The Health & Care Act 2022 - Hamilton Fraser


Although the majority of the aesthetics sector shows good practice when it comes to patient safety, there has been a rise in people being left physically and mentally scarred from poorly performed procedures. To address this, the Government is introducing legislation to reduce the risk of harm associated with ineffectively performed non-surgical cosmetic procedures. This follows on from the legislation which made it illegal to administer such treatments to under 18s and banning adverts targeting them on all forms of media, including social media.

The new Health and Care Act 2022 introduced a new licensing scheme for aesthetic practitioners completing non-surgical cosmetic procedures who operate in England. 

If you’re administering dermal fillers, botulinum toxin or other procedures that penetrate the epidermis or beyond, the new legislation applies to you.

Here, we explain what you need to know about the important regulatory changes – what is changing, why regulations in the aesthetic sector are changing, how the changes will affect you, and how you can prepare to make sure you’re in the best position.

Update on licensing for aesthetic practitioners in England: what is changing?

The Health and Care Act 2022 introduces a new licensing system for all practitioners who provide a range of more invasive non-surgical cosmetic procedures such as the injection of toxins and fillers. The new regulations prohibit any individual in England from carrying out specified cosmetic procedures unless they have a personal licence. 

It also prohibits any person from using or permitting the use of premises in England “for the carrying out of specified cosmetic procedures,” unless they have an additional licence for the premises from which they operate. Therefore, it is an offence to operate without a licence.

Background to the Health and Care Act 2022: why are regulations in the aesthetic sector changing?

The non-surgical cosmetic injectable sector has experienced rapid growth - the market is currently worth around £3.6 billion and is projected reach £5.4 billion in the next three to four years. Hamilton Fraser has chronicled the unstoppable rise of the sector in its article, ‘The journey – a 25 year history of the UK cosmetic industry’.

But while the sector has boomed, regulations to keep patients safe have failed to keep up, and anyone can carry out potentially life-threatening procedures with little or no training. There has been lots of publicity in the media about treatments gone wrong, sometimes with life-changing side-effects for patients. Experts and campaigners, who describe the aesthetic sector as like the ‘wild west’, have for some time been calling for greater regulation of non-invasive procedures.

The Keogh report

In 2013, a review by Sir Bruce Keogh, the NHS medical director for England, said that non-surgical procedures such as fillers to tackle wrinkles, botulinum toxin and laser hair removal were ‘almost entirely unregulated’, and that a person having a non-surgical intervention has no protection or redress. He singled out dermal fillers as a ‘crisis waiting to happen’ and this was corroborated by a British Association of Aesthetic Plastic Surgeons survey which found that 69% of its surgeons had seen patients presenting with complications following temporary fillers. He recommended an industry-wide standard of care to which practitioners can be held, including a register of anyone that performs surgical or non-surgical cosmetic interventions.

Health Education England’s ‘Qualifications in the non-surgical sector’ report

The Department of Health asked Health Education England to work with professional statutory regulators, royal colleges and stakeholders to review the qualifications required for non-surgical interventions and make recommendations on training.

In 2016 Health Education England published two reports aimed at improving and standardising the training available to practitioners who carry out hair restoration surgery and non-surgical cosmetic procedures, such as botulinum toxin, chemical peels and laser hair removal.

These two reports provided advice on necessary training requirements for practitioners delivering non-surgical cosmetic interventions and hair restoration surgery, and led to the establishment of the Joint Council for Cosmetic Practitioners (JCCP). A not-for-profit organisation, the JCCP is a self-regulating body for the non-surgical aesthetics market in England.

The role of the JCCP

The primary aim of the JCCP is to enable the public to easily identify safe practitioners across non-surgical aesthetic treatments and provide information to the public seeking non-surgical treatments.

The JCCP has two registers – practitioners who meet standards and trainers who meet standards and is accredited by the Professional Standards Authority (PSA).  

The JCCP has signed memorandums of understanding with key organisations in the aesthetics, dental and medical sectors including the General Medical Council (GMC), Nursing and Midwifery Council (NMC), General Dental Council (GDC) General Pharmaceutical Council (GPhC) and the Royal Pharmaceutical Society (RPS), which means that these bodies have a shared intent with the JCCP.

What does the licensing scheme mean for aesthetic practitioners?

