CHAPERONE POLICY

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.

Guidelines

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.
  • 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.

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 doctors treating/examining patients of the opposite gender – there are many examples of alleged assault by female and male doctors on people of the same gender.

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, but staff undertaking a formal chaperone role must have been trained in the competencies required. Where possible, it is strongly recommended that chaperones should be clinical staff familiar with procedural aspects of personal examination. Where suitable clinical staff members are not available, the examination should be deferred.

Where the practice determines that non-clinical staff will act in this capacity, the patient must agree to the presence of a non-clinician in the examination, and be at ease with this. The staff member should be trained in the procedural aspects of personal examinations, comfortable in acting in the role of chaperone, and be confident in the scope and extent of their role. They will have received instruction on where to stand and what to watch and instructions to that effect will be laid down in writing by the practice.  

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 contact reception to request a chaperone.
  • Where no chaperone is available, a clinician may offer to delay the examination to a date when one will be available, as long as the delay would not have an adverse effect on the patient’s health.
  • If a clinician wishes to conduct an examination with a chaperone present but the patient does not agree to this, the clinician must clearly explain why they want a chaperone to be present. The clinician may choose to consider referring the patient to a colleague who would be willing to examine them without a chaperone, as long as the delay would not have an adverse effect on the patient’s health. 
  • The clinician will record in the notes that the chaperone is present, and identify the chaperone.
  • 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.
  • 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 chaperone must be aware of the procedure to follow if they wish to raise concerns.
  • The patient can refuse a chaperone, and if so this must be recorded in the patient’s medical record. INFORMAL CHAPERONES Many patients feel reassured by the presence of a familiar person and this request in almost all cases should be accepted. This may not be deemed acceptable if a child is asked to act as a chaperone for a parent.    
  • Formal chaperones are clinical health professionals such as nurses or specifically trained non-clinical staff (such as receptionists). Formal chaperones should be:
  • FORMAL CHAPERONES
    • These may be informal or formal.
  • CHAPERONE TYPES
    • The same sex as the patient
    • Sensitive and respectful of the patient’s dignity and confidentiality
    • Prepared to reassure the patient if they show signs of distress or discomfort
    • Familiar with the procedures involved in a routine intimate examination
    • Prepared to raise concerns about a doctor if misconduct occurs
    • Prepared to be present throughout the examination – it is unlikely to be helpful to the doctor or patient to have a chaperone outside of the curtains during an intimate examination.

Reception staff should only be used as formal chaperones if they have been specifically trained in this role.

If a chaperone is not available and the patient or doctor feels that a chaperone is required, the appropriate course of action will need to be decided after discussion with the patient concerned. There are two options:

  • A decision to continue the examination without a chaperone may be made. In this case the discussion and decision must be recorded in the notes. This is likely to be particularly relevant when a delay in conducting the examination is considered to be detrimental to patient care – in which case the doctor should consider what is in the patient’s best interests
  • The patient may be invited back to have the examination on another occasion, within an acceptable time frame. In this case it is essential that the doctor ensures that a suitably trained formal chaperone or suitable informal chaperone will be available.

Cornford House Surgery & Fulbourn Health Centre Privacy Notice

How we use your information to provide you with healthcare

This practice keeps medical records confidential and complies with the General Data Protection Regulation and UK data protection legislation.

We hold your medical record so that we can provide you with safe care and treatment.

We will also use your information so that this practice can check and review the quality of the care we provide. This helps us to improve our services to you.

We will share relevant information from your medical record with other health or social care staff organisations when they provide you with care. For example, your GP will share information when they refer you to a specialist in a hospital, or your GP will send details about your prescription to your chosen pharmacy.

We use a medical record system called SystmOne. Other health and social care organisations, for example GP Out of Hours services and community services, who also use this system may have the ability to view your GP medical record when they are providing care to you. You may be asked if you are happy for your record to be viewed, or in some circumstances you may be sent a verification code to allow services caring for you to view your record. You can choose not to allow other organisations to be able to view your GP medical record.

