Special Report: HIS Update to Scottish Regulation

Healthcare Improvement Scotland (HIS) has released an exclusive statement to the Aesthetics journal clarifying its plans to regulate non-prescribing medical aesthetic practitioners.

This is a Special Report from Kevin Freeman-Ferguson, head of service review at Healthcare Improvement Scotland.

Private clinics that provide cosmetic interventions in Scotland and Healthcare Improvement Scotland (HIS) share a common goal: ensuring that people who receive cosmetic interventions do so in an environment that is as safe as possible. By emphasising safety and always looking to improve, private clinics in Scotland distinguish themselves from the unregulated areas of the cosmetic industry, where treatments may be provided by people without the understanding, experience and necessary credentials to carry out treatments effectively, nor the knowledge of what to do if things go wrong.

Most private clinics in Scotland are well run and have safety as a clear priority. This can be seen in our inspection reports, available for patients and potential future patients to see. These reports give the public objective information from us as the industry regulator to help them make informed choices about where they might go for a specific intervention.

However, it has become increasingly clear to us that we need to do more to keep people safe. The context within which we are all operating is changing and we need to adapt accordingly. There are more healthcare professionals setting up private clinics, particularly to provide cosmetic interventions, who have little experience, and there are more practitioners who are using technology to work remotely, which can present serious challenges if anything goes wrong. Cosmetic interventions are the one area where it is agreed by regulatory bodies that remote prescribing is inappropriate. Face to face consultations are required both for the initial assessment and if further medication is required to address an adverse outcome or emergency situation. Some aesthetic procedures may require the administration of prescription-only medicines that are not available as part of an emergency response, for example, when hyaluronidase is required to dissolve dermal fillers. 

Therefore, after a great deal of consideration, and after discussing with our reference group which includes industry professionals, we sent a letter to private healthcare clinics in November 2022 sharing guidance on compliance with Regulation 12, which requires healthcare providers to ensure that an appropriate number of suitably qualified professionals are working at their service and that a qualified and competent healthcare professional is present at all times.

What are the changes being introduced in Scotland?

The guidance for Regulation 12 amounts to a clarification of what a ‘suitably qualified’ professional is. Currently, ‘suitably qualified’ and ‘competent’ are not defined in legislation for private clinics.

We reviewed the recommendations from the Review of the Regulation of Cosmetic Interventions carried out by Bruce Keogh which set out recommendations relating to the education of practitioners that undertake cosmetic interventions, in particular, that there is a clear need for accredited training standards to be set for cosmetic procedures so that patients can be assured the person carrying out an intervention has the appropriate training. We also looked at additional training requirements, like basic or advanced life support, anaphylaxis and managing complications arising from procedures.

One of the other key elements that we considered were staffing levels. The number of suitably qualified and competent professionals has to be proportionate to the number of people using the service, so that should more than one emergency occur, a professional is on hand to administer help and ensure patient safety.

What does it mean for you?

We understand that services may require time to adopt the new guidance – for existing services regulated by us, we would expect to see plans in place to adopt the guidance over a timescale discussed and agreed with us. Any providers that lodge a new application to register a private clinic will be asked to show that they have adequate numbers of skilled and competent staff as a part of the registration process.

In practical terms, there will be little change for the majority of services who are registered with us, as all clinical staff are already working towards meeting the requirements. Those who do not currently have a prescriber working with them where prescription-only medicines could be required as part of the treatment will need to work towards meeting this requirement in a timely way and demonstrate how they will mitigate any potential risks to service users in the meantime.

We are sure that those running private clinics agree with us that it is vital that the people of Scotland who opt to use private healthcare services receive the best quality and standard of care. By working together to ensure that this happens, we can ensure that this is achieved for all patients in Scotland, no matter where or how they receive their treatment.