Dr. F Didar

Cosmetic Facial UK

• 2005 sir Harry Cayton (regulation of cosmetic surgery) ○ Increasing specialist training and accountability

• Provision of cosmetic surgery in England ( healthcare commission 2007)

• Good Surgical Practice 2008 • Good Medical Practice in Cosmetic procedures

Independent Healthcare Advisory Service 2010. • NCEPOD (National Confident Enquiry into patient

Outcome and Death 2010 ○ Lack of appropriate facilities ○ Surgeons competence ○ Lack of information for patients to understand risks of procedures.

• RCS published this year Professional Standards for Cosmetic Procedure

AuStralian Government in 2010

• New training Standards

• Advertising restrictions

• Hong Kong : where to draw line between

medical treatment and the beauty one

• Denmark has introduced new regulation

( who can perform the procedures)

• Sweden is following Denmark

• France set new Standards and regulation

in details

Safety and quality • To act in case of concern on patient safety • To protect patients and public 1. To improve and promote patient safety via quality

assurance 2. Regular clinical audits including feedback from patients 3. To report adverse incidents either via using a device or

products as well as suspected events. 4. To contribute to to confidential enquiries. 5. To co- operate with other organization dealing with public

health. 6. To seek advice from colleagues or defence body if any concern

regarding performance of colleague (not fit for practice and put patients at risk)

7. To consult a colleague if Any concern regarding health and performance of ours

8. To be immunized against common serious contagious disease. 9.To be registered with a GP .

Knowledge ,skill and performance License to practice • Must have a license to practice • Should be registered with GMC AND other

regulating body • Must demonstrate the confidence and

knowledge through appraisal and revealideation process.

Professional performances 1. Competent in all aspect of work a. Management b. Research c. Teaching

Knowledge ,skill and performance To keep professional performance up to

date a. Participate in activities to maintain and

develop it b. Mentoring c. Up dated with guidelines and

knowledge d. To monitor and improve the quality of

care

Applying knowledge and experience to the NSFA a. Practice in the limit of competence b. To provide a high quality of care

c. To provide advice, treatment and investigation if necessary

d. To prescribe the medication when needed with taking patient needs into consideration

e. To provide the best suitable treatment based on available evidence.

f. To consult colleagues as needed g. To get the consent before implementation or

involving in patients in a research project.

Safety and quality, Knowledge ,skill and performance,

4. Record keeping a. Clear,accurate and legible records b. Confidentiality and data protection c. clinical records should include: i. Clinical finding with the case ii. The decision for treatment iii. Provided information to the patient iv. Medication or other investigation

Communication ,partnership and teamwork 1. To listen to the patients 2. To respond honestly to their question and concerns 3. Provide enough clear information about the

procedure,complication and out come 4. With keeping confidentiality in mind providing

information to those close to the patient. 5. Been access able and available on duty and other

time if any concern or emergency arises 6. To treat colleagues family and respectfully. 7. To contribute toward teaching of staff and other

colleague. 8. To supervise other colleague if needed.

To explain and justify If refuses to provide a treatment .

To treat patients as individual and respect their dignity

• To be polite in the treatment procedure • To keep patients' confidentiality • To provide enough information in order

to help patient for an informed decision • To share treatment plan with patients • To correlate with colleague in order to

maximize patients' care and therapeutic plan

1. Not to use professional position in pursuing a sexual relationship with a

patient or close relative 2. To be honest with patients if things go wrong

a. To put matter right b. To offer an apology

c. To explain fully what happened and what to expect as long and short term effect.

d. Not to discriminate against patients or colleagues. e. To response promptly,fully and honestly to complaints f. To apologies when needed and appropriate. g. To end a professional relationship with a patient just when the trust is broken. h. To have adequate insurance and indemnity cover.

i. To be honest about qualification and experience as well as current role j. To be honest while designing ,organizing research

k. To be honest on providing information as well as communicating with colleagues and patients

l. Marketing and advertising should be factual and does not exploit patients' vulnerability(this emphasis in Keogh report too) m. To be honest and trust worthy in writing reports and signing forms. In area of conflict of interest ,to act in the best interest of patient and community .General

1.The report and review was initiated by PIP implant scandal. 2. Non surgical procedures accounts for 9/10 of all procedures . 3. NSA accounts for 75% of market value. 4. It emphasis the consumer of this market does not have any

protection and so much vulnerable . 5. It emphasis dermal fillers are particularly the cause of concern 6. There is no control on fillers in comparison to purchase a bottle of

toilet cleaner. 7. The commercial income is stalling. 8. Dermal fillers are a sitting duck. 9. Previous attempts failed. 10. The report provide a framework for surgical and non‐ surgical

fields. 11. Practitioners will need to have appropriate skills as well as safe

products. 12. The report has emphasis on individual safety and health. 13. There is no balance between the rapidly growth of cosmetic

procedures and existing regulatory framework .

