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.