DrDucu London

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

People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s personal and health needs. Care was mostly based on latest evidence. Staff worked well together to provide care and treatment to people to achieve best outcomes. They monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service did not always make sure people’s care and treatment were effective because staff did not consistently check or discuss people’s health, care, wellbeing and communication needs with them in a way they understood.
 

Clinical staff used a standard assessment tool to check whether patients were suitable for treatment. This included reviewing their current and past physical and psychological health, medical conditions, prescribed medicines and allergies. However, during the inspection we noted that these assessments were not documented clearly, and the assessment tool was not specific to the service.

The service had a pre‑operative assessment policy for staff to follow. It outlined the roles and responsibilities of staff and that all pre‑operative assessments must be undertaken by registered staff who had successfully completed relevant supervised practice. Patients told us they had a pre‑operative assessment before their treatment. The pre‑operative assessment process identified key risks and allowed staff to assess people’s needs and preferences. Prior to, during, and after a surgical procedure staff performed physical health checks including monitoring of blood pressure and heart rate.
 

Staff completed a daily huddle where they discussed all patients due to be treated that day and any risks and changes to standard procedure, for example extending an appointment time to allow for an interpreter if needed. Staff completed a full review of patients’ medical history prior to each treatment. We noted staff recorded any changes to, for example, medicines and general health, and we saw documented discussion notes of risks and impact.
 

Managers kept an up‑to‑date record of the total number of patients under the clinic’s care, including the number of new patients who had undergone a hair transplant. Many people were returning patients who attended the clinic for regular reviews or further treatments. The service did not report any post‑procedure infections or complications.

The service did not always plan and deliver people’s care and treatment with them, including
what was important and mattered to them.

Clinical staff told us they worked in line with national guidance and evidence‑based practice and had access to policies and procedures. However, several policies did not include a review date, which meant we could not be assured they reflected the latest national guidance.

Leaders reported that the clinic’s systems and processes supported evidence‑based care in line with national standards and NICE guidance, but we did not see any benchmarking or reference to these standards in practice. The absence of review dates on some policies was raised with the provider as a governance concern.
 

Managers audited staff compliance with evidence‑based practice through scheduled audits to identify where learning or development was required. Action plans were developed and implemented because of these audits. The service communicated changes to national guidance through staff meetings and email updates.
 

Staff received training on the Accessible Information Standard during their induction training. This was to enable staff to communicate with patients in the best way for the patient or their carer. Staff were made aware of the legislation and the responsibilities to support patients with a disability.

The service had a clear policy for ensuring patients waited a minimum of fourteen days from the point of consultation before they could consent to cosmetic surgical procedures in line with national guidance from the Royal College of Surgeons. This was so patients had time to think about the advantages and disadvantages of surgery before they decided if they wanted to go ahead with a procedure.
 

Staff worked collaboratively with patients when assessing and undertaking procedures. Patients told us they found staff to be knowledgeable and engaged well with them.
 

Leaders monitored staff performance to ensure they were working in line with evidence‑based practice. Staff told us they felt they communicated well with patients to understand how best to support patients with their procedures and treat them as individuals. Patients we spoke to during the onsite inspection confirmed this was the case.

People’s records showed there was input from a range of clinicians and that they shared information to ensure a consistent approach to care and treatment pathways.
Staff held regular and effective multidisciplinary meetings where required, to discuss treatment options for individual patients and improve their care. We reviewed clinical governance meeting minutes, which provided evidence of multidisciplinary discussions about patient care and agreed treatment options based on the individual medical needs of the patient. 

Monthly team meetings were minuted and circulated to staff. Minutes showed regular discussion of incidents, equipment, staff training and emerging risks, supporting communication and shared learning.
 

The service worked well across teams to support patients. Patients were asked to consent to the sharing of information with their GP. Patients advised us they felt the team worked well together and there was good communication between the clinicians, chaperones and patients and families.

The service supported people to live healthier lives and where possible reduced their future needs for care and support.

