Licensing and further regulation of non-surgical procedures: business and regulatory impact assessment

Section 1: Background, aims and options

The 2025-26 Programme for Government announced in May that the Scottish Government will bring forward a Bill to regulate the delivery of non-surgical cosmetic procedures, (n.b. as discussed in the introduction in this impact assessment the term “non-surgical procedures” will generally be used, but the form “non-surgical cosmetic procedures” will still be used in referring to previous documents where relevant) and this report includes the proposals that will be incorporated into that legislation.

The Scottish Government first consulted on the regulation of non-surgical cosmetic procedures in 2020, basing its proposals on existing local authority licensing schemes. The analysis of this consultation was published in July 2022 and showed that 98% of respondents agreed that further regulation of these procedures was required. A further public consultation was undertaken in 2024/2025 and the analysis and response was published in June 2025.

This section provides background to the issues that the consultations considered, and which the consultation response addressed. It also includes an outline of the proposed approach to taking forward these proposals.

Background to policy issue

There are a variety of procedures being offered in Scotland today which are not undertaken for healthcare reasons, and which are not generally considered surgical, but which do pierce or penetrate the skin of clients. The majority of these are not necessarily regulated, the exceptions being: where they are carried out by a healthcare professional who is therefore providing an independent healthcare service required to register with Healthcare Improvement Scotland (HIS); or procedures which require a licence under The Civic Government (Scotland) Act 1982 (Licensing of Skin Piercing and Tattooing) Order 2006 (“the Skin Piercing and Tattooing Order”), which includes tattooing, skin piercing and electrolysis hair removal. These procedures inevitably occasion some risk to the client, especially where the practitioner is poorly trained, or if the procedure is offered in an unhygienic setting or using inappropriate products.

The UK-wide Keogh Review, published in April 2013, identified that there was little regulation of the cosmetic interventions sector and called for a new legislative framework. In response, the Scottish Cosmetic Interventions Expert Group (SCIEG) was set up by Scottish Government. The group’s membership includes healthcare professionals, hair and beauty industry representatives, environmental health officers(EHOs), and a representative of Colleges Scotland (beauty and aesthetics educationalists). It has provided valuable evidence and insight to the Scottish Government. The SCIEG report of 2015 recommended a phased approach to the regulation of cosmetic procedures in Scotland.

In 2016 the Scottish Government implemented SCIEG’s first phase recommendation to bring independent healthcare clinics where services are provided by a doctor, dentist, nurse, midwife, or dental care professional under HIS regulation. This included clinics that offer cosmetic or aesthetic procedures. As part of a separate workstream to improve regulation of independent healthcare, and following the more recent consultation, the definition of “independent clinic” has, in June this year, been extended to include services provided by pharmacists and pharmacy technicians. This enables HIS to regulate services provided by pharmacists and pharmacy technicians from premises other than registered pharmacies, and/or which are provided outwith the terms of NHS contracts.

In 2020 98% of respondents to the Scottish Government consultation supported the regulation of procedures that pierce or penetrate the skin by individuals who are not qualified healthcare professionals and/or provided from premises that are not currently subject to regulation. In response to this the Scottish Government announced in July 2022 that it would consider legislation to restrict who can administer dermal fillers. In addition, with the increase in the number of non-surgical procedures available to the public, the Scottish Government stated that it would also scope other procedures to consider any need for further regulation. It was this work which informed the revised proposals consulted on in 2024-25.

The UK government is also considering further regulation of this sector, and provided an update on their plans, which included a response to a consultation undertaken in 2023, on 7 August 2025.

Widespread concerns have been raised about the public safety implications of procedures remaining unregulated where they are not being undertaken by a healthcare professional. Such concerns have been raised by MSPs, through correspondence to the Scottish Government and especially by local authorities whose environmental health and health and safety functions bring them into contact frequently with businesses undertaking these procedures, and with those clients who have had negative experiences. There have also been some high-profile cases of negative outcomes in Scotland and the wider UK. This includes a death in England reported in the media which appeared to follow the administration of a liquid Brazilian butt lift, a procedure in which large quantities of a dermal filler are injected into the buttocks to increase their size.

