- Posted Wednesday November 14, 2012
The lack of definitive guidance on Chaperones in general practice has resulted in a wide variation across practices in the way they identify the need for a chaperone and how any policy is implemented.
Results from a 2009 survey carried out by the BMJ showed the following rather surprising results:
- Only 37% of GP’s who responded indicated that they had a Chaperone Policy
- 64% of male GPs USUALLY OR ALWAYS OFFERED a chaperone when carrying out an intimate examination but only 5% of female GPs did
- However 54% of Male GPs and 2% of female GPs actually used a chaperone
- 70% of female GPs never used a chaperone
Where Chaperones were used they were from a variety of sources including;
- 78% of GP's indicated that they used practices nurses
- 43% had used non clinical staff
- 47% of respondents had used a family member or accompanying person
- 22% had used medical students or GP registrars
Most importantly, at the time the survey was completed,
- 66% did not record the offer of a chaperone
- 71% did not record the identity of the chaperone
Several factors were identified that influenced the GPs use of chaperones which included:
- Time Constraints
- Doctor patient relationship
The requirement for Registration with the Care Quality Commission is putting pressure on practices to begin managing the issues of chaperones more carefully. There are several ways in which Chaperoning would support compliance with CQC.
- Outcome 1 of the Essential Standards of Quality and Safety relates to patients having their privacy, dignity and independence respected and that they understand the treatment and choices available to them.
- Outcome 4 also requires the individual needs of patients to be assessed and their safety and welfare is ensured
- Outcome 7 states that providers must have processes in place for preventing the possibility of abuse and for safeguarding patients whilst in your care
The Guidance on the use of chaperones
June 2005 saw the publication of guidance on the use of chaperones from the Clinical Governance Support Team:
Guidance on the Role and Effective Use of Chaperones in Primary and Community Care Settings – Model Chaperone Framework.
The guidance made several important points about the use of chaperone including the recommendation that practices have a policy in place and that all staff who perform the role have appropriate training.
Another important point made in the guidance is about the issue of gender – chaperones are most commonly used when a male clinician is carrying out an intimate examination on a female patient – and although allegations of inappropriate behaviour are very rare, this is the situation in which they are most likely to occur. However, allegations could be made, and have been, when a male GP is examining a male patient. The guidance suggests that a chaperone should be considered and offered in any circumstances where there will be an intimate examination or there are other circumstances that could involve risk such as when a patient may be undressed for a long period of time or where lights might be dimmed during a procedure – REGARDLESS OF THE GENDER OF THE PATIENT AND CLINICIAN.
Practice Chaperone Policy
There are several things that each practice needs to consider in meeting the best practice guidance and having a policy is the starting point. The first question the practice needs to agree is often neglected:
What is the purpose of the chaperone?
Once this has been established the policy can be created and training put in place. There are a variety of potential roles:
- Provide comfort and reassurance to the patient
- Assist in the procedure
- Assist the patient with dressing or undressing
- Provide protection against unfounded allegations
- Protect the clinician against an unpredictable patient
- Ensure best practice in the procedure being carried out
- In rare circumstances, act as interpreter
From this list it is clear that some of these roles could only be performed by people with clinical training. Regardless of which roles the practices decide to cover, the chaperone has to be “inside the curtain” to perform any of them. The guidance suggests that:
A chaperone is present as a safeguard for all parties and is a witness to continuing consent.
Other key elements of the guidance include the offering of a chaperone as a routine where it is known at the time of booking that a procedure will require an intimate examination – however, the need for a chaperone often does not become evident until part way through the consultation. The clinician should make the offer of a chaperone during the consultation and this should also be supported by information in the practice booklet and notices in the surgery about the patients’ right to request a chaperone for any consultation.
The final point for practices to take note of is the recording of the offer and acceptable of the chaperone in the consultation notes. It should be routinely coded in the notes and READ codes are available for:
- Chaperone offered
- Chaperone present
- Chaperone refused
- Nurse chaperone
It would also be advisable to record in free text the name of the person who acted as chaperone.
Training for Chaperones
As the guidance suggests, appropriate training should be given to all team members who may be asked to act as a chaperone – it is recommended that this includes:
- What is the role of the chaperone nod the practice policy
- What is meant by the term intimate examination
- When a chaperone may be required by the patient or by the clinician
- Understanding their role and responsibility
- The special needs of patients
- The policy and mechanism for raising concerns
Thornfields@fpm, the leading trainers for the primary care sector, provide a half day course on Chaperone Training which covers all of these key issues and focuses on the needs of special groups of patients such as children and young people, older patients and those with communication or cultural barriers. The course refers to CQC requirements and can be delivered on your practice premises. Please contact us for further details.