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All things Pharma

The burning question




business a legitimate part of the healthcare industry?

Roger Green, President of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), talks to On Target about this rapidly evolving, but sometimes controversial, area of medical technology.

In your view, can all of the plastic, reconstructive and aesthetic surgery services that are available be termed ‘healthcare’?

Healthcare embraces the attainment of a sound physical or mental state, the condition of wholeness and wellbeing. Plastic surgery covers a wide spectrum of surgical procedures aiding recovery from trauma or illness, such as in treatment following cancer or burn and when rectifying cleft palate deformities and other birth defects. Cosmetic surgery, by changing perceived imperfections in appearance, can have a profound impact on an individual’s self-esteem. So all can be included in the term ‘healthcare’.

In terms of NHS provision, how would you describe the framework of procurement and commissioning around plastic, reconstructive and aesthetic surgery? How can the private sector best contribute to NHS provision in this area?

NHS provision of plastic surgery varies throughout the country, with different rulings about what is included in ‘procedures of lesser clinical priority’. (A classic example of postcode lottery!) Some Health Authorities will allow procedures that are aimed at treating physical conditions, such as breast reduction to combat the back pain associated with large breasts, but others restrict treatment purely to patients with cancer or with conditions resulting from injury. There is urgent need for a national decision as to what the NHS will provide.

With regard to help from the private sector in the provision of care to the NHS, there will inevitably be limitations in the type of procedures that can be carried out. Skin cancers, for example, might initially be excised in a private hospital, but require multidisciplinary team planning for decisions on the appropriate treatment option. Specialised radiological equipment may be needed for lymph node sampling to ascertain the spread of disease.

If large numbers of cases are taken away from NHS contracts, NHS plastic surgery units may be disadvantaged in terms of financing. There is virtually no cosmetic surgery carried out within the NHS, so the private sector has a role in contributing to the acquisition of skills by younger surgeons. At present, BAPRAS is working in conjunction with the Royal College of Surgeons to improve the training in aesthetic plastic surgery, which will help to develop and maintain surgical skills in this area.

Is there a common regulatory framework for all aspects of plastic, reconstructive and aesthetic surgery? What is the role of self-regulation within this sector?

Regulation of doctors is the duty of the General Medical Council, whose Specialist Register lists all fully-trained surgeons and their specialities. Inclusion on that list requires formal training and accreditation by the Royal Colleges of Surgeons, policed by their Specialist Advisory Boards. In addition, all private plastic surgery units are monitored by the independent inspectorate, the Healthcare Commission.

Although plastic surgery is very strictly regulated, with trainees having to complete a formal programme of training to be on the specialist register, there is no cosmetic surgery specialist register and this means that specialists from different disciplines are able to carry out cosmetic procedures.

BAPRAS is currently involved in the committee that advises the Chief Medical Officer about how cosmetic surgery practice in the independent sector should be regulated. The present discussions on self-regulation stem from a recent ruling by Lord Hunt with regard to the provision of nonsurgical interventions in cosmetic practice, such as injectables and fillers.

Does BAPRAS have concerns regarding the way plastic, reconstructive and aesthetic surgery companies sometimes promote themselves, and how they may be perceived by the public?

BAPRAS does not condone advanced ‘discounts’, or inappropriate inducements to a potentially vulnerable patient group. BAPRAS is adamantly opposed to any cosmetic surgery in minors below the age of 18, unless for the correction of a congenital deformity.

No form of surgery is without risk of complication. The decision to proceed should only be made after a consultation with the consultant surgeon who is to carry out the procedure, and who is able to assess the appropriateness of such surgery and can carefully explain the procedure and its potential drawbacks. It is only in this way that the patient, after an appropriate time for reflection, can make an enlightened decision whether to proceed with the planned operation.

While advertising for surgical procedures may not always reflect this, surgeons have a responsibility to ensure that any patient with whom they consult understands the risks as well as the benefits associated with the procedure they are considering.

How do you see the plastic, reconstructive and aesthetic surgery industry evolving in clinical and commercial terms? What are the challenges facing it, and how can they best be overcome?

  There is an ever-increasing demand for surgery to alter or improve perceived imperfections. As a result, the companies that provide such surgery are increasingly in competition to achieve financial success, and this could potentially affect business integrity.

The ease with which inappropriately trained surgeons are able to set up practice in business and to mislead the public brings those practising legitimately into disrepute. This needs to be countered by making the public aware of the pitfalls they might encounter when considering surgery – and more importantly, by the development and implementation of a robust method of enforcing the regulations.

In all cases, the best interests of the patient must be put ahead of commercial and political expediency.


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