Naveen Cavale is CEO and Consultant Plastic Surgeon at the REAL Clinic, a small clinic near the Battersea Power Station, South London. He has offered The PMFA Journal his insights into the setting up, and running, of a new hospital.
The elevator pitch, the key selling point, for the REAL Clinic is this: young, fit, healthy patients can have their botulinum toxin, fillers, peels, consultation and day case surgery (under general anaesthesia, local, or sedation) all under one roof.
The South London-based operation is run by a team of clinicians, including Naveen Cavale alongside Robbie Walker (Ophthalmic Surgeon), Dr Neel Desai (Consultant Anaesthetist), Jonathan Hewitt (Physician) and Duncan Walker (investor and business advisor). This team speaks to what Naveen believes underpins a successful, small clinic such as his: the potential to diversify and the potential to operate as a viable business.
During the COVID-19 lockdown of March 2020, Naveen was working at the Cadogan Clinic (a learning opportunity Naveen stresses was one he was immensely grateful for), a private practice based in Chelsea, London. When the country started slowly opening up, and when the clinic reopened its doors the following July, they had never been busier. This busyness carried on into 2021. Naveen then thought about the model of a small hospital, which he came to view as a way forward for cosmetic surgery in the UK. A smaller hospital’s dimensions were too modest to be commandeered by the NHS, and their equipment was of no real use to the Nightingale set-ups dealing with the pandemic.
The REAL Clinic exterior.
This new perspective coincided with the ‘Zoom Boom’ in cosmetic surgery, a term coined to describe the way in which people became hyper-aware of their faces. Working from home, the lack of a commute, the potential for furlough, all resulted in an increased interest in cosmetic surgery. The masks used to try to halt the spread of the virus doubled as the ideal cover for recovery marks. This led to a surge in rhinoplasty and facial surgery across the latter part of 2020 and 2021. Due in no small part to the amount of time people were spending at home, these patients were both properly motivated and informed, as they had the time and resources to consider their decisions.
Building a clinic
Naveen is a strong advocate for these types of clinics, ones which have a compact team of experienced and, crucially, insured staff. He posits it as a better option for patients than them getting cosmetic procedures done cheaply abroad, or by someone who is not licensed or insured in this country. Naveen outlined that, rather than adapting a preexisting site, like Cadogan, it was more straightforward to build a clinic from scratch. This was made possible, largely due to the increase in available, affordable office space during the pandemic. The location for the clinic was identified in August 2020, and after a year of planning, and agreeing to the relevant terms, was occupied by August the following year. The REAL Clinic initially housed a first-floor reception, with retail and non-surgical spaces completed within four months of its occupation, and general anaesthetics administered in the building after only seven months. This all combines to cement why Naveen set up the clinic initially – as an example to show and encourage others to do the same, and to emphasise his interests in gathering competent surgeons ahead of a customer base.
The REAL Clinic interior.
Naveen Cavale worked as a specialist registrar and was trained, and trained others, within the NHS. He still works as a consultant for the NHS, and rose to the level of ‘Clinical Director’ at King’s College Hospital, an equivalent to a ‘Chief of Surgery’ role. He has since reduced his commitments there to being, as he puts it, a “part-time jobbing NHS plastic surgeon. He firmly believes that surgeons that tick all the boxes should follow this model of having aided in the training of others. To set his operation apart from this, Naveen consistently encourages non-surgical aesthetic specialists to come and work at the clinic, whether they specialise in botulinum toxin, fillers, skincare advice, and so on.
The multidisciplinary approach
The term which seems to underpin the REAL Clinic is multidisciplinary. Having set up the operation with an ophthalmic surgeon and consultant anaesthetist, Naveen always aims to emphasise this approach, which allows the clinic to diversify. Despite the clinic being composed only of Naveen, Robbie, Neel and the team they employ, they are able to run a lean, three-theatre operating clinic with only eight-and-a-half staff (the half being Naveen’s secretary, who is employed by both Naveen and the clinic). He aims to have vascular, gynaecology, maxillofacial and more surgeons working with him in the future, and wants to break down any territorial barriers wherein specialists may worry about others stealing their roles.
Naveen’s emphasis on multidisciplinarianism is further underlined by the clinic’s plans to incorporate lasers. Whilst there are not any up and running in the clinic currently, their use has been future-proofed. Each room is equipped to house a laser and intraoperative x-ray – the first one to be purchased will set the precedent for laser use, allowing the rest of the dominoes to fall.
In setting up the clinic, Naveen hired an adviser from the Care Quality Commission (CQC). Like an MOT on a car, as he puts it, the adviser put the clinic through its paces to test if it was ‘roadworthy’. Good money, well spent, as the clinic made it through with no issues. The CQC also ensures that the clinic practises within the National Institute of Health & Care Excellence (NICE) guidelines. Naveen similarly paid for advisers on financial partnerships, with no leases signed or staff hired until the clinic had a full financial map. The signing of the first lease coincided with the clinic first paying salaries, with the employees closely involved in the building of the clinic as well as the running of it.
In the summer of 2022, Naveen and his team encountered a problem on-site. The clinic had a patient who was under anaesthetic when they encountered an issue and thought they may need to transfer the patient to a hospital nearby. Naveen’s team got in touch with the hospital early, to avoid a last-minute show-up at its doors in an ambulance – this meant the hospital was aware of the situation and could expect the patient at any time. Thankfully, the situation was resolved, and the patient was home by the same evening after a five-and-a-half hour total intravenous anesthesia (TIVA) with full intubation (the same anaesthetic NHS day surgery units are now giving). Given that the REAL Clinic does not have overnight facilities, each case is a day case, although they can stay open overnight in an emergency.
There are certain criteria for full general anaesthesia, with patients requiring a BMI of less than 30, with no external issues, and it being applied to only ASA 1 and 2 patients. The resolution of the situation, that the clinic was able to administer full general anaesthetic and have the patient returned home in the same day, is an indication of how quickly things have moved and developed within the operation. The REAL Clinic is located near Battersea Power station, a huge development space which will soon count Apple among its neighbours. Naveen lives within a 10-minute cycle of the clinic, and stresses the importance of having an understanding of the area where a new clinic may be set up. He urges anyone intent on following this model to do it within a part of their own locale, where they know the layout, the demographic, and potential walk-in business.
Whilst footfall for the REAL Clinic is currently limited, Naveen makes explicit that he is not opening a shop and hoping to draw customers. Put another way, he is opening a barber shop and intending to have the best barbers in the world come and cut hair with him, and whilst these barbers will bring their clients with them, the number of customers is of secondary importance. The REAL Clinic stands as a testament to the wider implications of a newly built, diverse and streamlined operating theatre, one Naveen hopes will encourage other surgeons to come and practise.
To return to the multidisciplinary facets of the clinic, Naveen advises that anyone planning to embark on a similar venture must not do so alone. A plastic surgeon, or even two plastic surgeons, will quickly come unstuck. Rather, other specialists, particularly anaesthetists, not only broaden the reach of the clinic, but add security. With Robbie Walker working as part of the team, should the bottom fall out of the cosmetic surgery market, the clinic can still carry out ophthalmic procedures, reinforced by the COVID-19 backlog for operations such as cataract surgery. With its many offshoots, the clinic is a model of modernity.
You can get in touch with Naveen Cavale at the REAL Clinic via email: email@example.com
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