Judith Hulf, Senior Medical Advisor at the GMC, chaired the group behind the newly-published guidance for doctors carrying out cosmetic procedures. She talks about why it was necessary, and the impact it will have.
Cosmetic treatments used to be a niche area of healthcare in the UK, accessible mainly to the rich and famous, but in recent years it has grown significantly, with more and more people able to consider a nip here, a tuck there, or a quick injection of filler.
But with that greater accessibility has come increased risks to more people, which is why the GMC’s newly-published standards for doctors involved in cosmetic practices is a real watershed in patient and public protection.
Cosmetic practice is a broad term, covering a wide and growing range of ‘lifestyle’ treatments and interventions to alter a person’s appearance; everything from fillers to face lifts, and from laser eye surgery to liposuction.
The need for new guidance
The need for our new guidance was firmly made by the work of Sir Bruce Keogh’s advisory group following the PIP scandal, when a manufacturer was found to be using industrial grade silicon, rather than medical grade, for breast implants.
Sir Bruce’s review found evidence of a range of poor practices – patients being hurried or influenced into making hasty decisions on procedures, misleading advertising, poor discussion of the risks involved, little understanding of, or appropriate support for, patients with psychological problems, and very poor continuity of care or support if something went wrong.
I was shocked by many of the stories that came to light, although I was also heartened by the professionalism of many doctors working in this field, and their determination to raise standards across the sector.
This new guidance seeks to address the issues, and by doing so it will raise standards. It provides practitioners with clarity on what the GMC expects of them.
For us as a regulator, it’s a new departure. It is the first time we have addressed a specific area of practice, rather than produce guidance applicable to all doctors in all specialties.
We have worked very closely with the Royal College of Surgeons of England, and their new professional guidance, published at the same time, complements ours, expanding on the specific issues relevant to surgeons. This summer, they are also introducing a new certification system to ensure surgical practitioners in this area are fit to practise, something that will also raise standards and provide increased assurance for the public.
It was important for our new guidance to cover all procedures, not just the most major ones, because ethical and safety issues arise right across this sector, just as the experience of people undergoing cosmetic procedures varies enormously. These standards apply across the piece.
Improving the patient experience
For people seeking cosmetic interventions, our new standards will help improve the experience they can expect. For example, doctors must seek their consent themselves, and not delegate to sales staff or anyone else. They must give people time to reflect, in effect a ‘cooling off’ period, take particular care if a person is aged under 18, and they must consider whether individuals have psychological needs or are vulnerable in any way.
Doctors must also market their services responsibly, no offers of procedures as competition prizes or packaged into ‘buy one get one free’ deals. They must make sure people have the right information, including explaining any medicines or implants used, and, as in all fields of practice, it is vital that they work within their competence, with appropriate supervision, and that they share information on outcomes and safety with colleagues and the appropriate regulatory authorities.
Of course, it is not only doctors who are carrying out cosmetic interventions. As the doctors’ regulator we can only produce guidance that applies to them, but the principles are relevant to everyone caring for people who seek cosmetic interventions. We hope other professional groups will find it useful, and that it will play a role in raising standards across the sector.
The guidance comes into force in June, and we are producing a short guide for anyone considering a cosmetic procedure about what they should look for from their doctor, and what they should expect during and after their procedure.
We are also developing case studies to illustrate in more detail how the principles of the guidance apply in particular circumstances. If you have views on areas to cover or resources that would be helpful, do get in touch at email@example.com or leave a comment below.
I would urge everyone involved in any type of cosmetic practice – and anyone considering becoming involved – to study our guidance in full, to reflect on any improvements they may need to make to their own practice, to discuss with colleagues how best to improve information and care for people, and to take action to ensure they are ready when the guidance comes into force in a few weeks’ time.
David Ward, Council member at the Royal College of Surgeons, on why cosmetic surgery is a big decision not to be taken lightly