Dr Skin Surgery Ltd

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We looked for evidence that staff involved people in decisions about their care and treatment and provided them advice and support. Staff regularly reviewed people’s care and worked with other services to achieve this.

This is the first inspection for this registered provider since its registration with CQC. This key question has been rated as Good.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

Patient feedback we reviewed as part of this inspection indicated they felt involved in any assessment of their needs. Further patient feedback highlighted the clinician displayed a genuine connection and demonstrated real curiosity about what matters to them when assessments of skin conditions were reviewed and treated.

Most consultation appointments were 30 minutes long and surgery appointments were between 45 and 90 minutes long. This allowed flexibility of timings based on complexity of the surgical procedure and site of lesion.

Patients’ immediate and ongoing needs were fully assessed. The clinician also advised this assessment considered any previous problems with wound healing or if the patient had any long-term conditions that may impact wound healing, for example diabetes or rheumatoid arthritis.

The clinician spoke in detail, that every skin lesion, may not be what it seems. With this in mind and to ensure all skin concerns were assessed appropriately, every piece of tissue removed was sent for histology (a microscopic examination carried out by specialist pathologists, checking for any unexpected abnormal cells). All results were then shared with the patient and if required, their registered NHS GP.

Further discussions with the clinician highlighted how this additional step was crucial because some skin conditions can look completely normal on the surface but have underlying changes that need attention. By analysing every tissue sample, they were confident that nothing concerning is missed and that no further treatment is needed.

Staff assessed and monitored patients’ comfort during treatments to ensure patients were comfortable and the pain control (where appropriate) was effective. This included the use of, when appropriate topical local anaesthetic or solution via injection.

The clinician had effective systems and was active within the dermatology sector to keep up to date with current evidence-based practice. We saw evidence they assessed needs and delivered care and treatment in line with relevant current legislation, standards and guidance. These included the National Institute for Health and Care Excellence (NICE) and British Association of Dermatology (BAD) best practice guidelines. We saw patient literature and aftercare advice given to patients, included links to relevant guidance to further support their recovery.

We saw the clinic used a combination of treatments when delivering treatment. The clinician explained and described 4 different surgical techniques and methods used when delivering treatment, including, cryotherapy (treatment that involves the use of freezing or near-freezing temperatures), curettage (treatment in which tissue is scraped and removed), cautery (treatment used to burn and remove lesions) and excision (treatment that involves the removal of tissue using a scalpel or other cutting tool).

Despite the small team, staff worked well as a team to support patients accessing the clinic. Staff had access to the information they needed to appropriately assess, plan, and deliver people’s care, treatment, and support.

Staff had contacts within the sector and wider system including dermatology and the NHS.

In addition, the clinician worked well with the 3 host sites in terms of managing and coordinating work.

Staff supported patients to manage their health and wellbeing to maximise their independence, choice and control. The clinician supported patients to live healthier lives and where possible, improve clinical outcomes.

Where appropriate, staff gave people advice so they could self-care.

The clinic website and social media channels provided information to patients and included information and photos of the range of skin lesions treated at the clinic.

Advice about maintaining a healthy lifestyle and improving the outcome of treatment was shared with patients, pre- and post-consultations and treatments. This also included aftercare advice and expectations following treatments, for example, advising of the likelihood of a harmless skin blister following cryotherapy. Patient feedback we reviewed commented that the aftercare advice they received following the procedure was clear and informative.

The clinic routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people. However, whilst outcomes and activity was monitored, this information was not collated into audit or quality improvement activity. This was discussed during the inspection, the clinician responded positively, clearly understood the process of auditing and the benefits associated, and they told us they would formalise a programme of clinical audits to demonstrate, record and document improvements. This would be supported by a tool and analytic dashboard built into the clinical record system to enable effective audit.

Patients were advised about possible expected and unexpected side-effects following treatment and what people should expect in the days following any treatments. All consultations for treatment were carried out in person and if a follow up appointment was required due to concerns, this was arranged urgently.

Staff told people about their rights around consent and respected these when delivering person-centred care and treatment. Staff understood and applied legislation relating to consent. Capacity and consent were clearly recorded.

Attendance at the clinic was initiated by people. If people expressed an interest in taking up treatment, they were given sufficient information about the range of treatments available to reach a decision on whether to progress with a particular treatment. Patients were provided with clear and transparent information about fees and different costs associated with their treatment.

From our review of records, we saw the clinic monitored the process for seeking consent appropriately. Staff understood the requirements of legislation and guidance when considering consent and decision making.

Consent was obtained for the use and retention of photographs before and after treatments. This included specific consent for the use of photographs for marketing and training/teaching purposes.