Since the 1980s, England has relied on local legislation to license and regulate skin-facing treatments. However, this has led to postcode-dependent rules, inconsistent standards, and gaps in public protection. With the introduction of the Health and Care Act 2022, it is critical to examine how this new national scheme overlaps with two earlier frameworks — the Local Government (Miscellaneous Provisions) Act 1982 (Part VIII, updated 2003), and the London Local Authorities Act 1991 — and what should happen next.
1. The Current Landscape: A Patchwork of 317 Councils
England has 317 local authorities:
Metropolitan Districts: 36
London Boroughs: 32 + City of London (covered by the 1991 Act)
Unitary Authorities: 62 (plus the Isles of Scilly)
County Councils: 21
District Councils: 164
2. Two Historic Frameworks
Outside London: The 1982 Act (Adoptive)
The Local Government (Miscellaneous Provisions) Act 1982, Part VIII, gave local authorities discretion to adopt licensing powers for certain skin-related treatments. Councils that adopted it were required to draft local by-laws to implement and enforce those powers.
Treatments covered under the 1982 Act (initially or via amendment):
Tattooing (1982)
Ear Piercing / Cosmetic Piercing (1982; updated 2003)
Electrolysis (1982)
Acupuncture (1982)
Semi-permanent skin colouring – added by Section 120 & Schedule 6 of the Local Government Act 2003
⚠️ Outside London, massage, manicures, light, and heat-based treatments are not included under Section 15 of the 1982 Act, but may be regulated as “special treatments” under local by-laws, especially if the council adopted Schedule 3 provisions of the Act.
Inside London: The 1991 London Local Authorities Act (Mandatory)
The London Local Authorities Act 1991 introduced a mandatory licensing scheme across London boroughs. It expanded significantly on the 1982 Act by requiring licences for a wider range of treatments—primarily those associated with beauty and wellbeing services.
Treatments covered under the 1991 Act:
Massage
Manicures / Pedicures
Tattooing
Cosmetic Piercing
Acupuncture
Electrolysis
Light, electric, vapour, sauna, or other baths or treatments of a like kind
Semi-permanent skin colouring (added later through by-law updates)
✅ All 32 London boroughs and the City of London adopted this framework, consolidating their powers under the 1991 Act and generally not using the 1982 Act for these purposes.
3. The National Patchwork
Initial research suggests that most councils outside London have adopted the 1982 Act. However, because adoption was never mandatory — and because councils were left to define their own by-laws and update them (or not) over time — major inconsistencies remain.
This is particularly evident when it comes to treatments not explicitly listed in the original Act, such as:
Microneedling
LED therapy
Intraoral or buccal facial massage
Advanced electrical or heat-based facials
Chemical peels
Certain forms of cosmetic skin care (e.g. nanoneedling, enzyme resurfacing)
In some areas, these treatments may fall under vague by-law terms like "special treatments of a like kind" — but interpretation varies. One council may require a premises licence for LED or massage; another may not recognise them as licensable at all.
This results in a postcode-dependent system, where:
A treatment might be tightly regulated in one borough
Entirely unlicensed just a few miles away
Described differently by different authorities
Subject to varying inspection standards and enforcement
Even common services such as massage or facial waxing are inconsistently categorised — some councils treat them as routine salon activities, while others include them in their “special treatment” licensing scheme.
The consequence: No one — not practitioners, insurers, suppliers, councils, or the public — can reliably say what’s licensable where, or why.
It is not a system of proportionate risk. It is a system of accidental variation — shaped by historical choices, local resources, and uneven legislative updates.
4. The 2022 Licensing Scheme
The Health and Care Act 2022 introduces new licensing powers intended to apply nationally.
Under the Health and Care Act 2022 (c.31), Section 180(2), the following procedures are defined as requiring a licence:
“Cosmetic procedure” means a procedure, other than a surgical or dental procedure, that is or may be carried out for cosmetic purposes; and the reference to a procedure includes—
the injection of a substance;
the application of a substance that is capable of penetrating into or through the epidermis;
the insertion of needles into the skin;
the placing of threads under the skin;
the application of light, electricity, cold or heat.
(Source: UK Public General Acts, Health and Care Act 2022, c.31, Part 6, Section 180(2).)
A proposed ‘red, amber, green’ (RAG) risk categorisation system is expected to classify treatments based on their level of clinical and procedural risk — with procedures such as microneedling, injectables, and lasers likely to be included.
However, many treatments already licensed at a local authority level are not currently included in the national 2022 proposals, as outlined in the JCCP framework and referenced in the public consultation. These include treatments such as acupuncture, electrolysis, saunas, and other procedures already subject to local licensing requirements.
The consultation appears to have drawn heavily from the JCCP’s risk categorisation system, though it does not currently address the full range of treatments already in circulation or regulated at local level, such as:
Acupuncture, electrolysis, tattooing (licensed under the 1982 Act)
Massage, manicures, vapour, sauna, and other “like kind” treatments (licensed under the 1991 Act, in London)
This means that, once the 2022 scheme begins, practitioners may need to hold two separate licences:
A national licence for invasive or higher-risk procedures (e.g. microneedling)
A local licence (under either the 1982 or 1991 Act) for other treatments still excluded from the national framework
5. The Case for Reform
This overlapping model creates unnecessary complexity, cost, and confusion. Even where the same Acts are in use, council interpretations vary widely. For example:
Camden licenses 77 special treatments (but not facials)
Westminster licenses over 140 treatments (including facials)
The government now has an opportunity to resolve this by:
Replacing local frameworks with a unified national licensing system
Requiring clear, named listings of all skin-facing treatments
Mandating consistent national standards for non-medical, skin-facing work
Without this, licensing will remain fragmented — and public safety, transparency, and practitioner credibility will continue to suffer.
A full research audit is recommended as part of national oversight reform. (see appendix).
Appendix: Sample Council Licensing Audit Template
A proposed format for standardised national data capture as part of reform
| Treatment Type | Licensed? | Under which Act? | Licence Fee | Renewal Frequency |
|---|---|---|---|---|
| Massage | ☐ Yes ☐ No | e.g. 1982 / 1991 | £____ | ☐ Annual ☐ Biennial ☐ Other |
| Manicures / Pedicures | ☐ Yes ☐ No | |||
| Tattooing | ☐ Yes ☐ No | |||
| Microneedling (manual/device) | ☐ Yes ☐ No | |||
| LED Therapy | ☐ Yes ☐ No |
Full version available in The Skin Well™ Phase 3 research section.
6. A Final Note
Regulation is needed — but licensing can’t be the final stop.
The government’s current push for licensing is being presented as the alternative solution. But licensing only works if we know what we’re licensing, why, and to whom. At present, the proposed 2022 scheme still leans on inconsistent foundations (including treatments listed in Acts from 1982 and 1991) and leaves too much room for confusion, patchwork enforcement, and public misunderstanding.
That’s why this must be seen as a holding phase — not the final answer.
Licensing might provide short-term control, but GSAC and S.C.I.M.™ offer a path to real long-term oversight: grounded in risk, education, scope, and national health priorities. If implemented properly, that framework would make it clear:
What each treatment requires in terms of knowledge and risk management
What level of training is needed to deliver it
And who can safely and legally offer it
Until then, any licensing scheme will remain a stopgap — better than nothing, but still not good enough.
The Skin Well®
A grassroots, evidence-aware initiative supporting public skin education.
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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.