Healthcare staff working in A&E and out of hours care may also have access to your information. For example, it is important that staff who are treating you in an emergency know if you have any allergic reactions. This information may be obtained from your Summary Care Record or from SystmOne. For more information see https://digital.nhs.uk/summary-care-records

You have the right to request to have any mistakes in your medical record corrected.

Other important information about how your information is used to provide you with healthcare

Registering for NHS care

All patients who receive NHS care are registered on a national database.

This database holds your name, address, date of birth and NHS Number but it does not hold medical information about the care you receive.

The database is held by NHS Digital, a national organisation which has legal responsibilities to hold the NHS register.

More information can be found at: https://digital.nhs.uk/services/systems-and-service-delivery/national-health-application-and-infrastructure-services/primary-care-registration or the phone number for general enquires at NHS Digital is 0300 303 5678

Identifying patients who might be at risk of certain diseases

Your medical records may be searched by approved computer programmes so that we can identify patients who might be at high risk from certain diseases such as heart disease or unplanned admissions to hospital.

This means we can offer patients additional care or support as early as possible.

This process may involve linking information from your GP record with information from other health or social care services you have used.

Safeguarding

Sometimes we need to share information so that other people, including healthcare staff, children or others with safeguarding needs, are protected from risk of harm.

These circumstances are rare.

We do not need your consent or agreement to share information in these circumstances, as we are required to do this.

Please see local policies for more information: http://www.safeguardingpeterborough.org.uk/

We are required by law to provide you with the following information about how we handle your information to provide you with healthcare.

Purpose of the processing:

To provide direct health or social care to individual patients.

For example, when a patient agrees to a referral for direct care, such as to a hospital, relevant information about the patient will be shared with the other healthcare staff to enable them to give appropriate advice, investigations, treatments and/or care.

To check and review the quality of care. This is called audit and clinical governance.

Lawful basis for processing:

These purposes are supported under the following sections of the General Data Protection Regulation:

Article 6(1)(e) ‘…necessary for the performance of a task carried out in the public interest or in the exercise of official authority…’; and

Article 9(2)(h) ‘necessary for the purposes of preventative or occupational medicine for the assessment of the working capacity of the employee, medical diagnosis, the provision of health or social care or treatment or the management of health or social care systems and services…”

Healthcare staff will also respect and comply with their obligations under the common law duty of confidence.

Recipient or categories of recipients of the processed data

The data will be shared with:

healthcare professionals and staff in this surgery;

local hospitals;

out of hours services;

diagnostic and treatment centres;

screening services;

or other organisations involved in the provision of direct care to individual patients

Organisations who help us manage our data for specific purposes, and under formal agreement, include:

Serco-ASP who provide our End of Life Care Dashboard for clinicians caring for patients who are terminally ill. For more information: http://www.sercoasp.com/

Cambridgeshire & Peterborough NHS Foundation Trust who help identify patients who are frail and may require additional care services. For more information: http://www.cpft.nhs.uk/

ICS Health and Wellbeing who send letters to patients on our behalf, inviting patients to attend a diabetes prevention service where we have identified them as being at risk of developing diabetes. For more information: https://icshealth.co.uk/

Right to object

You have the right to request to object to information being shared between organisations who are providing you with direct care.

This may affect the care you receive.

You are not able to object to your name, address and other demographic information being sent to, and held by, NHS Digital.

This is necessary if you wish to be registered to receive NHS care.

You are not able to object when information is legitimately shared for safeguarding reasons.

In appropriate circumstances it is a legal and professional requirement to share information for safeguarding reasons. This is to protect people from harm.

The information will be shared with the local safeguarding service(s).

Data we get from other organisation

We receive information about your health from other organisations who are involved in providing you with health and social care.

For example, if you go to hospital for treatment or an operation the hospital will send us a letter to let us know what happens. This means your GP medical record is updated when you receive care from other organisations.

How your information is used for medical research and to measure the quality of care

Medical research using population-based information

We share information from medical records:

to support medical research when the law allows us to do so, for example to learn more about why people get ill and what treatments might work best;

we will also use your medical records to carry out research within the practice.