Scope

The Scottish Government considers any procedures that pierce and penetrate the skin, and which are not undertaken as part of healthcare (whether NHS or independent healthcare) to be in scope for the purposes of its policy in this respect. In these procedures the skin can be pierced by a needle, but may also be penetrated by electricity, heat or cold, lights and lasers, sound or the application of penetrating chemicals or medicines. On this basis procedures such as massages, make up, or nail and hair treatments would not be included in this scope. Hair removal using lasers is in scope as the procedure targets hair follicles within the skin, electrolysis hair removal is already covered by the Skin Piercing and Tattooing Order. The Scottish Government is also deliberately excluding procedures undertaken for healthcare purposes.

Many of these procedures are undertaken for cosmetic effect, that is to say it is intended that the appearance of the client will be changed or improved in some way as a result of the procedure. In the course of preparations for the consultation the Scottish Government became aware of procedures such as the use of intravenous vitamin infusions advertised for the purpose of improving focus or vitality, rather than for a direct cosmetic effect. In many cases a procedure was advertised as having a “wellbeing” purpose as well as a cosmetic one. In some cases, a similar or identical procedure, for instance an intravenous infusion of certain vitamins or nutrients, is described as having different benefits (cosmetic or wellbeing) depending on who is offering the procedure and the clients they are seeking to attract. For this reason, such procedures were included in the consultation, and the Scottish Government’s policy is now applied to any procedure that pierces or penetrates the skin, regardless of the purpose (as long as it is not a procedure for a healthcare purpose). In deciding to clarify the scope in this way the Scottish Government notes that it is not aware of any other categories of procedure, other than the wellbeing or cosmetic purposes discussed here, and so there is very little risk of unintended consequences and that the risks of a procedure (which the proposals made seek to address and mitigate) are inherent in the procedure itself, not the purpose for which it is undertaken.

There are some procedures which would meet the definition of a procedure that pierces or penetrates the skin, that are already regulated through the Skin Piercing and Tattooing Order. The existing licensing of procedures covered by this Order will continue in its current form and will not be affected by the introduction of legislation for non-surgical procedures.

Purpose/ aim of action and desired effect

The primary aim of the proposed regulation of non-surgical procedures is to improve safety and ensure high standards of practice within the industry to protect .

The desired outcome is to establish a regulatory and licensing framework that ensures procedures are undertaken in an appropriate and hygienic setting, by appropriately trained practitioners. This will reduce the risk of harm to individuals undergoing these procedures and ensure that all practitioners meet a minimum standard of competence and safety. It will provide a framework through which responsible practitioners, regardless of their background, can successfully and safely carry out their businesses, and in which clients can access services with confidence.

The proposals set out in the Consultation response support the Scottish Government’s strategic aims of improving public health and safety and promoting high standards in healthcare. By regulating these procedures, the Scottish Government aims to protect individuals from potential harm and provide a framework for continued safe provision of procedures. If the Scottish Government does not act, untrained, unsafe practitioners working in unhygienic contexts or with inappropriate products could continue to pose significant risks to public health, and individuals may continue to unnecessarily suffer adverse outcomes. Additionally, the lack of regulation undermines the credibility of the industry, including the credibility of existing safe, reputable or regulated elements of the sector. Through a combination of a licensing scheme under the Civic Government (Scotland) Act 1982 for lower risk procedures, and the restriction of higher risk procedures to permitted premises regulated by HIS, we aim to develop a framework where training, hygiene and other standards can be established and enforced.

Adverse outcomes of procedures

The public health and safety aims of this policy are related to the desire to reduce the occurrence of adverse outcomes from procedures. As procedures are not regulated there is not a reporting system or robust intelligence on the volume of these outcomes. The nature of these outcomes, however, is well attested, both in publicly available media commentary, and in the experiences described to the Scottish Government through its engagement. The Scottish Government acknowledges that many people have procedures – in a variety of settings – without suffering the consequences. The Scottish Government is also aware that some people undertake procedures and have not achieved the results they are seeking, or have suffered short term impacts such as temporary swelling and discolouration. The nature of these adverse consequences is not considered sufficient to justify government intervention, however, and was not considered by the Scottish Government in its considerations.

