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Code of Practice 2013
All Members should seek the highest standards of clinical care in an atmosphere of honesty, integrity, respect and compassion.
The purpose of this code is to define acceptable behaviour in plastic surgery, to encourage the maintenance of the highest surgical standards, to support the professional regulation of the specialty and to provide a model for reflective practice in line with ongoing appraisal and revalidation.
Members of BAPRAS must comply with the GMC’s ‘Good Medical Practice’ and follow the guidelines for ‘Good Surgical Practice’ as laid down by the surgical royal colleges.
- Surgical Practice
- Financial arrangements
- Pre and post-operative surgical care
- Surgery undertaken at a distance
- Cosmetic surgery for patients under 18 years of age
- Involvement with Non-Medically Qualified Personnel
- Relationship with the pharmaceutical and medical device industries
- Use of the BAPRAS name and logo
- Data collection
- Compliance with the Code of Practice
- Appendix 1: Compliance
- Appendix 2: Trademark
- maintain high standards of surgical practice
- comply with revalidation requirements
- respect patients and colleagues
- acquire and maintain surgical skills/experience and competence
- strictly safeguard confidentiality
- not engage in any activity which brings the practice of plastic surgery or BAPRAS into disrepute
- maintain adequate and up to date records
- maintain a logbook
- comply with Data Protection legislation
You must familiarise yourself with the guidelines for advertising set out by the GMC and the Advertising Standards Authority and in particular those requirements that relate to:
- what is acceptable and unacceptable advertising
- claims being honest and truthful
- personal responsibility for the nature and content of all advertising or publications related to your services
- comparative advertising which implies that other suppliers are incompetent
- offering gifts, discounts or other financial inducements
You must be aware that this includes statements made on websites and other electronic media.
You are also responsible for any third party advertising issued on your behalf.
You must specify your GMC registered specialisation and the year you were registered on all advertising. You must specify your category of BAPRAS membership on all advertising.
You must be honest and transparent in all financial arrangements:
- disclosure of costs to patients is required and best practice is for a written disclosure of costs, including the possibility of additional costs should any revision procedure be necessary
- patients should not be financially disadvantaged following withdrawal from a proposed course of treatment • any deposit taken must be refundable save administrative expenses
- you must declare any conflicting financial interest (e.g. financial interest in a private hospital)
- you must ensure that any such interest does not influence patient care
- you must ensure that financial arrangements do not include any inducements by way of gifts or discounts
- any invoices/bills submitted should be at a rate commensurate with the service provided
Pre and Post-Operative Surgical Care
- you must ensure that patients are adequately informed about any proposed treatment, including any serious or frequently occurring risks and complications
- you are also responsible when information is provided by junior medical staff or nurses
- no recommendation for surgery should be made without a face-to-face consultation with the patient, unless the situation is urgent
- you must not rely on email, social media or telephone consultation alone
- in cosmetic surgery cases, an offer of a second consultation should be made prior to surgery and an adequate ‘cooling-off’ period of at least 2 weeks between consultations and surgery must normally be allowed
- you are responsible for post-operative care in person
- when you are not personally able to provide post operative care you must arrange to delegate to a named and appropriately qualified colleague
- delegation arrangements must be clearly made known both to the patient and your colleague
- adequate documented hand-over is essential when delegation arrangements are made
Surgery Undertaken at a Distance
- surgery must only be carried out where local facilities are adequate for the surgery and local medical personnel have the necessary expertise and skills to provide post-operative care
- adequate post-operative provision must be made, including the arrangement of competent post-operative medical cover by a named and appropriately qualified colleague who is able to manage any urgent or unforeseen situations
- adequate documented hand-over is essential
Cosmetic Surgery for patients under 18 years of age
Particular care should be taken when treating such patients to ensure that the treatment is in the best interest of the patient. The maturity of the patient and their understanding of issues relating to treatment are particularly important. You must ensure that all legal requirements in relation to consent are satisfied.
