UKAAP view on Government response to Keogh Report

February 20th, 2014

As a diverse group of Aesthetic Practitioners, we find ourselves positioned rather centrally in this argument.  Of course, as responsible professionals, we all value reasonable regulation, clinical governance, protection for patients and serious sanctions against rogue practitioners who create hazard for vulnerable clients.  On the other hand, one suspects that medical professional organisations such as the British Association of Dermatologists or the Plastic Surgery Groups would like to see very restricted practice, if for no other reason than the fact that they tend to see problem patients and complications which creates added burden onto the NHS – they don’t see the many thousands of patients who have good outcomes. Nor indeed do many of our Dermatological and Plastic Surgical colleagues even practise injection based aesthetic medicine – it would be very helpful to have a figure – our guess would be less than 5% regularly practising in this area – so statistics from these groups need to be very carefully assessed.

As in all these matters the sensible ground probably lies somewhere in the middle.  Of course, a paper qualification for example a Medical Degree or Nursing Certification does not confer clinical skills – but equally important is accountability.  By this we mean that Practitioners who are not part of a responsible organisation for example the General Medical or Nursing Council and who do not have to answer to the high moral code of such an organisation can simply behave any way they want with no fear of recrimination.

We asked Dr John Ashworth for his personal view:

Rogue Practitioners abound in every walk of society.  One of the biggest growth industries in the modern world is the industry of “Regulation and Accreditation”.  There is no shortage of experts in every walk of life claiming that it is their right to tell others how they should be doing their job.  In the field of medicine these people tend to claim that they work in “Centres of Clinical Excellence” – the strong implication being that colleagues who do not work with them are by definition practising their trade to a less than excellent standard.  These claims and insinuations are usually made with absolutely no supportive evidence whatever.

Unfortunately, Aesthetic Practice in the UK is virtually entirely unregulated and the only real set of rules which the public can rely upon relate to Courts of Law and legal action.  Because Aesthetic Practice spans across medical, nursing, etc professional organisations and indeed extends into non-medical areas of practice then there is no single body of experience to exact moral rectitude over its practitioners.

When organisations like the British Association of Dermatologists publish figures according to their surveys of members about side effects and complications it is very important to understand that virtually no members of the British Association of Dermatologists actually perform regular aesthetic interventions (I would guess less than 5% of BAD members on a weekly or daily basis).  Therefore the opinion of its membership, though valid in many areas of dermatological practice, would be skewed by seeing only the very worst outcomes from the overall national pool of patients being treated in this manner by many hundreds of practitioners on a daily basis across the Nation as a whole.  What is not known is exactly what percentage of clients develop these side effects in the first place.  If this percentage is significantly high (for example greater than 10%) then we know that we have a National problem.  If this percentage is very low for (for example less than 0.5%) then we would need to take a National view on whether there is anything at all wrong with the industry or whether in fact the industry is performing reasonably well as a whole.

The fact that we have virtually no statistics to discuss sensibly what is going on puts us in a difficult position and makes it very difficult for a Report like the Keogh Report to come to very firm and binding conclusions.