More serious adverse outcomes have included permanent or long-term scarring, allergic reactions or persistent pain. Some of the most serious adverse outcomes have been caused by the use of dermal fillers, but this may be as much because of the volume of such procedures as because they are inherently more risky. If dermal fillers, and some other injectable substances, are misapplied they can cause a vascular occlusion, where a blood vessel is blocked by the material being injected. Reduced blood flow can cause dangerous and irreversible consequences, including tissue death and additional infection if not swiftly addressed. Addressing vascular occlusion requires the use of a dissolver, hyaluronidase which is itself a prescription only medicine. The Scottish Government has been told that those who have suffered such complications have presented at NHS settings or to independent clinics to have these complications reversed. In some contexts a vascular occlusion can cause blindness or damage to the eye. In an intimate context the risks could also include loss of sexual or urinary function. More generally any procedure which pierces the skin carries the risk of introducing infection and procedures such as intravenous cannulation are associated with infection, even in a healthcare context.

Options Considered

No statutory or government action

Given the strong public feeling, acceptance in the sector that further regulation of some sort is required, and the real evidence of harm it is not considered acceptable for the status quo, where at least some procedures take place without any form of regulatory oversight to remain. Nor is it considered acceptable that the regulation that does exist is applied only to some practitioners, and that practitioners with a healthcare background are therefore more regulated than those without. It has been accepted by the Scottish Government since the recommendations made by SCIEG that the sector required regulation, and the Scottish Government has been applying this regulation in a staged way.

Self-regulation of the sector does not also appear to be a credible option to address these issues, even putting aside the desire for consistency with the part of the sector that is regulated on a statutory basis. The Scottish Government concluded that relying on voluntary, industry-led standards and guidance would not be sufficient to address the regulatory gaps in non-surgical procedures. Historically, the sector has not developed robust or universally adopted standards, and until recently, the unregulated areas have not appeared to have an organisation that could take on that role. Organisation in the sector has increased, but it still clearly at an early stage and not in a position to take a self-regulatory role. The Scottish Government welcomes the work of the existing voluntary registers operated by Save Face and the Joint Council of Cosmetic Practitioners and accredited by the Professional Standards Authority. The Scottish Government has met these bodies and considers that such registers will continue to have a role in supporting improved standards in the sector, providing a framework to support training, and giving additional assurance to the public. These registers are not, however, designed to support practice outwith a regulated sector, as they are aimed at healthcare professionals or practitioners working under oversight.

Even if a new register was put in place, it does not appear likely that it would be effective in addressing the safety of procedures or all practitioners in this sector. While there are many reputable practitioners in the industry, there are also some practitioners whose actions do not give the Scottish Government any confidence that they would conform in future with a wider regime or a new professional register that did not have legal force.

For these reasons, although these options have been carefully considered throughout the process, the Scottish Government has primarily focused on statutory models of regulation.

Licensing

The initial option considered by the Scottish Government was a licensing scheme for all relevant procedures under the Civic Government (Scotland) Act 1982. This was the model consulted on in the 2020 consultation. Under this model, all procedures could take place in premises that had a licence issued by a local authority, and this would need to be enforced by EHOs. This model built on the existing regulation of settings under the Skin Piercing and Tattooing Order. The response to the consultation was supportive, but there were several issues with this model.

The Scottish Government received feedback, in responses to the 2020 consultation and in subsequent engagement, that the level of protection and risk mitigation offered by a licensing model was insufficient for some procedures. Many stakeholders felt strongly that the risks of some procedures could be best mitigated through the involvement of a healthcare professional with suitable expertise, and that the procedures required a setting with standards of hygiene similar to a clinical setting, and which exceeded that required to safely undertake tattooing and skin piercing.

