Chaperone Policy

Bay Medical Group is committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is always followed, and the safety of everyone is of paramount importance. This policy is designed to protect both patients and staff from abuse or allegations of abuse, and to assist patients to make an informed choice about their examinations and consultations.

Our Chaperone Policy is advertised through the website and can be read at the Practice upon request. Posters are also displayed in the Practice waiting areas and clinical rooms, advising patients of their rights to use this service.

The Quality, Safety and Governance Team are responsible for reviewing and updating this policy.

What is a chaperone and who can request one?

A chaperone is a DBS checked and appropriately trained member of staff who is present during an examination or treatment of a patient. Their primary role is to assist the clinician undertaking the procedure in supporting the patient and to act as the patient’s advocate, being sensitive to their needs and respecting and maintaining their privacy and dignity.

All patients are entitled to have a chaperone present for any consultation, examination, or procedure where they consider one is required. Occasionally a healthcare professional may be the one to request a chaperone is present.

A chaperone may be a clinical or non-clinical member of staff, depending on staff availability, location and nature of the examination.

Home visits

If a chaperone becomes necessary during a home visit and family are not present, do not consent or are not suitable to chaperone, the clinician should contact a clinical colleague and arrange a joint visit. If a chaperone is not requested but the patient is at home or a location away form the surgery and on their own, increasing the risk of misunderstanding, the healthcare professional should ensure clear documentation and explain why the examination proceeded without a chaperone and that it was agreed with the patient.

Intimate examinations

The General Medical Council 2024 definition of an intimate examination is agreed to be, “examinations of the breast, genitalia and rectum, but could also include any examination where it is necessary to touch, examine intimate parts of the patient’s body digitally, or even be close to the patient”

For all intimate examinations a chaperone should be offered, however, a patient does not have to accept this. It is also acceptable for a healthcare professional to perform an intimate examination without a chaperone if the situation is life-threatening or time critical.

When can a chaperone be requested?

At Bay Medical Group we encourage patients to ask in advance of their appointment if they need a chaperone, however, sometimes the need for a chaperone cannot be foreseen or a patient may change their mind as the consultation progresses. As we aspire to assist as many patients as possible:

• Children and young people should always be offered a chaperone
• The clinician should offer use of a chaperone before beginning any examination
• Signs are in every waiting area and clinical room reminding patients of their right to ask for a chaperone at any time

We respect that our patients have individual values regarding privacy, dignity and intimacy and we will consider your preferences in relation to your choice of chaperone, including considerations relating to sex, religious belief or other personal circumstances.

We also appreciate some patients may have additional needs, such as communication difficulties or learning disabilities, and we will make reasonable adjustments to ensure they understand this offer and feel supported. If a patient cannot make an informed decision, the healthcare professional must use their clinical judgement and be able to justify their decision to proceed or otherwise.

Availability of chaperones

If a patient requests a chaperone on the day of their appointment and one is not available, the consultation/examination should be rearranged for a mutually convenient time when a chaperone can be present, unless the healthcare professional feels the delay in examination would be inappropriate.

If postponing an examination would pose risk due to the severity of the condition, this must be explained to the patient and recorded in their clinical notes. The decision to proceed or defer should be made collaboratively, between the patient and the healthcare professional.

Prescence of family members or carers

The presence of a family member, parent or carer does not automatically replace the need for a formal chaperone. However, the patient may wish to decline the offer of an

organisational chaperone if they feel their family member or carer is able to provide the support they need.

Any intimate examination on a child or young person under 18 years of age should be carried out in the presence of a formal chaperone. A parent, carer or someone known and trusted by the child may also be present during the examination or procedure to provide reassurance. Parents, carers and guardians must receive an appropriate explanation of the procedure to be able to provide informed consent when the young person is unable to do so themselves.

Situations where a chaperone is requested by the healthcare professional

Healthcare professionals will consider whether an intimate or personal examination of a patient is justified, or whether the nature of the consultation poses a risk of misunderstanding. If there is a risk of misunderstanding, the healthcare professional may request a chaperone directly.

