Bricks and mortar
Most medical practitioners have, or aspire to have, their own premises. Depending on the location and size, the costs can seem prohibitive. However, many may not realise the tax benefits of property ownership, which can greatly influence the decision of whether to rent or buy, writes Martin Murray

Unless you are fabulously wealthy, most of you will have to resort to borrowing to secure the financing to buy your own premises. The interest that is paid on the loan is tax deductible. This is good news, as it reduces in real terms the cost of financing the property acquisition.
     Most banks in respect of new premises and for certain individuals will offer interest-only loans for, say, three to five years. The capital repayments can commence thereafter. Again, this is good as it can work out that the cost of borrowing for those first few crucial years is less than would have been the case if the property were rented.
     It sometimes pays dividends to have a premier bank account, because the manager responsible for your affairs will have more intimate knowledge of you and, therefore, support your business case to his or her other colleagues that may deal with your application. More lenders are moving into the cosmetic field. Even so, the more established banks such as Barclays and Royal Bank of Scotland are familiar with doctors’ affairs and are competitive.
     In my own firm, when a new consultant or doctor is looking at acquiring a premises—which may include his or her new home—they may be just starting their private practice and, as such, have little by way of self-employed earnings. This does not exclude them from being eligible for loans, as my partners and I will have knowledge of their anticipated earnings and this will be relayed to their bank manager.
     Apart from tax relief on interest payments, other tax breaks are available in the form of capital allowances. In respect of fixtures and fittings, these take the form of a tax break that can sometimes be within the fabric of the building to be bought and should be identified before purchase. Or if these are part of a new build they will need to be discussed with the architect before building commences. These assets can represent anything from, say, 10%–25% of the value of the building and for which tax relief can be claimed either immediately or over a short period.
     The identification of such assets can assist greatly in the cashflow of the new medical aesthetics business. Many doctors over the past few years have considered putting their properties into a pension scheme. These schemes are generally called self-invested personal pensions (SIPPs). Tax relief at the highest rate of 40% is possible on the transfer of the property into a SIPP. Specialist advice is needed before this is done, as other factors should be taken into account—not least that the property ownership now becomes that of the pension scheme. This may be an issue when the ownership of the property is shared between two or more doctors.

Mental Capacity Act 2005
When dealing with people who may lack capacity, you must be satisfied that the patients are fully competent. If necessary, you must be able to test them for capacity using the statutory tests, writes Simon Charlton

It is estimated that two million people in the UK lack the capacity to make decisions for themselves about their lives. The new Mental Capacity Act 2005 and its accompanying code of practice have important consequences for those involved in the care and treatment of such individuals. Steps should have been taken by now to ensure that such carers and their organisations are ready for the changes brought on by this act, including a review of all relevant policies and training of all staff likely to be affected. Failure to ensure appropriate training of relevant staff can expose both individuals and their employer organisations to civil and criminal claims against them.
     Aesthetic practitioners will need to be quite clear that when dealing with people who may appear to lack capacity, that the patients are fully competent and that, if necessary, they are able to test them for capacity using the statutory tests. They need to be alive to the possibility that patients could be under the influence of drugs or alcohol and, therefore, temporarily lacking capacity.
     It may be that those with certain illnesses have made advance decisions that they wish certain procedures to be undertaken in order to rectify the aesthetic damage caused by the illness or the subsequent treatment. Aesthetic practitioners will need to be quite clear that consent has been given in advance, that it is properly documented and that there are no clear reasons why this form of treatment should not be undertaken.
     If individuals do lack capacity, decisions can be made on their behalf in respect of healthcare, but clearly the benefits must outweigh the risks and should be in accordance with their previously known wishes. If there is any lack of clarity on this or concern, then the aesthetic practitioners should seek legal advice.
   
Peer Press Review
Professor Beniamino Palmieri reviews the peer press to report on advances made in medical aesthetics research

Experience with fibrin glue in rhytidectomy Kamer, Frank M. MD; Nguyen, Davis B. MD; Plastic & Reconstructive Surgery, 120(4):1045-1051, 15 Sept 2007.  Two hundred consecutive patients undergoing elective rhytidectomy were studied. One hundred patients received fibrin glue over one year and were monitored. Another 100 patients from the previous year who had not received fibrin glue had their charts reviewed retrospectively.  All patients underwent bilateral facelifts using the deep plane technique.
     The results of the treated patients against controls were an expanding haematoma rate, 1% (controls 3%, p>0.05); seroma rate, 1% (controls 7%; p>0.05); prolonged induration, oedema, and ecchymosis, 0% (controls: 22% (p<0.05). The pain score for glue versus controls was 100% minimal versus 95% minimal and 5% moderate (p>0.05). The average core for patient satisfaction (scale, 1 to 10, with 10 being best) for glue versus non-glue patients was 9.5 versus 9.0 (p>0.05).
     The use of fibrin glue was associated with some benefits for rhytidectomy. Fibrin glue eliminated the use of drains. The difference in expanding haematoma was clinically, but not statistically, significant. The seroma rate was decreased and neared statistical significance.  There was an impressive immediate decrease in postoperative swelling. The fibrin glue was most advantageous in eliminating prolonged induration, oedema, and ecchymosis. There were no statistical differences between groups for patient satisfaction or pain. The use of fibrin glue is effective to reduce some of the morbidity and severe complications of face lifting.Animal-based hyaluronic acid fillers: scientific and technical considerations