EHOs expressed the view that their expertise is not suitable for all procedures, and that they would be ill placed to enforce standards that had more in common with healthcare than with existing licensable activities. If all procedures were to be included in a licensing scheme there would have been a substantial training requirement. In addition, existing capacity restrictions on the environmental health workforce were noted, and that it was considered unlikely that all local authorities would be able to manage an increase in licensing activity associated with the entire sector being brought into scope, even with additional fee income being collected by local authorities.

Finally, the view was expressed that a licensing model was inconsistent with the reserved parts of medicines legislation and existing regulation of healthcare professionals. This includes areas which are reserved, and the Scottish Government considers it important that the regulation of this sector is coherent with existing regulation. A licensing model was considered inconsistent with existing regulation for procedures that require the use of prescription only medicines, because professional regulators require that prescriptions for cosmetic purposes take place following a face-to-face consultation (including the Nursing and Midwifery Council, who changed their guidance this year). If a consultation is being offered it would appear that a service was offered that would require a service to register as an independent healthcare setting with HIS, and as such these regulatory regimes are not coherent with a licensing model, at least for procedures where a prescription only medicine may be used.

Healthcare Improvement Scotland regulation

By contrast with a licensing model, a model where procedures are regulated by HIS would appear to address many of the concerns highlighted in relation to a licensed model. HIS regulated settings, from which healthcare professionals offer services, already have requirements to adhere to certain standards which are appropriate for this sector. These requirements, and the guidance provided by HIS, have been developed in line with HIS experience of regulating settings, the majority of which are indeed providing non-surgical procedures of different sorts.

HIS inspectors are better placed than EHOs to consider the appropriateness of these settings and support safety improvements, and HIS already regulates settings from which regulated professionals operate, and from which medicines are dispensed and prescribed.

Final option – Graduated model

Although a HIS setting would appear to be an effective means of achieving public health and safety aims, the Scottish Government is conscious of the impact that a shift of all procedures to such a setting would have. For this reason the 2024/25 consultation proposed a graduated model, where procedures are grouped according to the most appropriate risk mitigation, and taking into account such factors as the use of medicines in procedures. Some procedures, (described as Group 1 procedures in the consultation) would be available in a licenced setting, whereas other procedures (Groups 2 and 3) would be restricted to a HIS registered setting, where they would be undertaken by or under the supervision of an appropriate healthcare professional.

This approach was broadly supported by consultation respondents, and is considered to be the most effective way of achieving the desired aim to improve public health and safety. In response to the endorsement of this model it was retained in the revised proposals, although some changes were made to the classification of individual procedures to ensure that procedures were subject to the least disruptive regulation that would mitigate the relevant risks and achieve the Scottish Government’s aims.

In arriving at this as the final model the Scottish Government has had regard to the principles of Better Regulation, in particular the need for the ultimate approach to be proportionate. The Scottish Government considers an intervention in this context to be proportionate if it achieves the public health aims of the Scottish Government without unduly impacting on businesses. This is achieved in the proposals through a grouping of procedures on the basis of the most appropriate risk mitigation.

The Scottish Government proposals also allow for greater consistency between businesses in the currently unregulated part of the sector and those which are healthcare professional led and therefore already subject to HIS requirements. It further remains consistent with the wider regulatory framework, including regulation of health professions and the regulation of medicines.

Fuller details of the proposals are included in the consultation response, but since the publication of that response two key further decisions have been made by the Scottish Government. Firstly, the Scottish Government proposes, following stakeholder feedback, to include midwife prescribers alongside the list of appropriate professionals that can supervise or undertake one of the procedures regulated by the Bill (described as Group 2 or Group 3 procedures in the consultation response proposals). This decision was taken considering that the training and regulation of midwives is equivalent to that of nurses, and evidence from HIS that a number of midwives were already undertaking procedures in existing independent clinics, and there was no evidence that this was leading to any public safety concerns. Secondly the Scottish Government proposes to stage the implementation of proposals, with this staging discussed in more detail in Section 5 of this impact assessment.

