1. Introduction
- The practice attaches the highest importance to ensuring that a culture that values patient privacy and dignity exists within our organisation. This policy applies to the care of patients who require clinical support of an intimate nature.
- Intimate and personal care is a key area of a person’s self-image and respect. The apparent intimate nature of many health care interventions, if not practised in a sensitive and respectful manner, can lead to misinterpretation and occasionally, allegations of abuse.
- Failure to understand the cultural background of a patient can lead to confusion and misunderstanding with some patients believing they have been the subject of abuse.
2. Scope of Policy
- This policy applies to all staff employed by Umbrella medical including General Practitioners, Doctors in training, Nurses, Healthcare Care Assistants, medical/nursing students and other staff including those employed by the PCN (primary care network), locums and bank/agency staff that are working on behalf of the practice and involved in the clinical care of patients.
3. Responsibilities
- All staff have a professional duty to care for patients. It is the responsibility of all healthcare professionals to manage and maintain professional boundaries.
- All clinical staff including Doctors, Nurses and allied healthcare professionals have responsibilities (including under their professional bodies) to act in their patient’s best interests and are accountable for their actions. Staff should be sensitive to differing expectations associated with race, ethnicity, culture, gender, disabilities and vulnerable people.
- Staff that provide clinical care of an intimate nature are responsible for ensuring that their actions comply with this policy nd also keep up to date with any new guidance produced by their own professional regulatory bodies (GMC, NMC etc).
- Patients should be informed of the practice’s chaperone policy, with written information being available either on the website or in the form of a leaflet.
- Chaperone advice posters are displayed on the Practice notice boards and in each consulting and treatment room.
4. Intimate Examinations
- Intimate examinations or procedures can be embarrassing or distressing for patients. Before a clinician carries out an intimate examination or procedure, it is essential that every effort is made to ensure patients feel as safe and in control of the situation as possible.
- Intimate examinations can be carried out for a variety of reasons (such as assessment, diagnosis, treatment and screening), and can take place in a variety of settings, including in person and remote consultations, such as by video-link or other digital technology.
- Intimate examinations are likely to include examinations of breasts, 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.
- Some patients may have particular concerns about undressing or exposing parts of their body but feel hesitant to speak up. Examinations by a member of the opposite gender are also, in some cultures and religions, effectively taboo.
5. Chaperones
- All patients have the right to have a chaperone present. A chaperone is an impartial observer present during an intimate examination of a patient. You should clearly explain to the patient what the chaperone’s role is.
- A chaperone is there for the patient. Their role includes helping to reassure the patient if they experience distress, protecting the patient’s dignity and confidentiality at all times, offering emotional support at an embarrassing or uncomfortable time or facilitating communication, especially if there is a language barrier.
- A chaperone also provides a safeguard for both patient and clinician, and can discourage unfounded allegations of improper behaviour. A chaperone should be given the chance to ask questions if anything about their role is not clear to them prior to the examination.
- The use of a chaperone when undertaking an intimate examination should be a consideration regardless of the gender of the patient i.e. even if the clinician and the patient are of the same gender. Their presence adds a layer of protection for the clinician, whilst acknowledging the patient’s vulnerability and helping to provide reassurance and support.
- Some patients may require a chaperone for other examinations too. For example, 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.
- Chaperoning must only be undertaken by appropriately trained staff, however, they do not need to be medically qualified.
- A chaperone must be prepared to raise concerns about a healthcare professional if misconduct occurs (Duty of Candour – CQC regulation 20). The Umbrella Medical Whistleblowing Policy & Procedure should be adhered to at all times.
- A relative or friend of the patient is not a trained impartial observer and so would not usually be a suitable chaperone. However, the presence of a chaperone does not override a patient’s wish to be supported by a relative, friend or advocate. You should comply with a reasonable request from the patient to have such a person present as well as a chaperone.
- Patients should be offered a chaperone to be with them during any intimate examination or procedure.
- The presence of a chaperone must be the expressed choice of the patient. This must be clearly documented in the clinical record.
- Patients have a right to refuse a chaperone and/or request someone different from the person originally offered to act as a chaperone.
- If a clinician is unwilling to conduct an intimate examination without a chaperone, they should explain to the patient why they would prefer to have one present. They may need to offer an alternative appointment or an alternative clinician who would be willing to examine the patient without a chaperone, as long as the delay would not adversely affect the patient’s health. Any such discussion must be documented in the clinical record.