High quality care plus safe products(effectiveness,safety) i. Fillers as prescription only medical device ii. EU medical device to expand to cover all cosmetic

implants including fillers iii. UK legislation to facilitate this expansion 1) To set standard 2) Formal certification of all practitioners 3) Training and experiences iv. RCS(Royal College of Surgeons) to established an

inter speciality committee on cosmetic surgery v. Performers of cosmetic procedures to get registered. vi. Record keeping for patients and their GPs vii. Skilled practitioners in line with responsible

providers

People to get accurate advice ii. Vulnerable are protected iii. Accessible redress and resolutions in case

of complications iv. Multi-stage consent process for operation in

order to share understanding of desired out come between patients and practitioners (RCS to do this)

v. Patient information leaflet by RCS vi. Record of consent for non surgical

procedures Advertisement and marketing should be up

dated in a way not to avoid inappropriate influence on pubic.

Accessible resolution and redress

• Continuity of care should be provided

in the event of complication.

• Insurance schemes to provide support

and reassurance

• Patients' access to guidance and help

in case of dispute resolution.

Current situation • No restriction on a person performing

• No qualification

• Training course by anyone to offer a qualification

• A number of self accredited training organization have sprung up.

• Non-medical,non-dental and non- nursing practitioners were greatly valued by consumers

No specific accredited training on

• i. physiology

• ii. Anatomy

• iii. Infection control

• iv. Treatment of anaphylaxis

• v. Understanding of co morbidity or per-existing health problem

a-Practitioners should be register with Denish Health board and pay1850 pounds per year:

b. Non-surgical cosmetic procedures like botulinum toxin injection,dermal fillers injections , lasers or IPL,chemical peel should be performed by:

i. Consultant dermatologist ii. Plastic surgeons iii. Ophthalmologist and neurologist for

Botox iv. Nurses and junior doctors can performs

all of them but undersupervision and the consultant remains responsible for the procedure or any complication.

Non- health care professional can perform

dermal filler ,weaker chemical peel and IPL but

no botulinum toxin injection,microdermabrasion

or sclerotherapy

1) They should hold recognized beauty therapy

qualification

2) To demonstrate their competent

3) Qualification should be recognized by Denish

Health Board

4) The doctor employed them should deem their

competent too.

1. RCS to stablished Cosmetic Surgery inter speciality committee: • a. To set standards for training and practice of

cosmetic surgery

• b. Issuing formal certification of surgeons

• c. To work with PHSO(Parliamentary Health Service Ombudsman) regarding dispute resolution

• d. Regular meeting with GMC, CQC and MHRA(Medicine and Healthcare products Regulatory Agency)

• e. To develop A specific code of ethic for cosmetic surgery (advertising, insurance and psychological Assesment of patients

i. Training necessary to able parishioners to

identify complications and treat them

ii. Regular trading for practitioners to deliver

latest treatments

iii. The curriculum and training Requirement

should be reviewed regularly.

iv. Accountability to a professional regulator in

case of prescribing filler or performing other

potentially harmful non surgical cosmetic

procedures.

2. Performing non surgical aesthetic procedures must be under responsibility of an accredited and qualified clinical professional.

3. Non- health practitioners with required accredited qualification may perform the procedures but under supervision of qualified clinical professional.

4. HEE(Health Education England ) mandate should include the development of appropriate accredited qualification for non surgical

procedures and its various professional groups. 5. All practitioners must register with annul fee to fund the registration

body. a. Accredited qualification b. Premises meeting certain requirements c. Code of practice to cover handling complain and redress , responsible advertising and consent practice. d. Annual appraisal 6. Criteria to enter to the Registery should be:

• a. Accredited qualification • b. Premises meeting certain requirements • c. Code of practice to cover handling complain and redress , responsible advertising and consent practice

7. Non- surgical premises subject to inspection by local

authorities.

• a. Awareness of requirement to operate from a safe

premises and responsibility involved.

• b. Training curriculum should include infection

control, treatment room safety and adverse incident

report.

• c. Code of conduct: minimum standards for

premises.

8. UK legislation to make fillers as prescription only

medical device. (EU Medical Device Directive to cover

dermal fillers and all cosmetic implants.)

9. For any non surgical intervention a record of consent is

necessary (must)

10. Advertisement should be conducted in a socially

responsible manner.

11. The following advertisements should

be prohibited

a. Time- limited deals

b. Financial inducements

c. Refer a friend, reduced price for two

people, buy one get one free

d. Competition prize as cosmetic

intervention

12. Continuity of care and follow up should be

offered

13. Medical director on board for all

organization offering cosmetic procedures

14. Complains investigated by the Ombusdman

should be publicly available.

15. Adequate professional indemnity cover is a

must. The insurance status should be displayed

on the practitioner register.

16. Creation of insurance risk pool