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GPs are increasingly offering chaperones for intimate examinations, but for their own protection rather than because patients have asked for them.
Patients are also more likely to turn down a GP's offer because most chaperones are not appropriately trained.
A GP-led study by the University of East Anglia found
23 per cent of GPs never or rarely offered a chaperone, compared with 65 per cent 10 years ago.
However, actual use of chaperones had not increased as dramatically over the decade.
Of the 284 GPs in the Norfolk area who were surveyed, 45 per cent said they never or rarely used chaperones. The figure a decade ago was 65 per cent.
The study, published online by the BMJ, also found that in 58 per cent of cases the final decision on whether a chaperone was used rested with the GP, not the patient.
Authors Dr Shaun Conway, a GP in Norfolk, and Professor Ian Harvey, professor of epidemiology and public health, concluded: 'Ultimately the chaperone is there for the protection of the doctor rather than the patient.'
GPs said their main reason for offering a chaperone was the patient's 'reputation'. The patient choosing to have one was only the third most common reason given by GPs.
Professor Harvey said: 'There have been a number of high-profile cases and GPs increasingly feel the need to have this protection, while it would seem that trust levels are still high among patients.'
He added that patients could also be declining a chaperone because they were unhappy with the quality of the person being offered.
The survey found that in three-quarters of cases the chaperone was a practice nurse. In just under a fifth of cases a receptionist was used.
The Ayling Inquiry recommended that trained chaperones should be made available where possible and use of untrained administrative staff was unacceptable.
Dr Mayur Lakhani, RCGP chair, said he was not surprised by the findings because GPs feel under increased surveillance. 'In the absence of trained chaperones from outside the practice, what are GPs to do? Official studies recommend trained chaperones but this needs many resources.'
By Joe Lepper