- You should record the detail and outcome of any discussion about chaperones in the patient’s medical record. If a chaperone is present during an examination, you should record that fact and make a note of their identity and role. If the patient does not want a chaperone, you should record that the offer was made and declined.
6. Procedure when Conducting Intimate Examinations and Procedures
Prior to examination/procedure:
- Establish that there is a genuine need for an intimate examination/ procedure and discuss this with the patient.
- Explain to the patient why the examination/procedure is necessary and give the patient an opportunity to ask questions. Discuss any alternatives there might be, if any.
- Explain what the examination/procedure will involve in a way that the patient can understand, so that the patient has a clear idea of what to expect, including any pain or discomfort. Explain to the patient that they can ask at any time for the examination to stop.
- Always obtain the patient’s informed consent before the examination/ procedure.
- A record of consent must be obtained in accordance to the practice Consent to Examination and Treatment Policy.
- If the patient is a child or young person you must assess their capacity to consent to the examination. If they lack the capacity to consent, you must seek their parent’s consent or make sure you have other valid authority.
- If the patient lacks capacity to consent to treatment or examination (e.g. if they have severe learning difficulties), decisions may be taken by the clinician to act in the patient’s best interests. In scenarios, all action must be carefully considered and be in accordance with the Practice’s Consent to Examination or Treatment Policy, the GMC’s Good Medical Practice and all Government legislation, particularly the Mental Capacity Act 2005.
- Consider and address any communication barriers that could impact on the patient’s experience or understanding of an intimate examination. Where the patient is not able to fully understand the information given, it is the responsibility of the member of staff to explore ways of presenting information in a more accessible manner.
- When a patient decides not to give consent, they normally has the right to have their decision respected. Only in circumstances of immediate necessity, when the patient lacks capacity (see Mental Capacity Act, 2005), should an intervention be made.
- All staff will offer a chaperone to be present during the intimate examination/procedure and explain what their role will be. If a chaperone is present this must be recorded and a note made of the chaperone’s identity. Chaperones should also document their attendance in the medical records. Equally, if the patient does not want a chaperone, this should be recorded in the clinical notes.
- If for justifiable reasons a chaperone cannot be offered immediately this should be explained to the patient and an offer made to delay the examination/procedure taking into account their clinical needs. This discussion must be recorded along with its outcome.
- You should 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.
- Be aware and respectful of cultural differences.
- Advice on chaperones should be explored when routine appointments are made which will involve an intimate examination or procedure. For example: Cervical Screening.
During the examination/procedure:
- Explain what you are doing at each stage of the examination/procedure. If this differs from what you have told the patient before, explain why and seek the patient’s permission. Be prepared to stop at any time if the patient asks you to.
- The amount of the patient’s body that is exposed should only be what is necessary to carry out the examination/procedure.
- Keep comments professional and relevant to the clinical examination. Unnecessary personal comments may cause distress or offence.
- Check whether the patient has any questions during the examination but avoid unnecessary discussion with other staff members.
- Ensure the patient’s privacy and dignity is protected at all times.
- Invite the patient to tell you if the examination becomes uncomfortable. While performing the examination, be alert for any signs of pain or discomfort and check that the patient agrees for you to continue.
On completion of the examination/ procedure:
- Keep the presence of the chaperone to a minimum. There is no need for them to be involved in any subsequent discussion.
- Explain the outcome once the examination/procedure is complete and give an explanation of what you propose to do next.
- Address any queries relating to the examination/procedure.
- Clinician to record details of which staff member chaperoned. Record any other relevant issues or concerns immediately.
- The member of staff who was the chaperone should also document their attendance in the electronic patient medical record.
7. Chaperone training
All staff at Umbrella Medical will receive chaperone training either online via Agilio Teamnet or via in-house training every 12 months. New staff will receive chaperone training before commencing their role as a chaperone, once an Enhanced DBS certificate has been provided.
8. References
Intimate examinations and chaperones (General Medical Council Good Medical Practice December 2023)
Intimate examinations and the use of chaperones (Royal College of Nursing 2015)
Professional Standards of Practice and Behaviour for nurses, midwives and nursing associates (2018)
Regulation 11: Need for consent – Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Chaperones: The who, when and what of having a chaperone present during intimate examinations (MDU January 2022)