THE CHISLEHURST MEDICAL PRACTICE
This document and the information contained therein is the property of THE CHISLEHURST MEDICAL PRACTICE.
This document contains information that is privileged, confidential or otherwise protected from disclosure. It must not be used by, or its contents reproduced or otherwise copied or disclosed without the prior consent in writing from The Chislehurst Medical Practice.
Author and Role
Jenny Wright, Practice Manager
The Chislehurst Medical Practice
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The policy applies to all employees and Partners, and also applies to other people who work at the practice e.g. self-employed staff, temporary staff and contractors.
The purpose of this document is to ensure conformity in order to achieve a good standard of medical practice. This is achieved by enabling the patient to have a chaperone present during the consultation and clinical examination of the patient. Medical examinations can, at times, be perceived as intrusive by the patient, having a chaperone present protects both the patient and staff member.
This document and any procedures contained within it are non-contractual and may be modified or withdrawn at any time. For the avoidance of doubt, it does not form part of your contract of employment.
TRAINING AND SUPPORT
The Practice will provide guidance and support to help those to whom it applies understand their rights and responsibilities under this policy. Additional support will be provided to managers and supervisors to enable them to deal more effectively with matters arising from this policy.
WHY AND HOW IT APPLIES
All clinical staff may at some point be asked to act as a chaperone at The Chislehurst Medical Practice. Therefore it is essential clinical personnel are fully aware of their individual responsibilities when performing chaperone duties.
The Practice aims to design and implement policies and procedures that meet the diverse needs of our service and workforce, ensuring that none are placed at a disadvantage over others, in accordance with the Equality Act 2010. Consideration has been given to the impact this policy might have in respect to the individual protected characteristics of those to who it applies.
DEFINITION OF TERMS
A Chaperone can be defined as an “independent person, appropriately trained, whose role is to independently observe the examination/procedure undertaken by the doctor/health professional to assist the appropriate doctor-patient relationship” .
RAISING PATIENT AWARENESS
At The Chislehurst Medical Practice, the chaperone policy is clearly displayed in the waiting area (see Annex A), in all clinical areas and annotated in the practice leaflet as well as on the practice website. The importance of a chaperone should not be underestimated nor understated.
PERSONNEL AUTHORISED TO ACT AS CHAPERONES
A variety of people can act as a chaperone in the practice. Where possible, it is strongly recommended that chaperones should be clinical staff familiar with procedural aspects of personal examination. Where suitable clinical staff members are not available the examination should be deferred.
Where the practice determines that non-clinical staff will act in this capacity the patient must agree to the presence of a non-clinician in the examination, and be at ease with this. The staff member should be trained in the procedural aspects of personal examinations, comfortable in acting in the role of chaperone, and be confident in the scope and extent of their role. They will have received instruction on where to stand and what to watch and instructions to that effect will be laid down in writing by the practice.
Patients must be advised that a family member or friend are not permitted to act as a chaperone as they have not received the requisite training nor do they have the clinical knowledge required. However, they may be present during the procedure / examination if the patient is content.
It may be appropriate to offer a chaperone for a number of reasons. All clinicians should consider using a chaperone for some or all of the consultation and not solely for the purpose of intimate examinations or procedures. This applies to whether the clinician is the same gender as the patient or not.
Before conducting any intimate examination, the clinician should:
- explain to the patient why an examination is necessary and give the patient an opportunity to ask questions
- explain what the examination will involve, in a way the patient can understand, so that the patient has a clear idea of what to expect, including any pain or discomfort
- get the patient’s consent before the examination and record that the patient has given it
- offer the patient a chaperone
- give the patient privacy to undress and dress, and keep them covered as much as possible to maintain their dignity; do not help the patient to remove clothing unless they have asked you to, or you have checked with them that they want you to help
- if the patient is a young person or child, you must:
- assess their capacity to consent to the examination
- if they lack capacity, seek parental consent.
Ensuring the patient fully understands the why, the what and the how of the examination process should mitigate the potential for confusion.
The Role of The Chaperone
The role of the chaperone varies on a case by case basis, taking into consideration the need of the patient and the examination or procedure being carried out. A chaperone is present as a safeguard for all parties and is a witness to continuing consent of the examination or procedure. Chaperones may be expected to:
- provide emotional comfort and reassurance to patients
- to assist in the examination (handing equipment to clinicians)
- assist with undressing the patient
- provide protection for the clinician (against unfounded allegations or attack)
- witness the procedure (ensuring it is appropriately conducted)
- if applicable act as an interpreter
- The chaperone will enter the room discreetly and remain in the room until the clinician has finished the examination.