This is important because:

the use of information from GP medical records is very useful in developing new treatments and medicines;

medical researchers use information from medical records to help answer important questions about illnesses and disease so that improvements can be made to the care and treatment patients receive.

You have the right to object to your identifiable information being used or shared for medical research purposes.

Medical research trials that individual patients may agree to take part in

If the practice takes part in a medical research trial, individual patients may be invited to be part of the trial. In order to take part, patients will be asked to consent to their data being used and shared for the particular research trial.

Checking the quality of care – national clinical audits

This practice contributes to national clinical audits so that healthcare can be checked and reviewed.

Information from medical records can help doctors and other healthcare workers measure and check the quality of care which is provided to you.

The results of the checks or audits can show where hospitals are doing well and where they need to improve.

The results of the checks or audits are used to recommend improvements to patient care.

Data is sent to NHS Digital which is a national body with legal responsibilities to collect data.

The data will include information about you, such as your NHS Number and date of birth and information about your health which is recorded in coded form – for example the code for diabetes or high blood pressure.

We will only share your information for national clinical audits or checking purposes when the law allows.

For more information about national clinical audits see the Healthcare Quality Improvements Partnership website: https://www.hqip.org.uk/ or phone 020 7997 7370.

You have the right to object to your identifiable information being shared for national clinical audits.

We are required by law to provide you with the following information about how we handle your information for research.

 Purpose of the processing

Medical research, and to check the quality of care which is given to patients (this is called national clinical audit).

Lawful basis for processing

The following sections of the General Data Protection Regulation mean that we can use medical records for research and to check the quality of care (national clinical audits)

Article 6(1)(e) – ‘processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller’.

For medical research: there are two possible Article 9 conditions.

Article 9(2)(a) – ‘the data subject has given explicit consent…’ (where an individual has agreed to take part in a specific research trial)

OR

Article 9(2)(j) – ‘processing is necessary for… scientific or historical research purposes or statistical purposes in accordance with Article 89(1) based on Union or Member States law which shall be proportionate to the aim pursued, respect the essence of the right to data protection and provide for suitable and specific measures to safeguard the fundamental rights and interests of the data subject’. (where data is used for medical research using population based information)

To check the quality of care (clinical audit):

Article 9(2)(h) – ‘processing is necessary for the purpose of preventative…medicine…the provision of health or social care or treatment or the management of health or social care systems and services…’

Recipient or categories of recipients of the processed data

For medical research the data will be shared with NHS

For national clinical audits which check the quality of care the data will be shared with NHS Digital.

Rights to object and the national data opt-out

Most of the time, anonymised data is used for research and planning so that you cannot be identified.

From 25th May 2018, the national data opt-out enables you have a choice about whether you want your identifiable confidential patient information to be used for research and planning.

To find out more or to register your choice under the national data opt-out, please visit nhs.uk. You can change your mind about your choice at any time.

 How your information is shared so this practice can meet legal requirements

The law requires the practice to share information from your medical records in certain circumstances. Information is shared so that the NHS or Public Health England can, for example:

plan and manage services;

check that the care being provided is safe;

prevent infectious diseases from spreading.

 We will share information with NHS Digital, the Care Quality Commission and local health protection team (or Public Health England) when the law requires us to do so. Please see below for more information.

 We must also share your information if a court of law orders us to do so.

NHS Digital

NHS Digital is a national body which has legal responsibilities to collect information about health and social care services.

 It collects information from across the NHS in England and provides reports on how the NHS is performing. These reports help to plan and improve services to patients.

 This practice must comply with the law and will send data to NHS Digital, for example, when it is told to do so by the Secretary of State for Health or NHS England under the Health and Social Care Act 2012.

 More information about NHS Digital and how it uses information can be found at:

https://digital.nhs.uk/home

NHS Digital sometimes shares names and addresses of patients suspected of committing immigration offences with the Home Office. More information on this can be found here: https://www.gov.uk/government/publications/information-requests-from-the-home-office-to-nhs-digital

 Care Quality Commission (CQC)

The CQC regulates health and social care services to ensure that safe care is provided.

