GPs will struggle to implement new NHS requirements for chaperones, BMA warns
New requirements for NHS chaperones will be ‘challenging’ to implement in GP practices, the BMA has warned.
The union has raised concerns about recent guidance from NHS England regarding the role of chaperones in general practice, which seems to ‘significantly expand’ current policies.
At the end of last year, NHSE announced that all GP practices must prove they are following the principles of the Sexual Safety Charter by March, including reviewing their chaperone policies.
An NHS chaperone is an ‘appropriately trained member of staff’ who is present during an examination or treatment of a patient, assisting the clinician and acting as the patient’s advocate.
According to the specific guidance on chaperones, published in December, in all cases of intimate examinations a chaperone should be offered to the patient; and it specifies that any intimate examination on children and young people under 18 years ‘should be carried out in the presence of a formal chaperone’.
NHS England said that in general practice healthcare professionals working alone, especially during intimate examinations or in isolated settings including home visits, ‘face increased risk of their actions being misinterpreted’.
To mitigate this, practices should offer a chaperone in advance of the appointment ‘where possible’. Where this is not possible, they should ‘ensure clear communication and thorough documentation’ explaining why the examination proceeded without a chaperone present and that this was agreed with the patient.
NHS England said that local policies from ICBs should ‘clearly’ set out who can act as a chaperone and have as a ‘minimum requirement’ that anyone undertaking the role has received ‘appropriate training’.
It acknowledged that in GP practices there will be a greater need for the use of the wider non-clinical workforce as chaperones, but that they should still receive training.
Practices should display information about the chaperone policy in waiting areas, consultation rooms and on practice websites to ensure patients ‘are aware of their rights’, the guidance added.
And chaperoning policies should be applied to video, telephone and online consultations, with local policies explaining ‘how to protect patients’ when images are needed to support clinical decision-making.
In an update to members, the BMA’s GP committee warned that some aspects of the guidance will be ‘challenging to implement fully’ and that the chaperoning guidance presents ‘practical difficulties’.
The guidance requires chaperones for all intimate examinations of children, but the GPC pointed out that this would mean that for example, a GP carrying out a new baby check, or assessing nappy rash would need a chaperone, and this would need to be separate to the parent or family member bringing the child.
The GPC also said that practices will struggle to practically offer chaperones for online and telephone appointments.
It added: ‘The guidance recognises the challenges of lone working, but does not acknowledge the capacity constraints, nor the impact of small practice sizes as factors.
‘GPs and their practices treat the protection of patients and staff alike with the utmost seriousness, and while we support the principles behind this guidance and recognise the potential for staff isolation, the fact that so many consultations are one-on-one presents issues for practices regarding keeping all who use, and work in, the service safe.
‘ICBs will be expected to provide support for practices in implementing these new standards, but some aspects of the guidance will be challenging to implement fully, with the chaperoning guidance in particular presenting practical difficulties as the document represents a significant expansion of the typical practice policy.’
NHS England acknowledged that the provision of chaperoning in primary care will have ‘unique challenges’ including the one-on-one nature of many consultations, less observed team-working and patients being visited by lone clinicians.
It added: ‘The presence of a family member, parent or carer does not replace the need for a chaperone.
‘A chaperone is for the organisation to provide, under their organisational chaperoning policy, on request of the patient or their family or carer.
‘However, the patient may wish to decline the offer of a chaperone if they feel that their family member or carer is able to provide the support they need.’
In September, ICBs were asked to review their chaperone policies and ensure GP practices and primary care providers receive the support they need to keep staff and patients protected from sexual misconduct.
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READERS' COMMENTS [5]
Please note, only GPs are permitted to add comments to articles
If the NHS want add new requirements to the way we currently deliver services then it needs to be costed and included in our contract payment. In what other area of service delivery where a cotnractor is carrying out work for a client would this not happen?
Magical thinking in the NHS. Alive and well.
I found this wonderful local builder to build me a shed for my bicycle. We agreed size, and price and everything. 20 minutes after he started I told him I would also need it to be a little bigger, maybe like a garage, so I could park my car in it too. He grumbled a bit, but laid out the larger foundation and got to work on the blockwork for the walls. It didn’t look very wide, so I got him to enlarge it to take a second car, with space for a workshop at the back. He grumbled a little, but got some more bricks delivered, and carried on. He was doing so well, that when the walls were about 4 foot high, I told him I would also need a connecting door through into a 4-bedroom detached house with 3 reception rooms and a conservatory.
He grumbled a lot about not managing to finish it in time to watch the saturday soccer match, or go on his honeymoon to the Bahamas, but you know what these workmen are like. I told him to get stuck into it, as I needed it by the end of next month.
Then he started moaning about running out of money to purchase materials, so I told him to take out a loan, like everyone else would, but a couple weeks later he said the loan repayments were crippling him, and he could not afford to do it on the original price agreed.
So I went and found a new builder who would.
I like it DC…the Parable of the Beleaguered Builder…or is it of the Mercurial Master? 🙂
GPs and NHSE take note.
The hospital appointment tariffs are in the region of £160-£240 for initial appt and £70-£110 for follow up. I suspect block tariffs don’t reduce this that dramatically.
GP practice income / appointments (which represents maybe 50% of our time but let’s disregard that work) is around £25/appt.
We will need system of clinic HCAs without their own list, just supporting the consulting clinicians, with either enough of them to avoid regular over runs or reduction in the expectation of GP productivity whilst waiting for the HCAs.
So let’s split the difference between the lowest follow up cost, £70 and £25, and provide funding for GPs at £47.5 per consult – sorted!
Been a long time coming.