Archived: Harpal Clinic

Updated 27 June 2018

The Harpal Clinic is based at 4 Moorfields, London, EC2Y 9AA.

At the Harpal Clinic patients can access a service of preventative medicine. This includes nutritional therapy and education along with bioidentical hormone replacement therapy (the use of hormones that are identical on a molecular level with endogenous (natural) hormones) for conditions ranging from constant tiredness, recurrent mild headaches and chronic fatigue syndrome. The clinic also provides a service for smoking cessation, alcohol consumption and age related changes such as menopause and andropause. The practice provides services for patients that walk in to the practice for appointments as well as appointments booked via email.

The practice is situated in a property above shops in Central London close to Moorgate and Liverpool Street rail stations. The building is not accessible to people who use a wheelchair or mobility aid. The area is well served by public transport.

Two doctors work at the practice, one who is also the managing director of the company, a manager and two administrative staff.

Opening hours were:

Monday - 10.30am to 7.00pm

Tuesday 10.30am to 6.30pm

Wednesday 10.30am to 7.00pm

Thursday 10.30am to 7.30pm

Friday 10.30am to 6.30pm

Appointments were available within 24 hours. Patients can book by telephone or e-mail or by walking in to the practice.

We visited the Harpal Clinic on 28 February 2018. The team was led by a CQC inspector, with a GP specialist advisor.

Before the inspection we reviewed any notifications received from and about the service, and a standard information questionnaire completed by the service.

During the inspection, we received feedback from people who used the service, interviewed staff, made observations and reviewed documents.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions therefore formed the framework for the areas we looked at during the inspection.

Updated 27 June 2018

We carried out an announced comprehensive inspection on 28 February 2018 to ask the service the following key questions; Are services safe, effective, caring, responsive and well-led?

Our findings were:

Are services safe?

We found that this service was not providing safe care in accordance with the relevant regulations

Are services effective?

We found that this service was not always providing effective care in accordance with the relevant regulations

Are services caring?

We found that this service was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this service was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this service was not providing well-led care in accordance with the relevant regulations.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the practice was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008.

The Harpal Clinic provides a bespoke service to patients of preventative medicine for non-debilitating medical issues (such as constant tiredness, recurrent mild headaches and low libido), help with more serious medical issues (such as hypothyroidism, polycystic ovarian syndrome and constant fatigue syndrome), as well as smoking cessation, help with reducing alcohol consumption, stress, and diet. Treatment is carried out using nutritional therapy and education and bioidentical hormone replacement therapy. Only people over the age of 18 were treated at the clinic.

The company director of Harpal Clinic is the registered manager. A registered manager is a person who is registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Six people provided positive feedback about the service.

Our key findings were:

• The service had not undertaken any clinical audits.
• Patient consultations were undertaken before treatment commenced. This included the taking of a medical history and if any physical concerns identified, patients were referred to their GP before any further treatment.
• The service had systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the service had a system to learn from them and improve.

• The service used both the evidence based guidance of the National Institute for Clinical Excellence (NICE), and of the research undertaken in America
• The practice prescribed some off-lable medicines (a medicine licenced used for a different indication to that for which it is prescribedlicensed). Medicines used outside of their licence have not been assessed for quality, safety and efficacy by the Medicines and Healthcare Products Regulatory Agency (MHRA) to the same standard as licensed medicines.

• Staff involved and treated patients with compassion, kindness, dignity and respect.
• Services were provided to meet the needs of patients.
• Patient feedback for the services offered was consistently positive.
• There were responsibilities, roles and systems of accountability to support governance and management.

There were areas where the provider must make improvements:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care. For example the development of a programme of quality improvement, including clinical audit.
• Ensure care and treatment is provided in a safe way to patients.

There were areas where the provider could make improvements:

• Review systems for monitoring safety alerts.