Nigel Mercer gives his views on the UK's medical tourism industry


The UK has many inbound medical tourists from all over the world. How big is the market and is it changing?

The market is growing and Harley Street relies on medical tourists for all sorts of medical procedures.  According to recent figures over 67,000 people came to the UK for treatment last year and this year the figure is expected to be close to 74,000, despite the economic downturn.

Why do people come to the UK, in particular for plastic surgery when it is surely cheaper to travel elsewhere, even in Europe?

Patients travel to the UK because it has a worldwide reputation for high quality surgery and medical expertise. In the last few years people have started coming back here for surgery in increasing numbers, they previously felt it was too expensive but cost is not the only driver for people seeking surgery.   The reputation of the UK for plastic surgery is very high internationally and people don’t think they’re being ripped off.  Compared to some other destinations, we offer good value for money and more importantly high standards of clinical excellence, our facilities and doctors are well policed and everyone has liability insurance.  

Patients coming to the UK have the reassurance that all our hospitals and care facilities are full covered by the Care Quality Commission.  The Care Quality Commission is an independent body that regulates health and social care services whether in the private or public sector.  

Who comes to the UK for surgery and treatment?

People travel here from all over the world and Europeans like coming here because of our reputation and also because of the availability of cheap flights to the UK available from some European destinations.

How do UK plastic surgeons market themselves to foreign patients?

People generally find us through Google and the European Association of Plastic Surgeons (EURAPS) also has a website with details of British surgeons on it, and of course word of mouth.

Are there any problems with foreign doctors practising in the UK?

In the UK, doctors and surgeons are members of the GMC (General Medical Council Register), so quality and assurance is guaranteed although patients must still check out qualifications, registration and liability themselves. 

One of the main problems here in the UK is that you can get struck off but still practice abroad.  For example, the Swedish doctor that is responsible for Susan Hendry’s death removed himself from the GMC list before he could get struck off and is now practising in Sweden.  It is hard to find information about a doctor’s history if they have moved from one country to another and there is currently little transparency or a Europe-wide or worldwide database of medical practitioners.

You have recently spoken out in the UK press about your own and BAAPS members views on UK patients travelling abroad for plastic/cosmetic surgery and you often appear in the media warning potential patients about the pitfalls they may encounter when travelling abroad for surgery. Why is this?

The problem is that in some parts of Europe and the rest of the world doctor/surgeons are not regulated as strictly as they are here and UK patients need to be aware that standards of clinical excellence, pre and post operative care, levels of English spoken and medical training are different all over the world, for example you can qualify as a doctor in Italy without ever have seen a patient. 

Note: Currently no EU-wide system exists that enables patients or organisations to obtain reliable information about a foreign doctor’s fitness to practice and there are huge discrepancies throughout Europe around Doctor registration.  UK and Nordic countries are much more advanced in doctor registration of healthcare providers than many other countries in Europe.

The GMC are currently coordinating a working group called “Healthcare Professionals Crossing Borders" which is trying to set up a system with a template providing at least minimal information on healthcare providers moving abroad.

Additionally Transparency International and the Council of Europe and have been involved in drafting recommendations on good governance in healthcare which will put instruments of fraud prevention into place and which was approved last week in Brussels.

What advice would you give to providers and facilitators hoping to attract medical tourists in order to make their practices more attractive by offering potential patients certain assurances etc through self regulation/accreditation etc.?  

Provide credible and transparent patient information about doctor qualifications and standards of clinical excellence. The UK media love stories about people travelling abroad for surgery and having bad results which need to be fixed back in the UK. The press are more likely to publish a negative medical tourism story than a positive one and clinics and facilitators need to know and understand the impact this negative publicity this can have and act accordingly in order to attract foreign patients.

What are the top five countries patients are returning from with post-operative problems that need to be fixed back in the UK?

The top five countries from which cosmetic surgeons reported seeing patients return with problems were South Africa, Poland, Belgium, Turkey and Thailand. 

Mercer's advice to patients is sound and should act as good advice to facilitators and clinics/surgeons that they need to be self regulating and operate policies of transparency and have certain standards, accountability and accreditations, liability insurance and independently monitored codes of practice in place in order to assure potential patients about the treatment they will receive before, after and during their trip. 

How would you advise patients travelling for surgery?

The most fundamental advice I would give anyone is to choose the surgeon and not the company offering the service.  It’s so vital to do your research but then again how do you know what their qualifications mean?
It is essential that potential medical tourists need to be a bit more suspicious about going abroad.  My advice is that patients need to ask who is regulating facilities, especially Thai or Eastern European facilities, for example do they have an independent organisation monitoring the health services they are offering?  Patients haven’t got a clue about quality and it is up to the patient to do as much research as possible before choosing a surgeon or facility. 

Another crucial factor that patients must check out before they travel abroad for surgery is to check the hospital and doctor’s level of indemnity in case anything goes wrong. It’s also essential that patients find out whether the staff at a clinic or facility speaks English and that it is easy to communicate with everyone you will be dealing with.

Additionally as a patient you need to find out whether you can sue as a foreign national if you need to take legal action.

Ideally facilitators and medical travel companies should be asking all these and more questions on behalf of UK tourists but patients need to check with individual facilitators that these points are all covered.  In any event the facilitator (the third party) is liable for any errors that occur.

Are there are any dangers for people having cosmetic procedures in the UK?

Well, yes there are.  The biggest problem is in the unregulated area of facial fillers, which are non-surgical procedures. There is currently no regulation on cosmetic treatments.  Most people are unaware of this but anyone, and I mean anyone in the UK can give patients/clients facial fillers. 

What is the UK government doing about this?

We are making slow progress here, the government might be moving toward regulating the industry but the British Government won’t adopt the same regulations as the FDA (US Food and Drug Administration) on injectibles, it seems like our Government is constantly making excuses not do anything.

Is this the same in the rest of the world?

The rest of Europe wants legislation for injectibles but they are not considered medicine in the UK and don’t have to be tested for safety.  In the US only seven injectibles are licensed for us in the UK over 140 are licensed and anyone can use them.  At BAAPS we are campaigning hard to change this.  



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