Liverpool Skin Clinic

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• 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 assessed all 6 quality statements from this key question. Our rating for this key question has improved to good. We found people received care, treatment and support that was in line with legislation and current evidence-based good practice and standards. Staff worked well to support patients. Staff supported patients to make informed decisions about their care and treatment. They followed national guidance to gain patients’ consent.

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.

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.

People told us they had a thorough pre-operative assessment which addressed their concerns. They were confident that their individual needs had been appropriately assessed and were fully understood.

Staff told us that assessments considered the persons’ health, care, wellbeing, and communication needs, to enable them to receive care or treatment that had the best possible outcomes. The hair surgeon assessed a patient’s psychological wellbeing during the initial consultation, managed expectations with patients prior to procedure and had an exclusion criterion for patients who presented with body dysmorphic syndrome.

The service had a process of recording pre-operative assessment which included psychological assessments. We saw evidence of this on the pre-op proformas and consent forms.

The service monitored hair growth through pre, and post procedure photographs taken with the patient’s consent which was in line with CPSA guidelines.

Patients told us they understood the procedure they were having, and relevant risks had been discussed with them.

The hair surgeon told us that they attended international medical conferences annually which included other hair transplant surgeons and specialists in the field. They kept up to date with new research and shared this information with their team. Food and drink were provided during procedures with patients having the option of bringing their own. The service made adjustments for patients’ religious, cultural and other needs.

Staff could access an employee handbook with relevant policies and procedures and the required audits to be completed. However, policies were past their review date and audits were not always completed as per recommended schedule. Risk assessments and presurgical proformas were in line with CPSA guidelines. Service had surgical pro-forma of patients’ observations during hair transplantation which was a tool adapted from the World Health Organization (WHO). It included the National Early Warning Score 2 (NEWS2). However, some policies were based on non-nationally recognised guidelines. The provider could not evidence, in keeping with antimicrobial stewardship, the choice of antibiotics prescribed. No evidence including NICE Guidelines or other relevant guidance could be provided as a reference for choice of medicines.

Patients told us they felt involved in the planning of their care. They had received information explaining their procedures and what to expect throughout their appointments with the service. They spoke positively about the professionalism of the team.

Clinical and non-clinical staff told us the team worked well together to provide care and treatment for patients.

We reached out to an independent complaint advisory service and no concerns were raised with us.

At the time of our site visit, nobody was receiving care and treatment. However, the provider talked us through processes of how they would carry out procedures and showed us before and after pictures of patients whom they had provided care for and consented for their pictures to be used in this manner. We did not observe any patient interaction as there was no patient in the service at the time of inspection. The provider described how they would work with other health partners to support the patients’ needs.

Care and treatment were co-ordinated effectively among relevant staff. Hair transplants were completed by a GMC registered doctor who was assisted by a trained technician. The surgeon was expected to be present throughout entire procedure. Surgical notes included time records of procedure and time of surgeon departure after the procedure was completed.

People shared positive feedback regarding the aftercare the service provided.

Staff told us that each patient was given health teaching on post-hair transplant self-care and given a health information leaflet.

Aftercare health information leaflets included instructions for patients on how to care for their new transplants and promote future hair growth.

People told us they the service provided with adequate follow up appointments after their procedure.

The clinical lead told us that they ensured their patients had a comprehensive follow up schedule beginning the day after the procedure and lasted up to 1 year post hair transplantation. Whilst the clinic followed up patients at appropriate times following treatment, they reported that some patients declined further follow up at 12 months or earlier as they were satisfied with the outcome of the treatment.

The service recorded patients’ photographs in line with CPSA guidelines to monitor outcome of hair transplant procedure and hair growth.

The practice did not identify specific key performance indicators and therefore did not have a system of monitoring performance.

People told us they received information about care and treatment in a way they understood and had appropriate support and time to make decisions.

Staff told us that patients were given information regarding the procedure and hair transplant surgeon was available to respond to questions prior to signing consent and subsequently. Written consent was sought for photography, if the patient declined, their pictures would not be used on the service’s public platforms for advertising.

The service followed the Royal College of Surgeons Professional standards for Cosmetic surgery Guidance which included the “14 day cooling off” period. We saw evidence of this in the 3 patient records we looked at on site. Consent form included the patient’s rights to withdraw or alter consent any time before the procedure was carried out.