Activity to protect patients since cosmetic interventions review must be implemented and communicated, urge UK plastic surgeons

Media Release- 27 November 2013

•    94% of consultant plastic surgeons are concerned by apparent inaction since Government-led review of cosmetic interventions
•    97% of consultant plastic surgeons believe a national register of implant devices must be established in the next year 
•    86% of consultant plastic surgeons think that current and planned levels of funding within the NHS means the UK may fall behind other countries in advancing plastic surgery techniques

Today (27 November 2013) the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) reiterates that critical implementation work on the government-led review of cosmetic interventions must happen urgently and be publically communicated, on the first day of its annual scientific meeting. The Association emphasises that action must include the establishment of a national, compulsory register for medical devices, including breast implants, within the next 12 months. 

This follows BAPRAS member research which shows that 94% of UK consultant plastic surgeons are worried about the low level of action since its publication in April 2013, and that 97% of UK consultant plastic surgeon members believe a national register of implant devices must be established in the next year to ensure standards of patient safety and care. BAPRAS believes a register is essential if the UK is to avoid another health disaster on the scale of the PIP implant crisis.

As part of its drive to improve standards and safety in plastic surgery, BAPRAS today also launches a new code of practice defining the professional standards its members must meet to protect patients.

Concern was also expressed by BAPRAS members in the study over how current NHS funding is impacting professional standards in plastic surgery, with 85% of UK consultant plastic surgeons believing that current NHS funding for plastic surgery risks holding back advances in patient care and safety. A further 86% of UK consultant plastic surgeons think that current and planned levels of funding within the NHS means the UK may fall behind other countries in advancing plastic surgery techniques.  

Given funding resources, BAPRAS research has shown that 89% of UK consultant plastic surgeons think that more education is needed to show the public the comparative value to patients of certain plastic surgery procedures that some deem ‘non-essential’ – these might include breast reduction surgery or post-bariatric body contouring surgery. 

BAPRAS President and Consultant Plastic Surgeon Graeme Perks said:

“It’s been over seven months since the Department of Health – led by Sir Bruce Keogh – outlined its recommendations around cosmetic interventions with high hopes around what could be achieved to protect and improve the care of patients. Yet so far very little change has been seen publicly and our members are worried. We know there is work happening behind the scenes but more needs to be done to raise awareness of that and we need to ensure the results of these discussions are implemented. 

“We strongly supported the recommendation that a register for implantable devices is created, starting with breast implants. We are working closely with the Australian Society of Plastic Surgeons who are already operating a best practice breast implant register and propose that this acts as a strong starting point for the UK. We are also working with other organisations to try and push for the database to become a reality and, whilst some progress is being made, our members have clearly stated that a registry must be established within the next year if we want to really show commitment to enhancing patient safety,”

BAPRAS has continually pushed for an international consensus for an agreed minimum dataset for breast implant and device registries with other international societies of plastic surgeons. Known as ICOBRA - International Collaboration of Breast Registry Activities - this will build on best practice operating in Australia. BAPRAS would like to see all cosmetic providers participate in ICOBRA until a national database is established and hopes that a national database may get closer to reality through its work to help inform a pilot project with Clinical Practice Research Datalink, a research service jointly funded by the NHS National Institute for Health Research (NIHR) and the Medicines and Healthcare products Regulatory Agency (MHRA).

Mr Perks continued: 

 “As our conference highlights today, innovations in plastic surgery treatment and care, from trauma and upper-limb surgery, to breast reconstruction and skin cancer surgery, are critical in improving patient outcomes, alongside raising professional standards to ensure another PIP crisis isn’t allowed to happen again. However, this is only possible with continued investment and communication about the role and value of plastic surgery in the UK, along with legislation from government to ensure the correct framework exists on which to build standards further.

“Professionalism and patient safety are our key concerns and BAPRAS is at the forefront of driving the highest standards of surgical practice, as demonstrated by our new code of practice launched today. We would like to encourage all plastic surgeons, regardless of whether they are BAPRAS members, to adhere to these standards.”

The annual BAPRAS Winter Scientific Meeting is being held for the first time in partnership with the Irish Association of Plastic Surgeons (IAPS) at The Convention Centre in Dublin, from 27 to 29 November. 

The meeting will include symposia on breast surgery, lower limb trauma, paediatric surgery, lipofilling, hand surgery, burns and training in aesthetic surgery, with invited lectures from plastic surgeons from Switzerland, Finland, Germany, India, the USA and Canada. 


Notes to editors
•    The BAPRAS-IAPS Winter Scientific Meeting is being hosted by BAPRAS President Graeme Perks who works as a consultant plastic surgeon and is Head of the Plastic, Reconstructive and Burns Surgery Department at Nottingham University Hospitals NHS Trust

About 2013 BAPRAS member research
•    103 consultant plastic surgeons and full BAPRAS members were surveyed in November 2013 

Summary of BAPRAS priorities for future regulation of cosmetic interventions
•    Information, consent & advertising
o    One clear set of rules relating to cosmetic surgery advertising with decisive action taken against practitioners who break the rules
o    Statutory protection across all forms of media to prohibit any form of financial incentive and any promotion to under 18s
o    Accurate use of language with number of years practitioners have been on a specific GMS Specialist Register as the only objective measure of experience and a ban on terms ‘leading’ or ‘expert’
•    Regulation of practitioners
o    Practitioners who use the term surgeon in their title must be on the GMC Specialist Register and work within the defined scope of practice for their designated specialty
o    Cosmetic surgeons should be trained via the NHS and have appropriate mentoring programmes when they establish independent practices
o    ‘Fly in/Fly out’ visiting surgeons must be subject to exactly the same standards and regulations as UK surgeons, and healthcare providers must be able to prove that such surgeons have validated assessment of surgical competence / ability
•    Regulation of providers
o    Private providers of cosmetic surgery must adhere to the same code of conduct and standards as those expected of the NHS, including mandatory reporting of procedures undertaken
o    Provider institutions need to be subject to robust regulation through active inspection and enquiry. There should be an annual reporting mechanism to the agreed regulator, who should at all times have the expertise and authority to act in the public interest
o    Private cosmetic surgery providers must be made responsible for the aftercare of their patients, regardless of the timeframes in which the interventions took place.  This is likely to require a system to support patients affected by provider bankruptcy
•    Medical implants, devices and other products; data and registries
o    A national, compulsory register for medical devices including breast implants must be developed
o    Improved surveillance of breast implants and other cosmetic devices must be conducted in order to ensure poor quality products are recognised and dealt with early
o    All injectable materials need to be registered as medical devices and CE marked, including both absorbable and permanent fillers, to ensure they are subject to the appropriate regulatory procedures
o    All practitioners using fillers and toxins by injection must maintain full records of treatments and record outcome data to a standard that can be audited independently