The law says that we must report certain serious events to the CQC, for example, when patient safety has been put at risk.

 For more information about the CQC see: https://www.cqc.org.uk/

 Public Health

The law requires us to share data for public health reasons, for example to prevent the spread of infectious diseases or other diseases which threaten the health of the population.

We will report the relevant information to local health protection team or Public Health England.

For more information about Public Health England and disease reporting see: https://www.gov.uk/guidance/notifiable-diseases-and-causative-organisms-how-to-report

We are required by law to provide you with the following information about how we handle your information and our legal obligations to share data.

Purpose of the processing

 Compliance with legal obligations or court order.

Lawful basis for processing

 The following sections of the General Data Protection Regulation mean that we can share information when the law tells us to:

Article 6(1)(c) – ‘processing is necessary for compliance with a legal obligation to which the controller is subject…’

Article 9(2)(h) – ‘processing is necessary for the purpose of preventative…medicine…the provision of health or social care or treatment or the management of health or social care systems and services…’

Recipient or categories of recipients of the processed data

The data will be shared with NHS Digital.

The data will be shared with the Care Quality Commission.

The data will be shared with our local health protection team or Public Health England.

The data will be shared with the court if ordered.

Rights to object and the national data opt-out

There are very limited rights to object when the law requires information to be shared but government policy allows some rights of objection as set out below.

NHS Digital

You have the right to object to your identifiable information being shared with NHS Digital for reasons other than your own direct care.

This is called a ‘Type 1’ opt-out – you can ask your practice to apply this code to your record.

https://digital.nhs.uk/about-nhs-digital/our-work/keeping-patient-data-safe/how-we-look-after-your-health-and-care-information/your-information-choices/opting-out-of-sharing-your-confidential-patient-information

From 25th May 2018, the national data opt-out enables you have a choice about whether you want your identifiable confidential patient information to be used for research and planning. This replaces a ‘Type 2 opt-out’.

To find out more or to register your choice under the national data opt-out, please visit nhs.uk. You can change your mind about your choice at any time.

NHS Digital sharing with the Home Office

There is no right of objection to NHS Digital sharing names and addresses of patients who are suspected of having committed an immigration offence.

Public health

Legally information must be shared under public health legislation. This means that you are unable to object.

Care Quality Commission

Legally information must be shared when the Care Quality Commission needs it for their regulatory functions. This means that you are unable to object.

Court order

Your information must be shared if it ordered by a court. This means that you are unable to object.

National screening programmes

The NHS provides national screening programmes so that certain diseases can be detected at an early stage.

These screening programmes include bowel cancer, breast cancer, cervical cancer, aortic aneurysms and a diabetic eye screening service.

The law allows us to share your contact information with Public Health England so that you can be invited to the relevant screening programme.

More information can be found at: https://www.gov.uk/topic/population-screening-programmes

We are required by law to provide you with the following information about how we handle your information in relation to our legal obligations to share data.

Purpose of the processing

The NHS provides several national health screening programmes to detect diseases or conditions early such as cervical and breast cancer, aortic aneurysm and diabetes.

The information is shared so that the correct people are invited for screening. This means those who are most at risk can be offered treatment.

Lawful basis for processing

The following sections of the General Data Protection Regulation allow us to contact patients for screening:

Article 6(1)(e) – ‘processing is necessary…in the exercise of official authority vested in the controller…’

Article 9(2)(h) – ‘processing is necessary for the purpose of preventative…medicine…the provision of health or social care or treatment or the management of health or social care systems and services…’

Recipient or categories of recipients of the processed data

The data will be shared with NHS Digital, hospital laboratory services, local breast screening units, and Health Intelligence who provide diabetic eye screening.

The Practice shares your diabetes related data with the Diabetic Eye Screening Programme operated by Health Intelligence, commissioned by NHS England. For further information: eadesp.co.uk

Rights to object

For national screening programmes you can opt so that you no longer receive an invitation to a screening programme.

See: https://www.gov.uk/government/publications/opting-out-of-the-nhs-population-screening-programmes

Data we get from other organisations

We receive information about your screening test results from other organisations who are involved in providing these services.