Final option – Supervision requirements for injectable procedures

The graduated approach is the key feature of the final proposals and is key to the Scottish Government’s balancing of the need to achieve legitimate public health and safety aims, and the need to ensure that measures are proportionate, and the impact on business goes no further than necessary. Within this broad model there have been a number of decisions made, and for each of these further options have been considered, which are not described here, although where these elements of the proposals are known to have an impact on businesses that impact is recorded in Section 3. Further information on the proposals can be found in the response to the 2024/25 consultation. The following paragraphs do provide more information on the options considered in relation to one aspect of the proposals which is particularly relevant to some of the impacts identified in Section 3, and was repeatedly identified in consultation and elsewhere as a key issue for businesses and practitioners.

Group 2 in the consultation response are those procedures where the Scottish Government considers that a suitably trained non healthcare professional practitioner may carry out the procedure, but where the procedure should be carried out in a permitted premises, and where the Scottish Government proposes there should be an appropriate healthcare professional available to supervise the procedure. The feedback to the 2024/25 consultation led to this group being revised to contain the majority of injectable procedures, where a substance such as Botox^®, dermal fillers, vitamins etc is injected into or under the skin. The exception to this would be any procedure carried out in an intimate area, under anaesthetic or in higher volumes for the purpose of augmentation, such as a Brazilian butt lift.

The Scottish Government proposes that the supervision of a procedure in this group should require the appropriate healthcare professional to be present at any initial consultation, which may be where any prescriptions are made, and to remain present on site, at the time any procedure is undertaken.

The Scottish Government considered the procedures to be included in this Group carefully, mindful that procedures involving Botox^® and dermal fillers appear to be some of the highest volume procedures, and are therefore at the core of the business model for many settings. The alternative options were to include such procedures either in Group 1, available to those in a licensed setting, and not requiring healthcare professional involvement, or to Group 3 where the procedure would be restricted to appropriate healthcare professionals only. There was support in the 2024/25 consultation for either of these options. Where respondents came from those involved in the industry responses tended to be correlated to the part of the sector respondents came from. 71% of respondents who identified as being involved in a regulated or medical setting providing procedures believed that injectable procedures should be in Group 3, whereas only 27% of those involved in the currently unregulated part of the sector held this view. 47% of these respondents felt that injectable procedures should be in Group 1. Those who did not report any connection the sector had views closer to those involved in the currently regulated part of the sector.

If the Scottish Government followed the majority view overall, or the general consensus amongst respondents to the survey (and other correspondents) with healthcare or medical expertise then injectable procedures would have been included in the group restricted to healthcare professionals only. The Scottish Government however discounted this option as the Scottish Government was convinced by the minority argument that a non-healthcare professional practitioner could indeed receive training that would allow them to carry out these procedures with a suitably safe technique. The Scottish Government discussed this position with clinical advisors and stakeholders. While requiring skill and training it did not appear to the Scottish Government that the process of administering an injectable procedure rested strongly on those skills that are likely to be present amongst healthcare professionals but unrealistic for non-healthcare professionals to acquire.

The Scottish Government also discounted the argument for inclusion of injectable procedures amongst procedures that may be undertaken in a licenced setting. The Scottish Government considered firstly that where a procedure involved a prescription only medicine such an approach would appear inconsistent with the wider regulatory regime, clearly these procedures already require a healthcare professional to be involved in the procedure and as such regulating the procedures through HIS appears appropriate. Even where a prescription only medicine was not required (or not necessarily required) in a procedure the Scottish Government also considered the risks inherent in breaking the skin, and to introducing any foreign substance into the body. In the former case it appears that these risks can be mitigated through appropriate training, and in support of this position the Scottish Government notes that procedures such as skin piercing already take place at far higher volumes than any non-surgical procedure without evidence of widespread complications. In the latter case the Scottish Government considers that introducing a foreign substance is a serious decision, that even in a routine procedure requires some consideration. The consideration of this should involve multiple factors, including any contraindications, interactions with other substances, as well as considering the risks of anaphylaxis or other reactions. Considering this range of factors requires decision making that rests on broad based training including anatomy and pharmacology and related skills that appear to warrant the involvement of a healthcare professional. On this basis injectable procedures were included in Group 2 despite strongly argued views that it should be included in either the less restrictive Group 1 or more restrictive Group 3.

