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30
Jul
2012

Are Insurers a Practical Key to Regulating the Aesthetic Industry?

As an Aesthetic Business Coach and Mentor, Ron helps aesthetic clinics and suppliers to maximise their profits.

You wouldn’t drive a car if you couldn’t get insurance, so will taking away medical indemnity policies for non-medics such as beauty therapists, podiatrists and physiotherapists stop the tidal wave of entry to the facial injectable ?

It’s been very to see the impact that the recently announced GMC guidelines remote prescribing of Botox has had on the segment of the industry affected, namely nurses (and other medical and non-medical specialities) remote prescriptions for Botox (and other brands of botulinum toxin) from Doctors.

The paradox for me is that this is not new news for the large number, (and we are talking hundreds here) of nurses involved in this model as the stating:

"The advice, ‘Remote prescribing and injectable cosmetic medicinal products’ makes clear the NMC’s position that remote prescriptions or directions to administer should not be used to administer injectable cosmetic medicinal products such as botulinum toxin (Botox®)."

The stating:

"Remote prescribing should not be routinely used to facilitate treatment, or in the provision of non-surgical cosmetic procedures such as the prescription or administration of injectable cosmetic medicinal products."

Both of these statements published a year ago had little effect on the industry; but it’s taken a high profile Doctor ( suspended by the GMC) to make the whole (nurses, and alike) sit up, take notice and examine this .

However, this isn’t the end for non-prescribing nurses who have a significant toxin business model, as so called "buddy prescribing" does appear to be a (if less profitable) route for going forward; (more to follow in future blogs about the exact mechanism of this model as it is still being debated).

The key for me is the positioning of in this debate.

Hamilton Fraser (the largest specialist broker in the industry) claims to have been clear in its with the recently issued :

"Hamilton Fraser Cosmetic Insurance has always made its position clear in respect of remote consultations and the prescription of medicines in the absence of the patient. All malpractice insurance policies offered to our clients are conditional on the practitioner following the professional guidelines laid down by their governing bodies, in this case the GMC, GDC and NMC."

We are not sure about other insurers, but certainly one might have questioned the nurses (and remote prescribers) insured by Hamilton Fraser (as both are involved from a perspective) and the potential value of their insurance cover in the event of a claim and a clever lawyer getting involved?

your views on the legalities of remote prescribing in facial aesthetics, (which may indeed still be by interested parties), with and the being explicit for some time now, why has it taken the for to look at this issue from a "risk management" perspective if they have been in this model for some years?

It’s hard to tell – but it does show the that some individuals can have over others in persuading them to follow them in of their business model and monetary aims.

Some that Dr Mark Harrison (via his Harley Aesthetics) built up a group of over 400 nurses remote prescriptions for botulinum toxins at a cost of £30 per telephone call. Many other and have sought to replicate this profitable model and have also prescribed for podiatrists, physiotherapists, and beauty therapists.

We have raised of these issues in several blogs over the years such as  and  – and when we try and pin this down, there is often a to the above with someone "championing the cause" and actively persuading insurers to cover them. This has included large insurance brokers such as Hamilton Fraser (and Marketform, the underwriters) who have recently decided to suspend all new applications supplementary including  for botulinum toxin.

They will review their position regarding the that they cover following Sir Bruce Keogh’s report that should be in March 2013.

Hamilton Fraser have always taken the stance not to insure beauty therapists, but they (and Marketform) have cited numerous cases where other underwriters and brokers have had an for this business and insurance cover.

Indeed, our recent investigations into the activities of the Treatments and Association (CTIA) who we covered in our blog on  led Lorna Jackson, Editor of The Consulting Room™ to have an interesting with a representative from JM brokerage, a small Yorkshire based broker who was happy to tell us that he is currently insuring 36 beauty for botulinum toxin and through malpractice insurance policies provided by Hiscox. A certain level of niaivety when it came to aesthetic industry knowledge was very when talking to the family run firm.

So what have we learned over the last couple of weeks?

1. There is still a potentially and insurable model via "directions to administer" for nurses who can’t prescribe.
2. This may still be used in the short term by podiatrists, physiotherapists and beauty therapists if they can find a prescriber willing to do face to face AND an insurance company willing to provide medical indemnity cover.

