetic medicine.”
The final say
With Scottish healthcare professionals subject to demanding and robust regulation and inspection from HIS, it’s easy to see how some feel non-medics would be given an easy ride in comparison under the proposed licencing scheme. “The Government thinks it is acceptable to create a two-tier system whereby non-medics and lay people can simply have their premises inspected for hygienic purposes. I find this thought process very offensive,” says Collier.
Ultimately, the question is whether the proposed legislation is going to improve the standards and patient outcomes of aesthetic procedures in Scotland. While non-medics are allowed to continue injecting, despite having to be accepted for a licence, it seems many clinicians at the top of their profession think it, at best, unlikely that public safety will improve and, at worst, that the situation may become even more dangerous. “Many people are guided by price and social media marketing when they choose their practitioner. Young people are especially vulnerable to things like ‘winning’ a procedure by ‘liking and sharing a post’ on Instagram. The quality of products these people are injecting is often questionable and the price is usually too good to be true, often at the expense of safety,” says Dr Robson. “Non-medics injecting affects the safe practice of the whole aesthetics business and puts patients unnecessarily at risk.”
Read about the ban for injectables for under 18s and the Beauty industry association warning members away from filler.