Having settled on the inclusion of injectable procedures in Group 2 the Scottish Government also considered the model of supervision, which received a high volume of comment from respondents, and is also identified in the survey by some respondents as a key factor in the impact on businesses. Given the reasons for inclusion in this group it is essential that an appropriate healthcare professional is involved in making the decision to proceed, and it would be inconsistent with the wider regulatory context, and the guidance of the regulators of healthcare professions for this not to take place during a face-to-face consultation. However, the Scottish Government also considered whether it was necessary for the appropriate healthcare professional to remain present at the time a procedure is undertaken, especially given in many cases a consultation will take place and an appointment made for a procedure on a different day.

The Scottish Government considered that the presence of a healthcare professional on site during a procedure was essential because this ensured that the professional was available to offer support to a practitioner during a procedure, and intervene in the event of any complications arising. This view was arrived at following discussion with clinical advisors and stakeholders, and after giving due consideration to the argument to the contrary. Complication management may require the use of prescription only medicine so a prescriber on site can substantially mitigate the impact of such a complication by ensuring medicines can be made swifty. 70% of respondents to the Scottish Government consultation agreed that the appropriate healthcare professional should be on site, and this is also consistent with the current expectations of healthcare professionals in HIS clinics.

Some correspondents have recently contacted the Scottish Government to highlight that the equivalent grouping in recent proposals from the Department for Health and Social Care(DHSC) requires only local authority licensing, although the DHSC proposals also require supervision and the Scottish Government notes that the model of supervision is subject to further consideration. As such the UK government model, coming as it does from a very different regulatory context, may well be similar to the Scottish Government one in terms of its impact. The Scottish Government is aware that a different approach to supervision may reduce costs to businesses, and make a significant difference to the ability of businesses not currently regulated to adapt their business model while continuing to deliver injectable procedures, but the benefit to business does not appear to be achievable without an unacceptable increase in the risk to clients.

As discussed in more detail in Section 5 not all parts of the Scottish Government proposals are to be legislated for at the same time, and the proposals for supervision are not provided for in the Bill as introduced. On the basis of the Bill, and assuming no changes to HIS regulations in this respect, procedures will need to be undertaken in a setting from which an appropriate healthcare professional provides services, but without any specific supervision requirement. Currently the Healthcare Improvement Scotland (Requirements as to Independent Health Care Services) Regulations 2011 require that a provider must ensure that “a suitably qualified healthcare professional is working within the independent healthcare service whilst service users are present”. The Scottish Government does propose to ensure some easement is applied to this requirement to support businesses carrying out a range of procedures, some of which are regulated by the Bill and others which do not require that level of regulation.

Sectors/ Groups affected

Scottish Government proposals will primarily have an impact on those businesses providing the proposals regulated either through the Bill or the proposed licensing scheme. Procedures are currently delivered both by healthcare professionals, including from independent healthcare services regulated by HIS, and by non-healthcare professional providers working from a range of settings which might include beauty or salon settings providing other services, or specialist settings. In general, currently unregulated businesses will be more substantially affected than those already regulated by HIS, and where services are being provided by healthcare professionals.

The current size of the sector providing non-surgical procedures is hard to assess. These procedures are offered from a range of settings, and operates in part as a subset of the wider personal care or hair and beauty sector, but it is not clear how large a subset, it is therefore it is not possible to make robust estimates of the size of the sector. It is clear that the sector is a significant one, with a presence on high streets across Scotland. The estimates given below represent the Scottish Government’s best efforts to assess the size of the sector in the absence of any more direct evidence.

