Since the Montgomery ruling in 2015, doctors must ensure that they understand a patient’s preferences and priorities in order to judge the volume and complexity of information to disclose during the consent process. The amount of time allocated to the consent process is known to be the strongest predictor of patient comprehension of their procedure and must be prioritised if dermatologists are to engage patients in truly shared decision-making. See the BAD’s guidance on consent – Guide to Validating Consent for Dermatology Examinations or Treatments 2017.

In November 2020, the GMC’s new consent guidance, Decision making and consent, came into force. This includes cosmetic interventions. The new GMC guidance is actually less prescriptive regarding communication of the level of risk, trusting doctors to use their professional judgement to apply the guidance in proportion to the specific circumstances of the decision.

The Paterson Inquiry and recommended 2020 report has brought renewed scrutiny of the relationship between surgeon and patient. The seventh anniversary of the Supreme Court’s landmark decision in Montgomery is a good time to review the current state of play on the law of consent and the implications for skin surgery.

If you are a staff grade, or associate specialist or dermatology trainee you should:

• Be accountable for your activities to a named lead consultant.
• Identify and agree the extent of your delegated responsibilities with a named lead consultant, including the level of the expected independent activity.
• Take responsibility for your continuing professional development, accessing support from your employer where appropriate.

If you are a locum dermatologist not on the specialist register you should be under the supervision of a named substantive dermatology consultant or surgical consultant where there is no substantive consultant in post.

See the BAD’s guidance on consent below.