- The chaperone will normally attend inside the curtain at the head of the examination couch and watch the procedure.
- To prevent embarrassment, the chaperone should not enter into conversation with the patient or GP unless requested to do so, or make any mention of the consultation afterwards.
- The chaperone will make a record in the patient’s notes after examination. The record will state that there were no problems, or give details of any concerns or incidents that occurred.
- The patient can refuse a chaperone, and if so this must be recorded in the patient’s medical record.
The clinician carrying out the examination or procedure must ensure they satisfy themselves that the chaperone will:
- be sensitive and respect the patient’s dignity and confidentiality
- reassure the patient if they show signs of distress or discomfort
- be familiar with the procedures involved in a routine intimate examination
- stay for the whole examination and be able to see what the doctor is doing, if practical
- be prepared to raise concerns if they are concerned about the doctor’s behaviour or actions.
If any doubt exists, the clinician should discuss the sensitivity of the role with the chaperone, prior to carrying out the procedure or examination.
COMPETENCIES AND TRAINING
Chaperones should undergo training which enables them to understand:
- what is meant by the term chaperone
- a knowledge of the range of examinations or procedures they may be expected to witness
- why they need to be present, including positioning
- their role and responsibilities as a chaperone
- how to raise concerns in conjunction with practice policy
- the rights of the patient
- the requirement to annotate their presence on the individuals healthcare record post consultation
Training will be undertaken by all staff who may be required to act as a chaperone at The Chislehurst Medical Practice Training is provided in-house by a GP Partner. The practice manager will provide further information on local training.
In a diverse multicultural society, it is important to acknowledge the spiritual, social and cultural factors associated with the patient population. Clinicians must respect the patient’s wishes and where appropriate refer them to another practitioner to have the examination or procedure undertaken.
Local guidance should be sought regarding patients suffering from mental illness or those with learning difficulties. A relative or carer will prove to be a valuable adjunct to a chaperone.
Chaperones are to ensure they adhere to the practice Caldicott and information governance policies. The clinician carrying out the examination or procedure should reassure the patient that all clinical staff within the practice fully understand their obligation to maintain confidentiality at all times.
If a chaperone was not requested at the time of booking the appointment, the clinician will:
- offer the patient a chaperone, explaining the requirement (read code 9NP0) and if the patient agrees
- contact reception and request a chaperone
- record in the individuals’ healthcare record that a chaperone is present and identify them (read code 9NP1)
- the chaperone should be introduced to the patient
- the chaperone should assist as required, but maintain a position so they are able to witness the procedure / examination (usually at the head end)
- the chaperone should adhere to their role at all times
- post procedure or examination, ensure they annotate in the patient’s healthcare record that they were present during the examination and there were no issues observed
- the clinician will annotate in the individuals healthcare record full details of the procedure as per current medical records policy
Should an individual refuse to have a chaperone present, this is also to be annotated using the read code 9NP2. If, for reasons outwith the control of the clinician there are not chaperones available, this should also be recorded using the read code 9NP4.
The relationship between the clinician and patient is based on trust and chaperones are a safeguard for the both parties at The Chislehurst Medical Practice The role of a chaperone is vital in maintaining a good standard of practice during consultations and examinations. Regular training for staff and raising patient awareness will ensure this policy is maintained.
Annex A – Chaperone Policy Poster
THE CHISLEHURST MEDICAL PRACTICE
This practice is committed to providing a safe and comfortable environment and strives to achieve good practice at all times.
All patients are entitled to have a chaperone present during any consultation, examination or procedure. Clinicians at this practice will advise patients a chaperone is necessary during any intimate examination; this is to safeguard both the clinician and you, the patient.
Where a chaperone is not available, the clinician will ask you to make an appointment and request the presence of a chaperone at the time of booking.
We only use staff who have received the appropriate training as chaperones they have knowledge of the examination or procedure you may be undergoing.
Family and friends are not permitted to act as chaperones as they do not have the knowledge required nor have they had the necessary training.
Should you wish to see the full chaperone policy please ask to speak to the Practice Manager. A copy of the policy is available on the practice website www.chislehurstmedicalpractice.co.uk
If you have any questions, please speak to the reception staff who will direct you to an appropriate member of the team.
 Definition of a Chaperone
 Intimate Examinations and Chaperones: Guidance
 Intimate Examinations and Chaperones: Guidance