I’m an aesthetician – do I need to register with the Care Quality Commission?
Under the Health and Social Care Act 2008 (“the Act”), a service provider who carries out a regulated activity must be registered with the CQC. This can mean both individuals and organisations. But what constitutes a regulated activity and why is this important to the cosmetic and aesthetic industry?
Regulated activities include surgical cosmetic procedures (such as facelifts) and services in slimming clinics (including liposuction). Failure to register with the CQC when carrying out such activities is an offence and can lead to financial penalties or custodial sentences. Providers of these services need to establish if they are caught by the registration requirements. By the time you find out you are required to register, it could be too late.
What you need to know
Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 ("the Regulations") defines surgical procedures as: "Surgical procedures cover the following procedures carried out by a healthcare professional: surgical procedures for treating disease, disorder or injury; or cosmetic surgery". Unfortunately, the legislation does not provide a specific definition of what is meant by "cosmetic surgery". It can therefore be confusing for providers to know with certainty whether they need to register with the CQC to provide the services they offer.
CQC does offer some practical guidance for providers. CQC states that "any procedure that involves the insertion of instruments or other equipment into the body would be considered a surgical procedure", and therefore the individual or organisation would need to be registered with the CQC.
CQC provides examples of what cosmetic treatments would be considered surgical procedures under the legislation: facelifts, buttock or thigh lifts, eyelid or brow surgery, nose surgery, tummy tucks or any procedure where an implant is used would all be considered surgical procedures. However, no exhaustive list is given so this guidance remains ambiguous, ultimately leaving it up to CQC to decide whether you should have registered or not (usually after you’ve started to perform the relevant procedures).
It is arguable that a grey area between surgical and non-surgical procedures exists and this is open to interpretation. For instance, although all types of thread lifting would be considered a surgical procedure, subcutaneous injections to administer substances such as Botox® would not be. Therefore providers delivering Botox® need not register with CQC. This is an interesting irregularity as, on the surface, both procedures appear to be similarly invasive. Each procedure requires the insertion of an instrument under the skin, yet a very different approach is taken for each.
It can therefore be extremely difficult for providers to understand where the line is and whether they are required to register with CQC. There are potentially very serious consequences for providers who fail to register with CQC unless there are mitigating factors. It is an offence under Section 10 of the Act to carry on a regulated activity without being registered with CQC. This offence can be dealt with in the Magistrates’ or Crown Court, can carry an unlimited fine and/or a sentence of up to 12 months’ imprisonment. In 2012 a provider called Northern Clinic.com was fined £40,000 for carrying out unregulated liposuction out of clinics in addition to £22,548 in costs plus a £15 victim surcharge.
If you provide cosmetic and aesthetic services, you need to be conscious of your obligations, even if the legislation and guidance is not clear.
It is best to err on the side of caution. If there is any doubt as to whether the service you or your organisation provide requires you to be CQC registered, you should contact CQC to make an enquiry and record their response in writing. It would also be prudent to take legal advice early. Although CQC does not have an exhaustive list of procedures that would be considered surgical procedures, they do provide some examples which may be enough to clarify any doubts. You may wish to obtain guidance from CQC in writing to protect your position in case you run into problems later.