A Briefing on England’s Fragmented Licence System for Skin and Personal Care Treatments — and the Case for National Oversight
Since the 1980s, England has relied on local legislation to license and regulate skin-facing treatments — leading to postcode-dependent rules, confusion among practitioners, and gaps in public protection.
This briefing outlines: • How the current licensing landscape came to be • The structural flaws embedded in the two key Acts • The consequences for councils, practitioners, and the public • Why the new aesthetic licensing scheme will not fix this • A national solution rooted in education, public health, and professional oversight.
2. Licence Origins: How We Got Here. Two key Acts shaped the current situation — one optional, one mandatory, neither consistent.
2.1 Local Government (Miscellaneous Provisions) Act 1982 – Part VIII • Applies across England — but only if a council chooses to adopt it • Grants powers to license: o Acupuncture o Electrolysis o Cosmetic piercing o Tattooing o Semi-permanent makeup – by definition, in most council by-laws, as a form of tattooing • Requires councils to write and publish local by-laws specifying how licensing will be applied (fees, inspections, conditions).
Some councils never adopted it. Others adopted it decades ago, but have not updated their by-laws to reflect modern skin treatments.
2.2 London Local Authorities Act 1991 • Applies to all 32 London Boroughs and the City of London • Makes licensing of "special treatments" mandatory • Includes a broad and open-ended definition of treatments.
The Act defines “special treatment” as any of the following: • Massage • Manicure • Acupuncture • Tattooing • Cosmetic piercing • Chiropody • Light, electric, vapour, sauna or other baths or treatments “of a like kind.
Councils are left to interpret which modern services fall under “light” or “electrical” treatments — or are “of a like kind” — leading to inconsistency.
As a result: • Some boroughs include facials, LED, and radiofrequency • Others do not mention these at all • There is no standard list of what counts as a “special treatment” across London.
3. Examples of Real World Variations in Licensing: Even among councils governed by the same Act, the application of licensing powers varies widely.
3.1 London Borough Examples (Mandatory under 1991 Act) • Camden: Lists 77 special treatments that require a licence but does not include facials • Westminster: Includes facials and lists over 140 special treatments • City of London: Requires “special treatment” licence for massage and other treatments, and a separate registration for electrolysis, tattooing, or piercing.
3.2 Councils Using the 1982 Act (Optional) • Barnsley: Requires special treatment premises licences for acupuncture, tattooing, SPMU, cosmetic piercing, and electrolysis • Birmingham: Includes massage and ‘special treatments’.
3.3 Councils with Limited Licensing Scope • Cheshire West and Chester: Only licences piercing. Explicitly excludes Botox, fillers, laser, and microneedling, but references future regulation under the Health and Care Act 2022 • South Cambridgeshire: By-laws published in 1984.
4. The Current Landscape: A Patchwork of 317 Councils.
There are 317 local authorities in England, made up of: • Metropolitan Districts: 36 • London Boroughs: 32 + City of London (LLA 1991 applies) • Unitary Authorities: 62 plus the Isles of Scilly • County Councils: 21 • District Councils: 164.
Outside London, councils fall into one of three categories:
🟡 1. Adopted the 1982 Act • Licensing limited to what the Act covers: acupuncture, electrolysis, cosmetic piercing, SPMU, tattooing • Must introduce local by-laws to define what they will licence and how.
🔶 2. Did not adopt the 1982 Act, but use other legal mechanisms • Some councils use local Acts, business licensing, or general public health powers • These schemes are inconsistent, poorly defined, or not skin-specific.
❌ 3. No Licensing Scheme in Place
• In some areas, there appears to be no formal licensing at all for skin treatments. This is often because the council has not adopted the 1982 Act — and there is no public record of a formal decision to reject it.
Practitioners offering facials, microneedling, or LED may therefore be operating in a completely unregulated environment — legally.
“Exempt – Unless You’re Not” The contradiction inside Section 4 of the 1991 Act
The London Local Authorities Act 1991 appears to offer licence exemptions for practitioners registered with certain health bodies — including those under the Health and Care Professions Council (HCPC). But the fine print says:
“This list is for recommendation only. Individual authorities may, if they wish, still require members of these organisations to apply for a licence in their borough.”
