Practice Policies

Introduction

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.

Current GMC Guidance can be found on the GMC Website http://www.gmc-uk.org/guidance

Clinicians (male and female) should consider whether an intimate or personal examination of the patient (either male or female) is justified, or whether the nature of the consultation poses a risk of misunderstanding.

• The clinician should give the patient a clear explanation of what the examination will involve and ensure informed consent is obtained (please see consent policy)
• Always adopt a professional and considerate manner – be careful with humour as a way of relaxing a nervous situation as it can easily be misinterpreted.
• Always ensure that the patient is provided with adequate privacy to undress and dress.
• Ensure that a suitable sign is clearly on display in each consulting or treatment room offering the chaperone service if required.

This should remove the potential for misunderstanding.   However, there will still be times when either the clinician, or the patient, feels uncomfortable, and it would be appropriate to consider using a chaperone.   Patients who request a chaperone should never be examined without a chaperone being present. If necessary, where a chaperone is not available, the consultation / examination should be rearranged for a mutually convenient time when a chaperone can be present.

Complaints and claims have not been limited to male doctors with female patients – there are many examples of alleged homosexual assault by female and male doctors. Consideration should also be given to the possibility of a malicious accusation by a patient.

There may be occasions when a chaperone is needed for a home visit.  The following procedure should still be followed.

 

Who Can Act As A Chaperone?

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 trained staff members are not available the examination should be deferred.

 

Confidentiality

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

 

Procedure

• The clinician will request a chaperone.
• The clinician will record in the notes that the chaperone is present, and identify the chaperone.
• Where no chaperone is available the examination will not take place – the patient should not normally be permitted to dispense with the chaperone once a desire to have one present has been expressed.
• The chaperone will enter the room discreetly and remain in room until the clinician has finished the examination.
• The chaperone will normally attend inside the curtain.
• 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. Please see GMC Guidance

 

Guidelines

They are intended as in information resource for staff who may be asked to become chaperones.

All examinations will place patients in a situation in which they may 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.

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 procedure
• Protecting 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

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 training be that courses or in house.  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.

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.

 

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.

Where mental health patients are concerned, 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).

Useful Documents:

https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/intimate-examinations-and-chaperones/intimate-examinations-and-chaperones

You can be assured that anything you discuss with any member of the surgery staff, whether doctor, nurse or receptionist, will remain confidential. Even if you are under 16, nothing will be said to anyone, including parents, other family members, care workers or teachers, without your permission. The only reason why we might want to consider passing on confidential information without your permission would be to protect either you or someone else from serious harm. In this situation, we would always try to discuss this with you first.

If you have any worries or queries about confidentiality, please ask a member of staff.

If you would like to discuss matters of a confidential nature, either with our receptionists or a member of the dispensary team, we have a side room available in reception for this purpose.

The Data Protection Act  (Reviewed Statement 6^th Feb 2020)

The Data Protection Act 2018 controls how your personal information is used by organisations, businesses or the government.

The Data Protection Act 2018 is the UK’s implementation of the General Data Protection Regulation (GDPR).

Everyone responsible for using personal data has to follow strict rules called ‘data protection principles’. They must make sure the information is:

• used fairly, lawfully and transparently
• used for specified, explicit purposes
• used in a way that is adequate, relevant and limited to only what is necessary
• accurate and, where necessary, kept up to date
• kept for no longer than is necessary
• handled in a way that ensures appropriate security, including protection against unlawful or unauthorised processing, access, loss, destruction or damage

There is stronger legal protection for more sensitive information, such as:

• race
• ethnic background
• political opinions
• religious beliefs
• trade union membership
• genetics
• biometrics (where used for identification)
• health
• sex life or orientation

There are separate safeguards for personal data relating to criminal convictions and offences.

Your rights

Under the Data Protection Act 2018, you have the right to find out what information the government and other organisations store about you. These include the right to:

• be informed about how your data is being used
• access personal data
• have incorrect data updated
• have data erased
• stop or restrict the processing of your data
• data portability (allowing you to get and reuse your data for different services)
• object to how your data is processed in certain circumstances

You also have rights when an organisation is using your personal data for:

• automated decision-making processes (without human involvement)
• profiling, for example to predict your behaviour or interests

This practice is committed to preserving, as far as is practical, the security of data used by our information systems. This means that we will take all reasonable actions to;

Maintain the Confidentiality of all data within the practice by:

• Ensuring that only authorised persons can gain access to our systems
• Not disclosing information to anyone who has no right to see it

Maintain the integrity of all data within the practice by:

• Taking care over input
• Ensuring that all changes are reported and monitored
• Checking that the correct record is on the screen before updating
• Reporting all apparent errors and ensuring that they are resolved

Maintain the availability of all data by:

• Ensuring that all equipment is protected from intruders
• Ensuring that backups are taken at regular, predetermined intervals
• Ensuring that contingency is provided for possible failure or equipment theft and that any such contingency plans are tested and kept up to date

Additionally we will take all reasonable measures to comply with our legal responsibilities under:

• The Data Protection Act (2018)
• The Health and Safety at Work Act (1992)
• The Access to Health Records Act (1990)

The Practice staff shall always show due respect and courtesy when dealing with patients and their representatives. We respectfully request that patients and their representatives do the same when dealing with members of the practice team.

The NHS operate a zero tolerance policy with regard to violence and abuse and the practice has the right to remove violent patients from the list with immediate effect in order to safeguard practice staff, patients and other persons.

No form of aggression (whether verbal or physical in nature) will be tolerated – any instances of such behaviour on the practice premises may result in the perpetrator being reported to the Police and removed from the practice’s List of Registered Patients.

Violence in this context includes actual or threatened physical violence or verbal abuse which leads to fear for a person’s safety. In this situation we will notify the patient in writing of their removal from the list and record in the patient’s medical records the fact of the removal and the circumstances leading to it.