If a healthcare professional wishes to conduct an examination with a chaperone present but the patient does not agree to this, they must clearly explain why they want a chaperone to be present. The healthcare professional may choose to consider referring the patient to a colleague who would be willing to examine the patient without a chaperone, if available, or request this is rebooked, providing the delay would not have an adverse effect on the patient’s health.

Patient declination of chaperones

Patients have the right to decline a chaperone for any reason, including personal, cultural or privacy concerns, because they feel a family member or carer will suffice, or because they do not feel it is necessary.

If a healthcare professional believes that proceeding without a chaperone would compromise professional standards or patient safety, they should postpone the examination until an appropriate chaperone is available. If the examination is to proceed, appropriate safeguards should be implemented, such as documenting the discussion and decision, maintaining clear and respectful communication and ensuring the examination takes place in a private and appropriate setting.

Starting a procedure or intimate examination

Prior to commencing a procedure or intimate examination, the healthcare professional should provide a clear explanation of what the examination will involve and why it is necessary. This is to ensure the link between the presenting symptoms and the proposed examination is understood, especially if they seem unrelated; for example, presenting with abdominal pains may require an intimate examination to aid investigation. This should be clearly documented by the healthcare professional, including confirmation of a patient’s capacity and best interest.

Healthcare professionals want every patient experience to be as comfortable as possible and will adopt a professional and considerate manner. Whilst humour can sometimes relax nervous or uncomfortable situations, this can easily be misinterpreted and should therefore be avoided.

A patient will always be provided with adequate privacy to undress and dress, and if clothing must be removed which may leave a patient overly exposed, they will be given provision of material to cover themselves during the consultation.

The chaperoning process and confidentiality

Patients should be reassured that all practice staff understand their responsibility not to divulge confidential information. To minimise information known, the chaperone should only be present for the examination itself and most discussion with the patient should take place while the chaperone is not in the room.

• The chaperone will enter the room discreetly and remain in the room until the clinician has finished the examination
• The chaperone will attend inside the curtain/screened-off area at the head of the examination couch and observe the procedure whilst maintaining privacy
• The chaperone will likely not converse with the patient or healthcare professional unless requested to do so, neither will they assist in any part of the examination unless they are of a clinical role and competent to do so
• The clinician will record in the notes that the chaperone was present and identify the chaperone (as well as any other person in attendance, e.g., parent or carer)
• The organisational chaperone will make a record in the patient notes after examination, stating the day, time, and the nature of the examination or procedure. The chaperone will be aware of the procedure to follow if they wish to raise concerns.

Chaperoning during remote consultations

During the Covid-19 pandemic we saw an increase in remote/digital consultations, many of which continue to be offered to patients. In these circumstances it is still important to consider using a chaperone where appropriate:

• A chaperone could be present with the practitioner (either virtually or in the same room) and could witness the nature and extent of the video examination that was undertaken
• The chaperone should be visible to the patient
• Their role, in this context, is to ensure the nature and extent of the assessment are appropriate and to protect the patient and practitioner from any suggestion the examination was inappropriate
• A family member of the patient is not an impartial observer and so would not usually be a suitable chaperone, but we will comply with reasonable requests to have such a person present as well as a chaperone, unless it would not be appropriate
• If a chaperone is not available, professional judgement should be used to carefully consider whether a remote examination method should proceed
• If we have concerns that a remote consultation may be filmed and about how that recording may be used, we will carefully consider whether a remote examination method should proceed. In line with our privacy statement, patients who record a private consultation should not share these recordings, and no filming should take place in public areas
• The healthcare professional will still document chaperone involvement, and the chaperone will still add a statement to the records; this should clearly state where they were in the room, as applicable.

If it is not possible to adequately assess a patient’s condition in this way, healthcare professionals should consider if a face-to-face consultation to examine the patient is necessary or signpost to other services where appropriate.