News Special: Defining a Medical Procedure

By Holly Carver / 01 Jun 2021

Aesthetics looks at the new JCCP definitions of what constitutes a ‘medical’, ‘medically-related’ or ‘cosmetic’ procedure

Aesthetic medicine is a specialty led by healthcare professionals, yet is still considered by many to be ‘cosmetic’.
This makes it difficult for many within the industry to understand which aesthetic procedures are medical, medically-related, or cosmetic. Indeed, this confusion became even more apparent during the COVID-19 lockdowns, when the UK Government stated that any premises providing beauty services had to close, including ‘cosmetic, aesthetic and wellness treatments’. The Government’s wording left aesthetic doctors, dentists and nurses within the profession wondering whether ‘medical’ aesthetic or cosmetic treatments can be performed at their clinic.1

To help create an understanding throughout the profession, the Joint Council for Cosmetic Practitioners (JCCP), has released new official guidance in order to clarify the difference between the three terms.2 The guidance has been formed with the help of 11 of its clinical advisory board members, and feedback on matters of factual accuracy was also shared with the Medicines & Healthcare products Regulatory Agency (MHRA), the Care Quality Commission (CQC) and the General Medical Council (GMC). Professor David Sines, chair of the JCCP, commented, “It is hoped that these principles can be applied to all instances of aesthetic practice where a medical or cosmetic determination is required, including procedural modalities that are currently outwith the JCCP’s remit, and indeed to be able to be ‘future proofed’ for application to adjunctive or emergent procedures that are not currently recognised officially within the aesthetics sector.”

The difference between ‘medical’, ‘medically-related’ and ‘cosmetic’

The JCCP explains that a treatment that is purely cosmetic in nature is any proposed non-surgical aesthetic procedure that is not linked to a ‘medical’ or ‘medically-related’ diagnosis, as determined by a suitable qualified and registered healthcare professional (HCP), and which does not have a clinically determined therapeutic outcome benefit for the patient. For example, microneedling, laser hair removal and superficial peels for purely cosmetic reasons.

A therapeutic benefit, the JCCP explains, can be determined as a positive outcome that occurs as a result of a method used to treat a disease or disorder. A treatment may be considered to have therapeutic benefit if it improves or enhances a patient’s physical or mental wellbeing. The difference between a medical procedure and a medically-related procedure is that a medical procedure will be linked to an ICD 11 code (the International Classification of Diseases 11th Revision starts on January 1 2022)4 and may (but not necessarily) require CQC registration. This does not apply to medically-related procedures; in such cases the regulated HCP will be required to exercise their clinical judgement and diagnostic skills to determine and evidence a reasonable and genuine therapeutic benefit for the treatment, supported by a written diagnosis and treatment plan.

When is a procedure medical?

The JCCP explains that any procedure can be medically determined as long as it can be demonstrated that the procedure has an evidence-based clinical therapeutic benefit. It must also be considered and diagnosed by the registered HCP to be in the patient’s best interests following the completion of an agreed (and recorded) pre-treatment holistic assessment of the patient’s presentation and an exploration of the patient’s expectations with regards to perceived treatment outcome.

Must a clinic be CQC registered?

The JCCP explains that aesthetic practice for unregulated aesthetic procedures is currently outside the scope of the CQC. However, some procedures fall within the scope of the CQC, for example hair restoration surgery carried out by a healthcare professional. In addition, botulinum toxin treatments may also fall within the CQC scope in some cases where the treatment is related to a disease, disorder or injury. For example, treating spasmatic torticollis, prophylaxis of headaches in chronic migraine. The same can be said of dermal fillers. The CQC has published a specific list of HCPs who are entitled to undertake ‘Regulated Activity of Treatment of Disease, Disorder or Injury’.5

Can a non-HCP carry out a ‘medical’ procedure?

The JCCP emphasises that only a suitably qualified and experienced registered HCP can undertake and determine whether a procedure is ‘medical’ or ‘medically-related.’ However, the JCCP explains that if an HCP makes a fully informed assessment of the patient first and identifies if the procedure is medical or medically-related, a non-HCP may carry out a medical procedure under supervision. Assessments must be made on a case-by-case basis and relate only to a single consultation and treatment and not subsequent treatments provided in the future.

Medical consultations

If a procedure identified during a consultation has been determined by a practitioner to have a clinical/therapeutic benefit then it can be considered to be ‘medical’ or ‘medically-related’ in nature, explains the JCCP. They note that the therapeutic basis for any intervention is determined by the HCP and must be justified with an appropriate medical record, assessment treatment plan and an outcomes measurement framework.

The future

Dr Paul Charlson and nurse prescriber Andrew Rankin, JCCP clinical advisory group co-chairs, commented, “We are delighted to announce the completion of this work which has important implications for the future of cosmetic practice. We welcome this outcome both for its contribution to patient safety and in raising the profile of professional practice.”

The JCCP hopes its new guidance will inform future high-level regulatory decisions and calls upon the UK Government to develop and implement primary and secondary legislation, to set standards that determine who can lawfully undertake and perform ‘medical’ or ‘medically-related’ procedures in the UK.

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