Chaperone Policy


 

Introduction 

The purpose of this policy is to ensure conformity of practice across all clinicians to ensure patients are correctly protected at times of perceived vulnerability and that a chaperone is routinely offered where appropriate. Medical examinations can, at times, be thought of as intrusive by the patient so having a chaperone present protects both the patient and staff member. 

Scope 

This document applies to all services provided by Solihealth Limited. 

It is a requirement that, where necessary, chaperones are provided to protect and safeguard both patients and clinicians during intimate examinations and or procedures. 

The sites used by Solihealth to provide services from are all CQC regulated premises and therefore are expected to have their own advertised chaperone policy. Policies may vary between sites especially with regard as to who can act as a chaperone. Some sites will have a policy of only using clinical colleagues, whereas another sites may choose to call upon trained and DBS checked medical receptionists especially if this means that a patients’ examination can proceed without the delay of a rebooked appointment. 

This document describes in general terms what is expected of a chaperone policy and can be used to check against sites own chaperone policy to ensure that the minimum standards are met. The requirement to advertise the sites chaperone policy and chaperone availability forms part of the premises checklist used by Solihealth when regularly assessing suitability for the provision of the service operating from contracted locations. This policy is also useful as a reference for Solihealth staff operating from site premises as they too can ensure they are adhering to the requirements for the provision of a chaperone. 

Equality and Diversity 

Solihealth Limited aims to design and implement Guidance documents that meet the diverse needs of the services, population and workforce, ensuring that none are placed at a disadvantage over others. It considers current UK legislative requirements, including the Equality Act 2010 and the Human Rights Act 1998, and promotes equal opportunities for all. 

This document has been designed to ensure that no-one receives less favourable treatment due to their personal circumstances, i.e. the protected characteristics of their age, disability, sex (gender), gender reassignment, sexual orientation, marriage and civil partnership, race, religion or belief, pregnancy and maternity. Appropriate consideration has also been given to gender identity, socio-economic status, immigration status and the principles of the Human Rights Act. 

In carrying out its functions, Solihealth Limited must have due regard to the Public-Sector Equality Duty (PSED). This applies to all the activities for which Solihealth Limited is responsible, including Guidance development, review and implementation. 

What is a chaperone? 

A chaperone is an impartial observer present during an intimate examination of a patient. They will usually be a health professional who is familiar with the procedures involved in the examination. The chaperone will usually be the same sex as the patient. 

Chaperone’s role 

A chaperone is there for the patient. Their function is to: 

  • reassure the patient if they experience distress 
  • protect the patient’s dignity and confidentiality at all times 
  • offer emotional support at an embarrassing or uncomfortable time 

A chaperone also provides a safeguard for both patient and doctor, and can discourage unfounded allegations of improper behaviour. 

In rare circumstances, the chaperone may also protect the doctor from physical attack. 

When to offer a chaperone 

Offer a chaperone routinely before conducting an intimate examination or any examination where the patient may feel uncomfortable, for example examination of an ear where it is necessary for the member of clinical staff to be near to the patient. A further example might be particularly vulnerable patients or those who have suffered abuse may need a chaperone for examinations where it is necessary to touch or be close to them This applies to both female and male patients. Cultural factors should be considered. This is important when examinations are performed by members of the opposite sex. 

In these circumstances, professional judgement should be used about whether to offer a chaperone, depending on the patient’s views and level of anxiety. 

What to note in the records 

The presence of a chaperone and their identity (name and full job title) in the records should be recorded into the notes. 

If an accusation of improper behaviour is made several years later and there is no record of who acted as chaperone, it would be difficult to recall who witnessed the examination. The record should reflect at which part of the consultation the chaperone was present. 

For patients who refuse a chaperone, you should record that you offered a chaperone but the patient declined. 

If the patient refuses a chaperone 

Patients have a right to refuse a chaperone. If the clinician is unwilling to conduct an intimate examination without a chaperone, an explanation should be given to the patient why it would be preferable to have one present. An alternative appointment, or an alternative doctor can be offered but only if the patient’s clinical needs allow this. 

No chaperone available/patient unhappy with chaperone 

When no chaperone is available or the patient is unhappy with the chaperone offered (for example, if they will only accept someone of the same gender), the patient can be asked to return at a different time, if this is not against their clinical needs. 

No pressure should be put on the patient to proceed without a chaperone. 

Children & Young people 

It is important that children and young people are provided with chaperones. The GMC guidance states that a relative or friend of the patient is not an impartial observer. They would not usually be a suitable chaperone. There may be circumstances when a young person does not wish to have a chaperone. The reasons for this should be clear and recorded. 

Current GMC guidance 

Current GMC guidance, Intimate examinations and chaperones (2013), says that doctors should offer the patient the option of a chaperone wherever possible before conducting an intimate examination, whether or not they are the same gender as the patient. The chaperone should usually be a trained health professional, although doctors should comply with ‘a reasonable request’ to have a family member or friend present as well as a chaperone.

Appendix 1

These guidelines should be read in conjunction with the Chaperone Policy [*]. They are intended as in information resource for staff who may be asked to become chaperones, either on a casual or one-off basis, or as a routine role.