It seems clear that the route of access by non-prescribing nurses to botulinum toxins has provided a reason for other medical professionals (who don’t have prescribing status themselves) and beauty therapists to enter the market of prescription facial injectables.

Their bodies seem to take stances to this, with the NMC supporting nurses as long as they strictly adhere to the guideline regarding "directions to administer".

This does not appear to be so clear for OnabotulinumtoxinAAbobotulinumtoxinAIncobotulinumtoxinAPrabotulinumtoxinALetibotulinumtoxinARimabotulinumtoxinBHyaluronic Acid FillersCalcium Hydroxylapatite FillersPoly-L-lactic Acid FillersPolymethylmethacrylate FillersAutologous Fat GraftingForehead Lines TreatmentGlabellar Frown Lines TreatmentCrow's Feet TreatmentBunny Lines TreatmentChemical Brow LiftLip FlipGummy Smile CorrectionMasseter ReductionJaw SlimmingDimpled Chin SmoothingCobblestone Chin SmoothingNefertiti Neck LiftMicro-BotoxMesotoxHyperhidrosis TreatmentChronic Migraine ReliefBruxism TreatmentTMJ TreatmentCervical Dystonia TreatmentNeck Spasm TreatmentBlepharospasm TreatmentLip AugmentationLip ContouringCheekbone EnhancementTear Trough FillersNasolabial Fold SofteningMarionette Line FillersLiquid RhinoplastyNon-Surgical Nose JobJawline ContouringJawline DefinitionChin AugmentationTemple VolumisingHand RejuvenationAcne Scar Subcision Filling where the Health Council (HPC) and the of and Podiatrists (IOCP) both refer to this practice as outside of the scope of podiatry, with IOCP stating:

"Podiatrists working as aestheticians must ensure that clear boundaries exist between their activities as a podiatrist and those as an aesthetician."

Also no or product (as far as we know) have come out in support of these groups.

The beauty therapist world is even more split, as they are not as such, so we just have the of the two large groups, HABIA and BABTAC.

BABTAC in their own member magazine, Vitality, earlier in 2012 that Julie Speed, BABTAC is keen to be in the development of a level 4/5 for suitable practitioners, including therapists to train practitioners to have all the necessary skills to carry out safe and injectable cosmetic procedures.

The big question is - what does this mean in terms of their medical indemnity cover? Are they really covered in the event of a significant problem, and is the ?

with insurers could be the answer to this issue?

Although brokers and state, quite rightly, that they don’t want to be involved in the of the world of aesthetic medicine, in practice, they are the gatekeepers to practitioners into this field.

From recent discussions with brokers, it is clear that some are not aware of all the facts regarding prescribing and the risks and problems associated with botulinum toxins (and dermal fillers, where there are more problems and fewer to access).

Suppliers, who also state that they do not want to be in the market and seem to be unable to the channels for their can also play their part. If they were clear in with the industry who they think should be using their and why, alongside what they think is appropriate training, it would provide clear guidance from the brand owners, who, after all, should have the clearest stance on this!  In practice, this is not currently being done in a co-ordinated fashion.

BCAM, , BAAPS etc. could help by providing the detail that is needed to the insurance (brokers and underwriters) about the precise details regarding best and access to prescription medicines alongside problems that members have had to sort out for from beauty and other non-medics using injectables, that may never be reported to them .

Insurance is a risk game but seem to be being issued by some insurers without access to the possible of the many controversial issues that abound!. This may mean that policies have holes in them for the involved.

The devil is in the detail and how many of us read (or even understand) the small print of our insurance policies?

If practitioners can’t get insured, they most likely will not offer the . The more we can do as an to the insurance brokers the bits of paper (i.e. the indemnity policies) and be crystal clear on the groups who should not be (and the mechanisms of access to drugs if non-prescribers), the closer we’ll get to a practical solution in making sure that the industry is at least restricted to the who have the possible support from the aesthetic industry in general.

We can then address other issues such as starting to raise standards of training, another "hot potato" that is probably even more to address than the main topic of this blog!

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