This creates an unworkable tension for skin treatments:
A physiotherapist offering LED or massage may be exempt in one borough — but required to apply for a special treatment licence in another.
A chiropractor may be specifically exempt under the Act — but still chased for compliance depending on the local authority’s interpretation.
A beauty therapist working within the same premises, under the direction of a regulated health professional, may not be exempt at all if the council decides.
There is no fixed, enforceable national exemption — just a patchwork of “recommended” interpretations that vary by borough.
This ambiguity creates legal grey zones, undermines fairness, and makes consistent enforcement almost impossible.
Licence Duration: Even the length of time a licence remains valid varies across councils — with no clinical justification. • In London Boroughs, where licensing is mandatory under the 1991 Act, licences are typically valid for 12 months only. Example: Camden Council requires annual renewals for special treatment licences — regardless of treatment type, practitioner history, or risk level • Under the 1982 Act, many councils issue lifetime or indefinite licences unless the premises or treatment type changes. Example: In Barnsley, practitioners may not need to reapply unless they change location or expand their treatment menu.
This inconsistency creates: • Unfair financial pressure on practitioners working in London and across boroughs • Unbalanced compliance demands depending on postcode • No clear evidence base for why identical treatments require different oversight schedules.
It reinforces a core truth: postcode-based regulation is no regulation at all.
Regulated with CQC from £800. Charged up to £2,873 for a massage: A clinic providing diagnosis and treatment of medical conditions can be fully registered with the Care Quality Commission (CQC) for as little as £800 per year. Meanwhile, a therapist in Camden offering a massage or manicure must pay up to £2,873 to apply for a licence — and nearly the same amount again to renew it annually.
There is no risk-based logic behind this comparison. There is no national oversight to explain the disparity. There is only postcode policy — and a system that fails everyone.
5. Why This Matters.
Fragmentation Harms Everyone • Practitioners must navigate 317 different interpretations of treatment risk • Insurance, training, and compliance vary wildly between regions • LED is often wrongly grouped with laser and IPL — leading to unnecessary training costs and enforcement action.
Local Authorities Are Set Up to Fail • Licensing teams are expected to classify treatments they are not trained to understand • No national guidelines exist to support their risk assessments • Enforcement is uneven, and inspection standards differ from one council to the next.
The Public Is Left Unprotected • A person receiving an LED facial in Camden may be covered by council oversight • That same person could receive the identical treatment across the border with no oversight at all.
6. Will The New Licensing Scheme Solve This?
The Health and Care Act 2022 empowers a national licensing regime for non-surgical cosmetic procedures, defined as: (a) Injectables (Botox, fillers) (b) Penetrative substances (chemical peels, mesotherapy) (c) Needle-based treatments (microneedling, thread lifts) (d) Thread placement under the skin (e) Application of light/electricity/cold/heat (LED, laser, IPL, cryolipolysis).
➡ LED is explicitly included, but massage, facials, barrier care, nail care, consultations, sunbeds, and saunas remain outside scope.
The issue: This national framework will work alongside existing local licensing regimes. Any council still using the 1982 or 1991 Acts will continue to enforce their own rules for those treatments and services excluded from the Health and Care Act 2022. The result is an overlapping, fragmented oversight system where different treatments in the same clinic are governed by different legal frameworks.
• Practitioners could be registered nationally for one treatment, but still subject to outdated, locally variable rules for another — within the same business.
• There is no published cost for the national licence, but practitioners may still be required to pay both national registration fees and local council licensing fees, depending on their treatment menu and location.
• A skin clinic offering microneedling and massage may need to obtain:
o A national licence for microneedling
o A local council licence for massage
o Two inspections, two systems, and two sets of fees
👉 This is not efficiency. It is duplication — and it creates more confusion for councils, practitioners, and the public trying to navigate or access these services.
7. Skin Is an Organ — Not a Service. The problem is not just structural. It’s conceptual. • Skin is the body’s largest organ — vital to barrier function, immune response, hormone interaction, and visible wellbeing • Whether it’s PRP or a cleansing facial, any treatment affecting the skin should be recognised as working on an organ • The current system treats skin care as a luxury service, not a health intervention — and that is where the model fails.
