Private cosmetic clinics are employing surgeons to carry out breast implants, nose jobs and tummy tucks who are not qualified to work as consultants in the NHS, the Guardian can reveal.
Experts are concerned about the level of training and qualification required of surgeons working solely in the private cosmetic industry. many who trained in the UK reached only a basic level and are not on the General Medical Council’s specialist register, which means they are barred from becoming consultants in the NHS. Up to that point, in the NHS, a surgeon is still in training and will normally work under supervision.
The clinics say it does not matter, because their surgeons have years of experience in the procedures they do, which makes them just as good as any NHS surgeon. The private clinics also point out that all meet the standards of the Care Quality Commission, which regulates both the NHS and private sector.
But the revelation has shocked members of the expert group set up by the health secretary, Andrew Lansley, to look into the scandal of substandard breast implants and which has been asked to investigate standards in the cosmetic surgery industry more generally.
“I’m very concerned indeed that they are not on the register,” said Tim Goodacre, a plastic and reconstructive surgeon at the John Radcliffe hospital in Oxford and a member of the group. “That should be a bare minimum for independent practice in this country.”
Doctors who have worked for years as cosmetic surgeons without specialist registration are not breaking the rules and may be more than competent, but the absence of required qualifications means that patients cannot know for sure how skilful they are. Entry on to the specialist register indicates that a surgeon has finished their training and can apply for a consultant post in the NHS.
Plastic surgeons working for the major private healthcare groups, such as Nuffield, BMI and Spire, are all NHS consultants who do some private work as well. The majority of those working for the cosmetic chains, however, such as Transform and the Hospital Group, do not hold NHS posts. Both have some surgeons who are not on the GMC specialist register, although both say this is unnecessary for their work and maintain that their standard of work is as high, if not higher, than that of an NHS surgeon who does private cosmetic operations in his spare time.
Goodacre, however, says it is possible for doctors who were not good enough to progress up the ladder in the NHS to move into the private sector as cosmetic surgeons. “In most other specialities, those who do private practice have got to the top of the tree,” he said. “We have this other cadre who have come in because they have not succeeded.”
There are growing demands for further regulation of the cosmetic surgery industry, which has always operated very much as a free market, following the breast implant scandal. on Saturday, 60 women who had received faulty breast implants made by PIP (Poly Implant Prostheses) in France, filled with industrial grade silicone, marched in Harley Street, demanding that private clinics agree to replace them for free.
On Sunday Lansley said private firms currently refusing to replace PIP breast implants free of charge were “not stepping up to their responsibilities”. The health select committee of MPs is the latest to announce an inquiry into standards in the industry.
Qualifications and the training of cosmetic surgeons will be an issue for the expert group. The two main professional organisations of plastic surgeons in the UK, based at the Royal College of Surgeons, are also concerned about the arrival in the UK of a flood of cosmetic surgeons who qualified in Europe and whose diplomas and certificates, they argue, are not necessarily an indication of reaching the same exacting standards as in the UK – even though the GMC accepts them on to the specialist register.
While there are some outstanding plastic surgeons from Europe working in the UK, others have been trained to a lower standard, says Fazal Fatah, the president of the British Association of Aesthetic and Plastic Surgeons (BAAPS), who holds an NHS consultancy in plastic surgery in Birmingham.
“We very often get applicants from Europe. although they automatically get on the specialist register, the quality of training they have had is in no way equivalent to a trainee in the UK and they are often not deemed suitable for an NHS post,” he said.
“The EU regulations are a significant problem. You can’t differentiate between any graduate in Europe. We have lost total autonomy on this heath issue.”
There have been concerns about the equivalence of medical qualifications obtained in Europe, compared with those awarded in the UK, since the case of Daniel Ubani, the German-qualified doctor who killed a patient with an overdose of the painkiller diamorphine on his first locum shift in Cambridgeshire.
Submitting evidence to an EU green paper consultation on the issue, the GMC said the “lack of transparency on the nature and content of medical education and training or the skills, knowledge and competencies acquired means that the level of assurance that states can draw from the training obtained by migrants is limited”.
An investigation into cosmetic surgery in 2010 by the government-funded but independent organisation NCEPOD (National Confidential Inquiry into Patient Outcome and Death) also expressed concerns, saying: “The present reliance on inclusion in the specialist register does not give any assurance that a surgeon has received adequate training on cosmetic surgery.”
BAAPS and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS), of which Goodacre is a senior member, believe the equivalence rules, which assume all medical education across Europe is equal, should be re-examined.
“It should be toughened up,” said Fatah. he points to the stricter rules in the US, where medical qualifications gained in one state are not always accepted in another and doctors sometimes have to sit new exams to work across the border.
It is hard for patients to judge a surgeon’s ability from his CV. those who are not on the GMC specialist register are often an FRCS (Fellow of the Royal College of Surgeons). this, however, is a basic qualification needed to train as a specialist surgeon in the UK. The gold standard, says Goodacre, is FRCS Plast, which denotes a high level of training and proficiency in plastic surgery. this has only been introduced relatively recently, and Goodacre himself does not have it, even though he has been an examiner for it for 10 years.
Cosmetic surgery is also a global industry. some private surgeons in the UK also have clinics abroad, whether in Karachi or Rome. some have qualifications from Brazil, where cosmetic surgery is a huge industry, while others are Fellows of the West African College of Surgeons.
Transform said in a statement that its surgeons were leaders in their field. “The specialist register is applicable only to surgeons working in the NHS. our surgeons work in the private sector. Therefore this register is not relevant to the highly qualified professional surgeons we employ,” it said. “Any suggestion that our surgeons are not adequately qualified or trained is highly offensive and ill-informed.”
It added: “Qualifications obtained in other parts of Europe are at least the equal to those obtained in the UK” and said it was “completely untrue and highly misinformed” to suggest otherwise.
“Our surgeons are recruited, appraised, audited, monitored and reviewed to a level that is at the very least commensurate to those employed in the public sector,” it said.
The Hospital Group failed to respond to questions.
Mel Braham, owner of the Harley Medical Group, said that all of their surgeons, with the exception of two who were “grandfathered-in” under a Department of Health directive, were on the GMC specialist register in plastic surgery. some of their surgeons also worked for the NHS as plastic surgeons.
“An important point to bear in mind is that there is no official training for cosmetic surgery in the UK as cosmetic surgery is not available on the NHS. as a result many plastic surgeons working in the NHS have little or no training in cosmetic surgery and far less experience than surgeons working in the private sector,” he said.
On Sunday Lansley said private firms currently refusing to replace PIP breast implants free of charge were “not stepping up to their responsibilities”. he said he had asked Sir Bruce Keogh, the NHS medical director, to convene an expert group to look at the future regulation of the cosmetic service industry. “I think their ability to meet their liabilities towards their patients should be one of the issues we look at,” he sa