When complications occur you must:
- provide a full and honest explanation at the earliest opportunity
- ensure the patient receives expedient management
- seek a second opinion if necessary
- bear in mind the financial and personal cost to the patient when revision surgery is required
- avoid making inappropriate or deprecating comments about another doctor or healthcare professional
Involvement with Non-Medically Qualified Personnel
- you assume full responsibility even when nonmedically qualified personnel provide treatment in your practice
- non-medically qualified personnel must have appropriate qualifications and training to complete the task assigned to them and should have appropriate indemnity
Relationship with the Pharmaceutical and Medical Device Industries
- if you have financial or commercial interests in organisations providing healthcare, or in pharmaceutical or other biomedical companies, these interests must not affect the way you prescribe, treat or refer patients
- patients must be informed of any conflicts of interest
- conflicts of interest should be declared on all advertising
Use of the BAPRAS Name and Logo
- membership of BAPRAS must not be used as a qualification
- your category of membership should be clearly and fully stated
- your membership category on website advertising must be hyperlinked to the BAPRAS website membership page
- the use of the term “Member of BAPRAS” alone on letterheads, websites and in advertising is not permitted
- Only Full Members may reproduce the BAPRAS logo on their stationery or website for the sole purpose of communicating their membership of BAPRAS
- membership categories other than Full Members cannot use the BAPRAS logo in advertising
- BAPRAS logos are registered trademarks and their use is protected by law [Appendix 2]
- you must not make yourself out to be representing BAPRAS unless prior authorisation has been given by Council
- you must maintain an annual log of your surgical activities and outcomes
- you will submit your log to the Association upon request to facilitate enquiries and workforce planning
Compliance with the Code of practice
Failure to abide by these guidelines may constitute unprofessional conduct or professional misconduct, and a breach of this code. Non-compliance with this code may result in suspension or termination of your membership. Further, where deemed appropriate, BAPRAS have the duty of mandatory notification to the GMC’s Fitness to Practise Committee, or other appropriate body:
- members of BAPRAS will sign a written acknowledgement that they have read, understood and will abide by this Code of Practice
- members will agree to submit to a BAPRAS disciplinary procedure where a complaint has been made
- complaints against members must be made in writing; anonymous complaints will not be considered
- complaints will be investigated by the Professional Standards Committee who will make appropriate recommendations to Council
- any appeal will be heard by a formally constituted Hearing Panel as set out in article 25(2) of the Articles Of Association.
Please refer to Appendix 1 for further details.
Appendix 1: Compliance
- you must comply with the regulations covering your appropriate category of membership (see articles 2-13 of the Articles of Association of BAPRAS)
- the annual subscription appropriate to your category of membership must be paid
- you must be aware of and comply with your obligations as laid down by the General Medical Council to report notifiable conduct on the part of another medical practitioner
- you will give written assurance of your compliance with this Code when joining BAPRAS
- by annually continuing your membership you confirm that you will continue to abide by the Code
- comments of a defamatory or offensive nature must not be made, including comments on the actions of other members, and you must not purport that your opinion in some way has the authority of BAPRAS
On becoming a Member of BAPRAS you are required, as a condition of membership, to sign a written acknowledgement that you:
- have read and understood and agreed to comply with the codes of conduct and standards of the surgical royal colleges of the United Kingdom and Ireland
- that you have complied with BAPRAS codes, guidelines and standards in your professional practice over the previous 12 months
- agree to submit to a BAPRAS disciplinary procedure if a complaint is made against you and to be bound by the outcome of the procedure
The Professional Standards Committee will review any complaint at its next meeting, or sooner if deemed necessary, and will:
- inform the Member in writing of the details of the complaint and provide a copy of the complaint and give the member 28 days within which to provide a written response to the complaint
- undertake such further investigation of the complaint as it feels appropriate
- thereafter deal with the complaint, taking into account matters contained in the complaint and response received from the member and the results of further investigations, if any, undertaken by the PSC or other parties 15
- make a recommendation to the Council of BAPRAS as to what action, if any, BAPRAS should take in response to the complaint.
If the complaint raises issues that may involve unprofessional conduct on the part of the member, a risk to patient safety or a breach of any GMC codes or guidelines, then the PSC will recommend to Council that the complaint be referred to the GMC for further investigation. If the complaint raises issues that warrant further substantial investigation (e.g. contravention of Advertising Standards Authority regulations) the PSC will recommend to Council that the complaint should be referred to the appropriate body. If the complaint in the opinion of the PSC is trivial and/or does not raise issues of such significance as to warrant further investigation the complaint may be dismissed and the complainant and the member to whom the complaint relates will be informed accordingly.
Recommendations by the PSC suggesting action, if any, to BAPRAS Council may include any or all of the following:
- dismiss the complaint 16 17
- require the member to participate in counselling or other similar remedial programme
- require the member to sign a statutory declaration that he or she will in future comply with the Code and other relevant codes of conduct
- reprimand the member
- impose conditions upon the member’s continuing membership of BAPRAS
- suspend membership of BAPRAS for a specified period of time
- terminate membership of BAPRAS
When making its recommendation, the PSC must review any complaints previously made against the member and where appropriate take this complaints history into account. This information should be supplied to BAPRAS Council as part of their recommendation for further action.
The Council of BAPRAS will consider the recommendation of the Professional Standards Committee at its next meeting, or sooner, and will decide what action, if any, will be taken in response to the complaint. The Council will write to the member and the complainant informing them of their decision.
17 Any decision by the Council of BAPRAS to reprimand, impose conditions, suspend, or to terminate the membership of a member will be published on the public domain of the BAPRAS website.
Any appeal will be heard by a formally constituted Hearing Panel as set out in article 25(2) of the Articles of Association of BAPRAS.