This means your GP medical record is updated with screening results.

Data we hold about you

We hold data about you in electronic and paper records. We use a combination of working practices and technology to ensure that your information is kept confidential and secure.

The type of data that we hold about you may include the following:

Details about you, such as your address and next of kin;

Any contact the surgery has had with you, such as appointments, clinic visits, emergency appointments, etc.

Notes and reports about your health;

Details about your treatment and care;

Results of investigations, such as laboratory tests, x-rays, etc.

Relevant information from other health professionals, relatives or those who care for you.

Your medical record is held in a computer system called SystmOne. This system is provided to us under a National contract. Your data is held and managed in secure data centres by TPP. For more information: https://www.tpp-uk.com/

SMS and Email

We will hold your mobile phone number and email address where you have provided these to us.

We may use these to send you text messages or emails about your care, for example, messages about appointments, test results, or inviting you to attend for a clinic.

You have the right to provide your mobile number for calls only. If you do not wish to receive text messages from us, please speak to the practice so we can add this to your record to prevent text messages being sent to you.

You have to right to have your email address or mobile phone number removed from your GP record.

We will only use the email address or mobile phone number for direct medical care purposes, unless you have provided us with your explicit consent to email you for other purposes as well, for example, for us to send you surgery newsletters, details from patient participation group meetings, or details about new services.

If you provide your consent for us to send you information other than for your direct care, you can remove this consent at any time.

Right to access and correct

You have the right to access the data we hold about you, and request to have any errors or mistakes corrected. Please speak to a member of staff or look at our ‘subject access request’ policy on the practice website cornfordhousesurgery.org

We are not aware of any circumstances in which you will have the right to delete correct information from your medical record; although you are free to obtain your own legal advice if you believe there is no lawful purpose for which we hold the information and contact us if you hold a different view.

Retention period

GP medical records will be kept in line with the law and national guidance. Information on how long records are kept can be found at: https://digital.nhs.uk/article/1202/Records-Management-Code-of-Practice-for-Health-and-Social-Care-2016

Right to complain

If you have concerns about the way we manage your data. Please contact: S. Bowtle Practice Manager

You have the right to seek independent advice about data protection, as well as the right to complain, by contacting the Information Commissioner’s Office. https://ico.org.uk/global/contact-us/ or call the helpline 0303 123 1113

Data Controller contact details: Cornford House Surgery 01 223 247505

Data Protection Registration Number: Z7035754

Data Protection Officer: Ian Bowtle

Date last reviewed or updated:  24th May 2018

Confidentiality & Medical Records

The practice complies with data protection and access to medical records legislation. Identifiable information about you will be shared with others in the following circumstances:

  • To provide further medical treatment for you e.g. from district nurses and hospital services.
  • To help you get other services e.g. from the social work department. This requires your consent.
  • When we have a duty to others e.g. in child protection cases anonymised patient information will also be used at local and national level to help the Health Board and Government plan services e.g. for diabetic care.

If you do not wish anonymous information about you to be used in such a way, please let us know.

Reception and administration staff require access to your medical records in order to do their jobs. These members of staff are bound by the same rules of confidentiality as the medical staff.

Freedom of Information

Information about the General Practioners and the practice required for disclosure under this act can be made available to the public. All requests for such information should be made to the practice manager.

Access to Records

In accordance with the Data Protection Act 1998 and Access to Health Records Act, patients may request to see their medical records. Such requests should be made through the practice manager and may be subject to an administration charge. No information will be released without the patient consent unless we are legally obliged to do so.

Violence Policy

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. 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.

Chaperone Policy

In our organisation we are committed to providing a safe, comfortable environment where patients and staff can be confident that best practice is being followed at all times and the safety of everyone is of paramount importance.

This chaperone policy adheres to the General Medical Council guidelines on intimate examinations and to the NHS Clinical Governance Support Team’s ‘Model Chaperone Framework’. Information can also be found on the website http://www.gmc-uk.org/guidance/ethical_guidance/21168.asp

Patients are encouraged to ask for a chaperone if required at the time of booking appointment an wherever possible.