Staff reported routinely discussing health promotion and lifestyle choices with people using the service during the initial booking and consultation, as well as during aftercare. Advice included alcohol consumption and smoking cessation to support post‑operative recovery. Assessment questionnaires completed by people who used the service incorporated questions about healthy lifestyle habits. The provider’s website also offered information and guidance on healthier living in relation to aesthetic surgical procedures.
 

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. Whilst hair transplant procedure was usually undertaken to enhance the visual look of a patient the medical team recognised that baldness and hair loss was the result of some medical conditions, including alopecia, dermatitis, malnutrition, patients were advised to seek medical help from their GP prior to undergoing their hair
transplant procedures.

With the patient’s permission, the service wrote to their GP informing them of their diagnosis or treatment required. The service gave post‑operative advice on the care of the graft areas and maintained contact with patients to ensure that they did not experience any complications.

The service routinely monitored people’s care and treatment to continuously improve it. Staff ensured outcomes were positive and consistent, and they met both clinical expectations and the expectations of people themselves.

Outcomes for patients were positive and consistent and focused on patient satisfaction. Senior leaders told us they used before and after photographs to demonstrate outcomes. Patients spoke positively about the quality of the care and treatment they received. They reported positive outcomes after surgery such as an improvement in their health and wellbeing. Patients we spoke with said, they were pleased with their recovery and that they had been fully
informed about the recovery process and what to expect. An online patient review (ten reviews) showed all patients who reviewed the service were happy with the service and would recommend the service to their friends and family.
 

Patients said they felt listened to and were involved in discussions about their care and treatment. Staff told us patients were always followed up after a surgical procedure. In some cases, this follow‑up took place by telephone, but most reviews were carried out through face‑to‑face appointments or video consultations. Staff said patients were asked how well they felt the procedure had gone and whether the results met their expectations.

Patients spoke positively about the quality of care and treatment they received. They reported positive outcomes after surgery, including improvements in their emotional and psychological wellbeing. Patients said they were pleased with their recovery and told us they had been fully informed about the recovery process and what to expect.
 

All patients were asked to leave an online review of their treatment. All the patients we spoke with said they were pleased with the outcome of their procedure. They also said the post‑operative follow‑up exceeded their expectations. As well as face‑to‑face appointments, they could access unlimited virtual consultations with the lead doctor. Staff also held regular face‑to‑face or virtual follow‑ups to discuss satisfaction with the outcome of the procedure.

Staff had the appropriate skills and knowledge to seek consent from patients. Staff were clear on how they sought verbal informed consent and written consent before providing care or treatment. The consultants sought consent from patients undergoing surgery during the initial consultation and again on the day of surgery.

Staff clearly recorded consent in the patients’ records and made sure people consented to treatment based on all the information available. Consent forms showed the risks and benefits that were discussed with the patient prior to carrying out a surgical procedure. Records we reviewed showed consent forms had been signed, and patients had received a copy. The provider’s policy on consent to examination or treatment provided guidance to staff on how to
obtain consent. Staff told us they also sought advice from managers and the safeguarding lead if they needed support and guidance around consent to care and treatment.

All the staff we spoke with confirmed they had received training on providing consent and their responsibilities under the Mental Capacity Act (MCA) 2005, the training record we review confirmed this was the case. Staff knew how to access the service’s policies on consent. Staff understood the difference between informed and implied consent and ensured consent was documented in line with legislative guidance. Staff followed a pre‑assessment process that included a two‑week cooling‑off period. This ensured patients were provided with enough time
to investigate their treatment and provide informed consent. We checked five patient records
and noted consent was documented in line with guidance.
 

The service told people about their rights around consent and respected these when delivering person‑centred care and treatment. The service had a consent policy which outlined all staff’s roles and responsibilities. This was in line with national guidance and legislation, such as the MCA Patients told us they provided written consent prior to commencing treatment and all the risks and benefits of the treatment were clearly explained to them.
 

Consent for sharing information with the patient’s GP and other healthcare professionals involved in their care was obtained and documented within the care record booklet.
 

Where concerns for a patient’s capacity were identified, staff applied the MCA principles, and this was supported by the provider’s policy. Staff were aware of the legal requirements of the MCA and Deprivation of Liberty Safeguards (DoLS). This was incorporated within safeguarding training.