Upper Tribunal Tax and Chancery Chamber

UT/2023/000122 - [2025] UKUT 00341 (TCC)

Fecha: 06-Jun-2025

The FTT’s findings of fact

The FTT’s findings of fact

We can summarise the FTT’s background findings of fact at [43] – [62] of the Decision as follows:

(1)

Dr Shotter is a qualified doctor. She was training to become an anaesthetist but in 2012 decided to focus on aesthetic medicine and obtained a postgraduate diploma in aesthetic medicine from Queen Mary University of London. She treated patients in her own home, as well as offering treatments from three independent beauty salons. Initially she combined this work with working in the NHS but in 2014 she left the NHS and set up the Appellant. She is a full member and trustee of the British College of Aesthetic Medicine.

(2)

In VAT period 12/16 the Appellant offered treatments including Botox and dermal fillers, Aqualyx injections (which we understand reduce fat cells in specific parts of the body) and treatment for thread veins. Other services were offered including make-up and retail skincare products which, it was accepted, were standard rated for VAT purposes.

(3)

In the relevant period, Dr Shotter carried out all treatments herself and in October 2016 she saw about 55 patients. Treatment was not generally offered at a first appointment although it might be on occasion. The FTT records one example of a patient being treated with Aqualyx for a double chin on a first visit.

(4)

At least some of the treatment is “client-led” in the sense that a client might specify the treatment they wished to receive. Following a discussion of the risks and benefits, the client could insist on the treatment. The FTT gave two examples: One where a client had been diagnosed with fibromyalgia and had read about the benefits of B vitamins which was what the Appellant provided. Another where a client complained that her lines and wrinkles had not disappeared completely (possibly following a previous treatment, although it is not clear). The client insisted on Botox treatment despite being warned that this was likely to cause a relatively frozen look.

(5)

The Appellant does not routinely write to a client’s GP following a treatment. It would do so if the client had a health condition being managed by their GP and if the client gave permission.

(6)

The majority of the Appellant’s clients, some 85-90%, are women. Most are in their mid-thirties or above. The Appellant is not licensed to treat under-18s.

(7)

Since 13 August 2018 the Appellant has been registered with the Care Quality Commission. It was inspected on 5 October 2020 and rated as "Good" in terms of being "safe", "effective", "caring" and "responsive". It was "Well-led" at "caring for adults over 65 years" and "caring for adults under 65 years" and latterly at "treatment of disease, disorder or injury", "surgical procedures" and "diagnostic and screening procedures".

10.

The FTT also made findings of fact when it came to discuss the issues. It was provided with records completed by Dr Shotter which it regarded as good evidence of what was being done, and why. The FTT’s findings at [84] – [89] are particularly relevant for present purposes:

“84.
A "Medical History" would be taken, including questions about "Has your appearance ever caused you to lose confidence" and "Have you ever been depressed about your appearance".
85.
An A4 page records the "Initial Consultation". It records 5 things: the patient's age; "Patient Concerns"; "Examination"; "Diagnosis"; and "Plan".
86.
By way of example, two such "Initial Consultations" read, in full, as follows:
Initial Consultation 1
Age: [redacted]
Patient Concerns: Recently treated for breast cancer - surgery and chemo. Chemo has heavily caused facial ageing.
Examination: Fine lines and wrinkles to upper face. Lower face is heavy and loose skin.
Diagnosis: Collagen loss secondary to chemo.
Plan: 1. 2ml Volume and Vycross to midface to lift and stimulate collagen.
2.
3 areas Botox.
Initial Consultation 2
Age: [redacted]
Patient Concerns: Skin crepiness. Neck - so loose that wattle touches chest. Very upsetting. Excess fat on arms and abdomen despite weight loss, with skin laxity on top.
Examination: Neck - very severe sagging. Solar elestosis ++ to face.
Subcutaneous fat layer is very grabbable.
Diagnosis: Collagen loss. Excess fat.
Plan: 1. Aqualyx under chin
2.
CoolSculpting x 8 cycles to arms and stomach
3.
Facial volumesetion to stimulate collagen.
87.
The "Diagnosis" sections on the various forms which we have seen read collagen loss; excess fat; atrophic scarring; verrucae; filamestous wart; tension headaches; solar elestosis; facial asymmetry; skin excess; volume loss.
88.
These capture the scope of the Appellant's work in this period and give a clearer, more reliable, insight into the work of the clinic. None of these are diagnoses of any recognised health disorder.
89.
They are very cursory documents. They could not properly be described as scientific documents. It is conspicuous that, apart from age, and except for a very few exceptions, neither they (nor the so-called "Medical History") record anything about the patient's physical attributes such as height, weight, or any measurements at all such as blood pressure. They do not record the administration of any tests. There is nothing in the notes to suggest that any of the patients had been referred to the Appellant by another doctor, or for diagnosis of a particular condition. There is nothing in the notes to suggest that the Appellant was minded to refer the patient to another professional.”

11.

The undisputed evidence before the FTT records that intravenous vitamins were administered to treat fibromyalgia, Botox was used to treat collagen loss and headaches, Thermavein was used to treat verrucae and dermal fillers were used to treat collagen loss and sun damage.