Aesthetics looks at the Healthcare Improvement Scotland registration that has come into effect for medical aesthetic clinics in the country
Regulation in the medical aesthetic specialty throughout the UK, or lack thereof, causes huge discussion and debate.
In April 2016, it was announced that private clinics that are independent of NHS Scotland that have practising doctors, nurses and/or dentists must be registered with Healthcare Improvement Scotland (HIS) or risk violating the law.1,2
Clinics were given one year to pay the £1,990 fee to apply to have their clinics assessed and approved by the healthcare improvement organisation and become registered.
As of April 1 2017, it became an offence to operate an unregistered independent clinic in Scotland; meaning those clinics that are not registered are breaking the law.2 Kevin Freeman-Ferguson, senior inspector at HIS, explains that clinics that are not already registered must pay an increased registration fee, or alternatively, will be subject to a £5,000 fine and/or up to three months’ imprisonment for continuing their practice.3,4
To many practitioners, regulation of any kind is welcome, but some are skeptical as to what this registration will achieve.
Due to concerns about patient safety following the Poly Implant Prostheses (PIP) breast implants recall and the Keogh Review,5 the Scottish Government requested an expert group be set up to make recommendations on the regulation and provision of cosmetic procedures.6
The Scottish Cosmetic Interventions Expert Group (SCIEG) was established by Scottish ministers in 2014 to determine how the industry could be regulated. Recommendations in their 2015 report suggested that healthcare improvement and quality organisation HIS, should regulate all independent clinics.6,7
Under the regulations, doctors, nurses and dentists cannot practise unless they are working for a clinic that is registered with HIS and clinics are not allowed to run without registering.2
Freeman-Ferguson says, “The new registration system for independent clinics creates a system of quality assurance, which is extremely important. Once registered, clinics will be subject to regular inspections. A report of each inspection will be published so the public can see how a clinic is performing. The service will be graded on the quality of care, environment, staffing, management and information.”
According to HIS, inspections will be carried out every 12 or 24 months, depending on the performance of the clinic, and the majority of inspections will be unannounced.7 Grading of different quality areas will be published in a report online eight weeks after the inspection so the public can determine how it is performing.8 HIS also has the ability to receive and investigate complaints from patients.2
Freeman-Ferguson says, “We can take enforcement action if services do not comply with the requirements of the law. This action includes imposing conditions on a service’s registration, serving a notice on a service, which requires them to improve and, ultimately, if a service continues to ignore our requests to comply with the law we can cancel their registration.”
According to Freeman-Ferguson, in mid-March around 200 clinics were still yet to register. He says that there will be consequences if they continue to practise after April 1 and do not submit their registration, noting, “We will report providers who are willfully evading registration to the Procurator Fiscal Service (prosecution service in Scotland) for prosecution.”
Independent nurse prescriber and clinic owner Frances Turner Traill, who practises in Glasgow and Inverness, and also represents the BACN as a board member on the HIS board, believes that this regulation framework encourages patients’ confidence in clinics.
She says, “It gives the public a form of redress for when a patient has had an issue or a bad experience. I think these regulations bring the benefit of being able to demonstrate to the public that medical cosmetic clinics operate to the highest professional standards.”
Dr Nestor Demosthenous, who owns a clinic in Edinburgh and is on the HIS board, says that an additional benefit is that patients treated by anyone not registered by HIS can also complain to the body. Although he notes that, at present, HIS will have limited authority for action.
He says, “Hopefully this will help build some sort of database of those who have performed treatments that have led to complications because at the moment, the complaint from many Government institutions is that, overall, we don’t have any evidence that it is dangerous for beauty therapists to inject because there has never been anywhere for patients to voice their complaints.”
He hopes this will eventually provide evidence of the dangers of non- medically trained practitioners performing non-surgical treatments.
“I think these regulations bring the benefit of being able to demonstrate to the public that medical cosmetic clinics operate to the highest professional standards” Frances Turner Traill
Glasgow-based clinic co-owner and Association of Scottish Aesthetic Practitioners founder Dr Simon Ravichandran believes the HIS regulation is a step in the right direction, “It’s going to mean that every medical practitioner in Scotland practising aesthetic medicine has to practise within a regulated clinic. I think there are other aspects of aesthetic medicine that we could be regulating, but there’s no doubt that we have to start somewhere and clinics are a good place to start,” he says.
Like many new developments, there is going to be some criticism, says Dr Ravichandran, “The main criticism is that we are regulating a group of people who are already regulated – and that’s true. The currently regulatory provision has no space for non-medical people, which means it doesn’t even apply to podiatrists, pharmacists or beauty therapists.”
Turner Traill agrees, saying, “Someone’s got to be regulated first but the wider issues do need to be tackled. To me, that is those who are not already registered with a regulatory body.” However, the concerns surrounding the regulation of non-medical professionals has been recognised by HIS. Freeman-Ferguson says, “There are plans to address this and the Scottish Government
is currently working on this issue. The SCIEG recommended a second phase of change, which will bring aesthetic treatments provided by other professionals into an appropriate regulatory framework.5 Further information will be available in due course from the Scottish Government.”
Turner Traill believes that although some Scottish practitioners may be apprehensive about the HIS regulation, she says, “I think we need to look at the bigger picture and look at what the landscape is going to look like in 10 years’ time. Hopefully it will be better for patients’ safety – if you are inviting inspectors into your clinic it shows your transparency – and this can only be a good thing.”