The currently unregulated part of the sector

The currently unregulated part of the sector providing non-surgical procedures encompasses a diverse range of businesses, including beauty salons, independent practitioners, and mobile aestheticians who operate outside the scope of HIS regulations. Some of these businesses will already be subject to a local authority licence under the Skin Piercing and Tattooing Order, insofar as they may offer skin piercing or tattooing (including semi-permanent make up). This currently unregulated segment of the industry is substantial, with numerous small and medium-sized enterprises providing services including dermal fillers, Botox^® injections, and other cosmetic treatments. However, the exact size of this sector is challenging to quantify due to the lack of comprehensive data and oversight. Following discussions with those in the sector we believe the size of the currently unregulated part of the sector to be larger than the currently regulated part of the sector of c. 550 settings (see below). The total number of hair and beauty businesses represents an upper limit on the number of businesses in the sector (c. 4000), and as such we can conservatively estimate the number of businesses in the unregulated part of the sector to be around 1000- 1500 businesses. The absence of regulation and the wider data issues means that there is limited information available on the locations, and the demographic or socio-economic profiles of those employed within this sector, but it appears that the majority of practitioners and business owners in this sector are women.

Businesses in this sector will offer different ranges of procedures, and those procedures may be offered alongside other beauty treatments or wider services such as massage or complementary therapies. This means the procedures included in these proposals for regulation will have a different level of impact on different businesses.

The unregulated part of the sector is the part of the sector that stands to be most affected by further regulation, as businesses will be required to adhere to new regulatory or licensing requirements. These requirements may require changes in business models, and in some cases these businesses may no longer be viable given the new regulatory model.

Healthcare Improvement Scotland regulated clinics

Independent clinics and hospitals where healthcare professionals are providing procedures operate under the oversight of HIS. HIS have around 550 clinics registered with them, of which the majority provide non-surgical procedures. These businesses are already subject to HIS requirements and as such will face less change under the Scottish Government proposals.

Under our proposals we expect that procedures restricted to a HIS regulated setting will be undertaken by or under the supervision of medical practitioners, dentists, prescribing nurses, prescribing midwives and prescribing pharmacists. Not all HIS regulated settings are staffed by one of these professionals, and as such any services operated by pharmacy technicians, dental care professionals or non-prescribing nurses, midwives or pharmacists will also be affected. Nurses, midwives and pharmacists all have potential routes to acquire prescribing rights, and we believe that only a minority, if any, of services registered with HIS will be staffed by only dental care professionals or pharmacy technicians.

Other clinical settings

Certain clinical settings are exempt from HIS registration including General Practices and Dental Practices providing services under an NHS contract, and community pharmacies. The Scottish Government is not aware that any General Practices are providing procedures, but a number of dental practices and community pharmacies are providing procedures that will be regulated by the Bill or are proposed for inclusion in a licensing scheme.

There are around 1050 dental practices in Scotland, the majority of which are providing a mixture of private and NHS services, and around 1250 community pharmacies. Not all of these settings offer non-surgical procedures, but a significant number do. The Scottish Government proposals are that in the long term these premises should be subject to regulation in respect of their delivery of procedures, however further policy work is required before this can be delivered. The Scottish Government is not currently aware of any specific public health or safety concerns about the procedures being offered in these settings.

Clients

As well as businesses, the clients they serve will also be affected. Like the businesses themselves it appears that the majority of clients of procedures are female, but otherwise there are a range of different clients seeking these services for different reasons. The differentiated demographic impact is considered separately as part of the other impact assessments, in particular the equalities impact assessment conducted for this policy. Whilst some clients may find procedures less accessible, or more expensive as a result of the proposals, the Scottish Government’s intention is that they will be able to access the services with less risk of adverse outcomes.

Other Businesses

Businesses delivering procedures creates demand for a range of other businesses. This includes: businesses supplying materials (including pharmacies, drug companies and providers of medical/ aesthetic devices such as needles etc); businesses providing cleaning and waste disposal services; and training providers. Businesses providing procedures are frequently a presence on high streets, which increases overall footfall and support wider businesses in less tangible ways. The size of the sectors that may be affected by the proposals is unknown.