1. The Medical Board seek to establish an area of practice endorsement for cosmetic surgery.
2. If an area of practice endorsement is approved for cosmetic surgery, Ahpra and the Medical Board, in consultation with other stakeholders, undertake a public education campaign to assist consumers to understand the significance of an endorsement.
3. Ahpra and the Medical Board continue their joint work with the Australian Commission on Safety and Quality in Health Care on improving the consumer experience of making health notifications in Australia.
4. Ahpra and the Medical Board consider:
- a) producing notifier educational material (with case examples) tailored specifically to cosmetic surgery matters including providing advice about:
- – Ahpra and the Medical Board’s role and the limit of their powers
- – pathways to HCEs and other complaint agencies that offer dispute resolution
- b) providing more specific advice (on the above matters) in initial correspondence to consumers who have made a notification about a cosmetic surgery matter
- c) making public their position in relation to practitioners’ use of NDAs as a means to prevent consumers making a notification.
5. Ahpra and the Medical Board review its educational material that is available to practitioners about mandatory and voluntary notifications and include more information about:
- a) notifications involving concerns that a practitioner may have placed the public at risk of harm because the practitioner has practised the profession in a way that constitutes a significant departure from accepted professional standards and is placing the public at risk of harm
- b) protections for notifiers and the ability to make a confidential mandatory notification or anonymous voluntary notification.
6. Ahpra and the Medical Board undertake a targeted education campaign in relation to making mandatory and voluntary notifications aimed at the cosmetic surgery sector and also the classes of practitioners/employers outside the sector who may subsequently treat cosmetic surgery patients (including emergency departments and their employees).
7. Ahpra and the Medical Board:
- a) develop training and guidance material (for example, a manual) specifically about the management of cosmetic surgery notifications to supplement and support the current assessment/investigation processes (which may include what other open source enquiries should be made and when). This should be directed towards ensuring that any specific key issues raised by the notification (either directly or indirectly) are consistently and appropriately considered and the risk assessment methodology is rigorously applied
- b) take further steps to enhance consistency in the management of issues raised in cosmetic surgery notifications, including for example, building up the specialist expertise of staff managing these notifications (whether in one team or across teams)
- c) ensure that where necessary key claims in a practitioner’s submissions are scrutinised, including seeking corroborative evidence (for example, medical notes or GP records) and attempts are made to resolve key factual disputes (including seeking clarification from the notifier or other witnesses).
8. Building on the work undertaken by the review:
- a) Ahpra identify and clearly map the roles, responsibilities and powers of each regulator in the cosmetic surgery sector (including on a state-by-state basis) and produce a corporate document available to relevant staff; and
- b) Once the mapping exercise is completed, Ahpra identify where any improvements are required to enhance the flow of information between these relevant regulators, including for example, identifying key contacts and/or where necessary entering into a memorandum of understanding or other agreement.
9. Ahpra obtain legal advice specifically about the application of section 133(1)(e) to cosmetic surgery and the extent to which it may effectively prohibit forms of advertising of cosmetic surgery. Final report: Independent review of the regulation of medical practitioners who perform cosmetic surgery August 2022 26
10. Ahpra and the Medical Board review their regulatory approach to advertising in the cosmetic surgery sector including by:
- a) ensuring that the risks posed by advertising in this sector are appropriately categorised within the risk framework set out in the Advertising compliance and enforcement strategy for the National Scheme so that stronger enforcement action is taken about high-risk matters (including, where appropriate, taking prosecutorial action in some matters)
- b) undertaking an industry-specific audit which should, among other things, inform the future proactive monitoring/auditing of activities in this space.
11. Ahpra and the Medical Board revise the Advertising Guidelines, the Cosmetic Guidelines and/ or produce additional material specifically about cosmetic surgery to clarify the standards expected of practitioners (including specific examples of inappropriate content or approaches) by addressing such areas as:
- a) avoiding the glamorisation and trivialisation of procedures including the downplaying of risk
- b) avoiding the use of images of models who have not undergone a cosmetic procedure(s) to promote a cosmetic procedure
- c) avoiding the promotion of procedures through the use of social media influencers
- d) avoiding the use of content that implies cosmetic surgery should be utilised to obtain an acceptable/ideal body type
- e) promoting the use of disclaimers
- f) limiting benefit statements to those that are objectively demonstrable/provable (that is, the physical changes – not claimed psychological or social benefit)
- g) limiting the filming and use of content that shows surgical procedures to educational purposes only and not for entertainment
- h) strengthening procedures for informed consent on the use of and storage of patients’ before and after photos
- i) preventing the targeting of young or otherwise vulnerable groups with advertising (including through algorithms and other marketing technology).
12. Ahpra and the Medical Board consider the use of technology to assist in the monitoring/auditing of advertising in the sector.
13. The Medical Board review, consult on and update its Guidelines for medical practitioners who perform cosmetic medical and surgical procedures to clarify expectations, including amending the following sections as detailed in ‘Chapter 4 – Influencing Practice’:
- a) Definition
- b) Section 2 – Patient assessment (including preoperative screening, cooling-off period, video consultations)
- c) Section 4 – Consent (including informed financial consent)
- d) Section 5 – Patient management (including sedation and anaesthesia, and postoperative care)
- e) Section 8 – Training and experience
- f) Section 11 – Facilities
- g) Section 12 – Financial arrangements.
14. The Medical Board strengthen the Cosmetic Guidelines by reviewing where ‘should’ is used and consider using ‘must’ to make expectations clearer.
15. The Medical Board and Ahpra take on a role in seeking to facilitate reform in areas outside its powers and responsibilities where patient safety issues have been identified (for example, writing to the Ministerial Council recommending work be undertaken to develop a standardised national approach to health facility licensing and accreditation, including what types of cosmetic procedures can be done in each type of facility).
16. The Medical Board consider periodically publishing lessons learned in cosmetic surgery using deidentified data, outcomes of notifications and other information sources as an educative tool for practitioners and to further inform consumers