All examinations may place patients in a situation in which they will feel uncomfortable, and this may be compounded further by the need to undress, consent to intimate touching or intrusive examination. The presence of a third party may alleviate some of these concerns and provide protection for both patient and clinician.

Where a chaperone is not routinely provided patients must be aware that they are able to ask for one without feeling difficult. The READ codes below must be used in all cases.

It is often not known prior to an examination commencing whether a chaperone will be desirable. Often, staff may be called upon to undertake this role without prior warning, enabling them to prepare. It is essential therefore that chaperones are trained in their role, familiar with what is expected of them in carrying this out, and understand the support aspects of the role for the patient.

Ideally, the clinician will have explained the nature of the examination, the reasons for it, and what is involved prior to it commencing, and will have given the patient the opportunity to have a chaperone present. Alternatively, the clinician may themselves have elected to have a chaperone present for their own security. Either way, it is important for at least one of the persons present that the third party is also there.

Role

This will vary a great deal, and may be passive (simply a presence in the room) or active (assisting with patient preparation or the procedure itself). It may involve:

  • Providing patient reassurance

  • Helping the patient to undress or prepare, or helping with clothing or covers

  • Assist with procedures (if a nurse or healthcare assistant)

  • Helping with instruments

  • Witnessing a procedureProtecting a clinician

  • Being able to identify unusual or unacceptable behaviour relating to a procedure or the consultation

  • Being able to identify whether the implied or implicit consent given at the start of the procedure remains valid throughout, and determine whether the attitude of the patient or the clinician has changed

Non-clinical staff should not be involved in the procedure itself and not normally enter into conversation with the patient in relation to this. It is expected that, in general practices, you will be specially and formally trained in your role, either through professional competencies (e.g. nurses) or through formal training courses delivered by the PCT or other bodies (reception or other staff). It is essential that you thoroughly understand what is expected from you, not only what the practice / the GP expects, but also what a patient may reasonably expect by virtue of your presence.

Clinical staff acting as chaperones may be the most appropriate staff group to undertake this role, as they may be able to interpret the procedure / examination, and form a judgement as to whether the actions are appropriate to the investigation or not. This is a fundamental part of the ability to reassure the patient. For this reason you, as a chaperone should be of the same sex as the patient.

As a chaperone you should bear in mind that the patient may decline to have you present (as an individual) whilst still requiring a chaperone generally. This is within the rights of the patient and should be considered as usual, and not a personal slight on your abilities.

The use of “informal”, casual or one-off chaperones drawn from the general practice staff should be discouraged.

Competencies

You should be comfortable in your role across a range of examination type, and if you do not feel confident in what you are being asked to observe, or how to do it, ask for guidance or further training, perhaps externally.

  • Understand your duties

  • Understand where you are expected to be at each stage of the examination, and what you are expected to hear, and observe

  • Understand the rights of the patient relating to your presence, and their ability to halt an examination

  • Understand how to identify concerns and raise them within the practice so that they are given a fair hearing in an objective manner, perhaps with other clinician, without causing offence. This should be done immediately following the consultation.

Considerations

In some cultures, examinations by men (on women) may be unacceptable. Some patients may be unwilling to undress, or raise concerns related to culture. These concerns should be respected and recorded, and in a similar way, if there is a language difficulty, it may be best to defer an examination until an interpreter is available.

When treating mental health patients, or those who may have difficulty in understanding the implications of an examination, it may be inappropriate to proceed until more secure arrangements can be made.

There may be instances where, as a chaperone, you may be required to act in this capacity outside the practice (e.g. on a home visit). Where a GP wishes to examine a patient in their own home where another family member may not be present, it may be more important that a chaperone is present, and you need to be aware of your responsibilities in these circumstances (e.g. do you leave the room whilst the examination is in progress to obtain a glass of water from the kitchen?)

Training

Formal training is recommended, preferably by your local PCT. You may discuss your role with your clinical trainer (e.g. senior partner) and obtain their endorsement for your attendance on a course, with a commitment to review your training on your return in order to:

  • formalise your role, and give you post-course support

  •  incorporate your training and views into your job description

  • establish the practice’s expectations of you based on what you have learned, and a “mode of operation” for you to adopt in a variety of situations

  • incorporate your role into the practice Chaperone Policy [*]

  • establish a recognised mechanism whereby you can discuss cases and concerns with another member of the clinical team (perhaps another GP) without awkwardness

  • agree refresher training at an appropriate interval

Appendix 2: Sign detailing Chaperone Policy

CHAPERONE POLICY 

Are you nervous about being examined? There are occasions when the doctor or nurse needs to give you a full examination. If you feel embarrassed about this we can arrange for someone to be there with you. 

We can arrange a chaperone who will be one of our trained members of staff at any time before or during your appointment. Just ask. If we can’t provide someone straight away you may need to return for the examination. 

Trust is important in the relationship between our clinical staff and you, our patient and we would, at all times, wish you to feel able to ask for a chaperone, should you require it 

Appendix 3: Alternate Text for Sign 

It is our policy to respect the privacy and dignity of our patients.

If you would like a chaperone to be present during a physical examination / consultation, or if you would prefer to be examined by a health professional of the same gender as yourself, please let us know and we will do our bet to comply with your wishes.

Further information regarding our chaperone service is available from Solihealth Limited.