Last month, the regulator for Scottish independent healthcare services, Healthcare Improvement Scotland (HIS), announced that non-prescribing medical practitioners can no longer perform dermal filler injections without a prescriber present on-site, although when this will come into effect remains unclear.1
For many practitioners in Scotland, particularly non-prescribing nurses, this announcement came as a shock, and has left them uncertain about their future within the specialty. In a document emailed to aesthetic practitioners in early December, HIS laid out the updated healthcare rules, including the new requirement contained within Regulation 12 of the ‘Requirements as to Independent Healthcare Services’.2 It stated in the report that the presence of the prescriber is intended as a safety precaution for the scenario in which hyaluronidase is required to dissolve dermal filler, and originally enforced their required presence with immediate effect.
Following a number of complaints from non-prescribing injectors, HIS has since stated that it is looking into a solution, and all medical practitioners can continue treating patients for the time being, to allow them to make arrangements to implement prescribing into their clinic. No set timescale for this has yet been outlined.
In a statement from an HIS spokesperson, it was explained that this development can be attributed to “An increase in applications for registration from newly-qualified healthcare professionals where experience is very limited, and a recent increase in service providers offering training to healthcare and non-healthcare professionals in non-surgical aesthetic treatments and procedures.”
However, many Scottish practitioners feel this regulation change was handled insensitively due to the apparent lack of warning. In this report, Aesthetics spoke to an HIS spokesperson and a number of nurses in Scotland to gauge the reaction to the news and consider how Scottish aesthetic regulation may progress going forward.
Advancing regulation
Medical aesthetics is widely regarded as an industry lacking in the adequate regulation to sufficiently preserve patient safety.3 Under current Scottish law, all medical aesthetic practitioners must be registered with HIS in order to practise, but non-medics performing injectable treatments have no such obligation.4 Whilst the recent regulation changes have not altered this fact, they are designed to protect patients by ensuring a safeguard is in place in the case of complications. According to an HIS spokesperson, the organisation’s priority is ensuring patients of private healthcare services in Scotland receive the best quality treatment in safe and regulated environments. They explain, “For these reasons, registered clinics are required to demonstrate that they take the safety of their patients seriously, that they operate to the highest standards and are committed to continually improving the service they provide.”
Nurse prescriber and honorary board member of the British Association of Cosmetic Nurses (BACN) Frances Turner Traill agrees, saying that best medical practice must be evident whenever dermal fillers are being administered. “Although the specialty is geared toward an aesthetic outcome,” she says, “the procedures involved are still medical and should therefore only be carried out by healthcare practitioners. It may look like beauty, but the second you break skin to reach muscles, arteries, veins, fat, bone and nerves it’s no longer beauty, it’s medicine. Complications are rare but they do happen, and they can become a burden on the NHS.”4
However, nurse prescriber and founder of the online HIS Support Group Jill Smith has rejects the idea that implementing the changes without sufficient warning or planning will improve patient safety. “I support patient safety and a potential move towards having clinical oversight whereby there is a prescriber onsite during injections,” she says, adding, “however, there should be a significant transitional period to allow us to look at strategies to support those applying for prescribing courses or university places so they can practise independently. I think this would take a couple of years, so if the changes are introduced without sufficient time for provisions to be put in place, there may be a number of practitioners unable to perform treatments which is very concerning.”
An uncertain future
Through her HIS Support network, Smith has seen an influx in nurses concerned about the impact this announcement will have on their businesses. “Nobody expected or knew that this was coming. A lot of people were really distressed,” she adds.
Linda Strachan, aesthetic nurse prescriber and regional lead of the BACN for Scotland, is disappointed with how HIS has handled this announcement due to the distress caused, but acknowledges the value of being a prescriber, saying, “The BACN wants nurses to work towards the highest level of competency, and part of this would be for everyone to become a prescriber in their area of expertise, but this has to be done at the right time so they have sufficient experience to do so.”
Change moving forward
The future of medical aesthetic regulation in Scotland, and indeed across the UK, is uncertain, with as yet undetermined changes projected to be on the horizon. Until further details regarding these regulatory changes are finalised, Smith advises practitioners to reach out to local networks for reassurance, and join associations like the BACN to receive updates and support.
Turner Traill believes HIS is on the right track to a safer specialty. She concludes, “I think there were a few shockwaves after this announcement amongst colleagues who aren’t prescribers, but the path to independent nurse prescribing is now a well-trodden one, and regulatory changes such as this have been discussed by HIS for some time. I hope HIS brings more medical personnel under its jurisdiction to tighten other loopholes.”5