8. The Call to Action: National Oversight, Grounded in Health. Before we regulate, we must understand what we’re regulating.
The Skin Well® believes: • All treatments and touchpoints affecting the skin — from skin consultations to microneedling — should be defined, classified by risk, and nationally regulated • Consultations are not neutral — they involve decisions, recommendations, and long-term influence on the skin’s health • Councils should no longer bear the burden of writing by-laws — but instead enforce clear, nationally consistent standards • Practitioners should follow nationally recognised education pathways, such as S.C.I.M.™ (Skin Competency & Integrity Modules), to ensure evidence-based, organ-focused care • Oversight should be transferred to the Department of Health and Social Care, in recognition of the skin as a health organ — not a luxury surface.
9. A National Blind Spot
“We cannot regulate what we do not map.”
To The Skin Well’s knowledge:
No central record exists showing which councils have adopted the 1982 Act
There is no single source of truth outlining which of the 32 London boroughs (plus the City of London) license which treatments
There is no uniform fee structure, inspection protocol, or minimum training requirement
This fragmentation is not sustainable — and it undermines public confidence, practitioner safety, and council enforcement.
🔍 Case in Point: Bradford Council
Bradford licenses only four treatments under the 1982 Act: acupuncture, ear piercing, electrolysis, and tattooing. But its Environmental Health team has published clear guidance documents covering:Body piercing
Tattooing
Micropigmentation (semi-permanent makeup)
These documents confirm that skin-interface and cosmetic procedures are already treated as public health concerns — but without national oversight. Environmental Health teams are actively managing risk and issuing guidance. Yet each council determines its own licensing structure, definitions, and fees. For example, in Bradford, a practitioner offering tattooing, ear piercing, and electrolysis could face three separate registration charges, plus an administrative surcharge. In other regions, the same work might require fewer licences, or cost significantly more — or less. This example reinforces the core argument: skin-based procedures are already within the public health sphere, yet there is no national framework to align cost, risk, or responsibility.
10. The Way Forward. The Skin Well® is not calling for more bureaucracy. It is calling for clarity.
Any effective national framework must: • Begin with a definition of skin-facing treatments, not assumptions • Classify all treatments by level of risk to the skin barrier, function, and structure • Set consistent education and competency expectations, accessible through public routes • Position skin as part of the UK’s wider health infrastructure — not just as a cosmetic concern • Relieve councils of the burden to create regulation and instead focus, where appropriate, on enforcement of nationally agreed standards.
11. The Illusion of Progress
By keeping the 1982 and 1991 Acts in place — with all their flaws — and layering a new national aesthetic licence on top, the government is not fixing the problem. It is masking it.
What looks like action is, in reality, a deflection.
The system remains fragmented.
The public remains unprotected.
Practitioners are confused — and financially burdened.
This isn’t progress. It’s policy by patchwork.
Connected Open Letters:
Open Letter #6 To England’s 317 Councils
📎 Appendix: Council Licensing Overview (Sample available soon) A sample of councils and their known licensing positions is provided separately. A full research audit is recommended as part of national oversight reform.
The Skin Well®
A grassroots, evidence-aware initiative supporting public skin education.
👉 @theskinwell_
Disclaimer
A Clear Case for National Skin Health is part of an independent advocacy series by The Skin Well™. These pieces are written from lived professional experience and personal reflection. They are intended to raise questions, highlight gaps, and explore opportunities for public health improvement.
They do not replace professional medical advice, and they do not represent the views of the NHS or any governmental body.
It should not be used as a substitute for professional medical advice, diagnosis, or treatment. If you have concerns about your skin or health, please speak with your GP or a qualified healthcare provider.
I welcome constructive feedback. If you notice any information that may be inaccurate or outdated, please let me know so I can review and improve.
© 2025 Jacqui de Jager | The Skin Well® & The Happy Skin Clinic®
All rights reserved. This leaflet is for personal use and education only. It may not be reproduced, distributed, or adapted without written permission.