The JCCP has produced a detailed licensing in aesthetics FAQ fact sheet, which provides more information for both patients and practitioners and should answer most of the questions you will have about what is to come. There is also a handy infographic explaining the changes and a video, which you can watch below:

We don’t know exactly what will be included within the licence and what level of training will be required, but we do expect that once the legislation comes into effect, practitioners performing procedures that fall within the scope of the licence will have to demonstrate that they meet a nationally determined standard of knowledge and skill to perform those procedures safely and effectively.

Practitioners will also be required to work from premises that meet a national standard in health protection and infection control which will be determined by local authority environmental health officers.

Other standards are also expected to be included in the licence around issues of product supply, storage of products and medicines, prescribing practice, complaints procedures, insurance and the information given to clients by practitioners.

When it comes to the procedures that will need to be licensed, in the wording of the Health and Care Act law passed in April 2022, a cosmetic procedure is defined as a procedure, other than a surgical or dental procedure, that is carried out for cosmetic purposes, and includes the following:

  • The injection of a substance
  • The application of a substance that is capable of penetrating into or through the epidermis
  • The insertion of needles into the skin
  • The placing of threads under the skin
  • The application of light, electricity, cold or heat

Procedures affected are therefore likely to include:

  • Use of botulinum toxin
  • Dermal fillers
  • Skin boosters
  • Threads
  • Lasers
  • Micro needling

However, it will likely include others such as vitamin infusions, cryolipolysis, sclerotherapy, invasive chemical peels and hair restoration surgery. Some treatments, such as superficial peels and laser treatments, might be ‘deregulated’ and some beauty treatments, such as acupuncture, may be brought into scope. The exact procedures included will be defined as the licensing law is drafted.

The law will also enable the creation of a redress scheme and make indemnity insurance compulsory, as well as providing for compulsory reporting of adverse effects to a central body. It will be enforced by Trading Standards.

What happens next: how can aesthetic practitioners prepare for the changes?

Although now inscribed in law, there is a process before the changes come into force, during which the exact scope and details of the scheme and how it applies to procedures and premises will be defined.

In total the process could take two to three years, but we don’t yet know exactly – current estimates are that licensing will be adopted in 2026.

The JCCP is working with partner organisations including the Cosmetic Practice Standards Authority (CPSA), and a range of regulators and representatives from across the sector to support the design and promotion of schemes that are fair, safe and effective.

Although we can’t predict exactly what the new licensing scheme will look like, we can safely make some assumptions which will help practitioners prepare for the changes.

We know that the key aim of the new legislation will be to make sure that every patient is safe and that correct safeguarding is carried out before, during and after procedures. Practitioners will also need to provide evidence that they meet a minimum standard of training, education and competence, which has yet to be decided.

What can practitioners do now?

The legislative changes that are coming are the biggest shake-up the aesthetic sector will have seen since its inception, so it’s important that you are ready.

  1. If you’re a new practitioner think carefully about how you plan your training and career pathway. There has been much speculation about whether the ‘minimum standard’ will be the Level 7 Diploma in injectables, and this qualification was mapped to the Health Education England (HEE) guidelines from the beginning. It was also the first, and remains the only, Ofqual-regulated postgraduate injectables qualification in the UK. We don’t yet know whether this will turn out to be the required standard, but since the JCCP is one of the only organisations with published, evidence-based standards in the non-surgical sector, it would be a good idea to refer to these and work towards achieving these standards.
  2. It’s a good idea to maintain a log of training and case details including date, patient initials and procedure type, and to have this signed by the trainer if completed in a training environment. It’s also worth adding a reflection to this. Also be sure to maintain a log of CPD and complications.
  3. For more experienced practitioners, maintain a log / portfolio of your cases including date, patient initials, procedure outcomes and complications, and document any CPD you complete.

Hamilton Fraser is working closely with the JCCP to create a safer and more structured aesthetic sector, and to further improve standards for consumers and training excellence for practitioners.

“We have a history of working together with the JCCP and share the same vision of raising standards and putting patient safety at the heart of the sector. Regulation of the aesthetic sector has become increasingly necessary and important as the market has grown, and we at Hamilton Fraser want to support practitioners in raising their standards and improving their business processes, to provide better protection for patients and show their commitment to high professional standards.”

Eddie Hooker, Founder of Hamilton Fraser

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