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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 Chapel Street Surgery 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 and 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 Chapel Street Surgery 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)

Childrens Privacy Notice

We ask for personal information so that you can receive appropriate care and treatment.
The information is recorded on computer and we are registered under the Data Protection Act (1998). The practice will ensure that patient confidentiality is maintained at all times by all members of the practice team. However, for the effective functioning of a multi-disciplinary team it is necessary on occasions to share medical information about you with other members of the team.

View/ Download our Covid Privacy Notice.

Privacy Notice for Staff

Employee Privacy Notice

For important information regarding GDPR, please view the below document:

Data Protection Privacy Notice

Privacy Notice

All GP’s are required to declare the mean earnings (average PAYE) for GP’s working within the Practice.

The average pay for GP’s working in Chapel Street Surgery in the last financial year was £101,100.50 before tax and national insurance.

Contributions – This is for 1 full time GP and 1 locum GP working at the practice for more than 6 months.

How we use your Information

Updated for the UK GDPR 2016 and Data Protection Act 2018

Better information, better health

This leaflet explains:

• Why the Practice collects information about you and how it is used
• Who we may share information with
• Your right to see your health records and how we keep your records confidential

How we keep your records confidential

Everyone working for the NHS has a legal duty to keep information about you confidential.

We have a duty to

• Maintain full and accurate records of the care we provide to you
• Keep records about you confidential, secure and accurate
• Provide information in a format that is accessible to you (i.e., in large type if you are partially sighted).

We will not share information that identifies you for any reason, unless:

• you ask us to do so;
• we ask, and you give us specific permission;
• we must do this by law;
• we have special permission for health or research purposes or
• we have special permission because the interests of the public are thought to be of greater importance than your confidentiality

Our guiding principle is that we are holding your records in STRICT CONFIDENCE

Why we collect information about you

In the Practice we aim to provide you with the highest quality of health care.  To do this we must keep records about you, your health and the care we have provided or plan to provide to you.

These records may include:

• Basic details about you, such as address, date of birth, next of kin
• Contact we have had with you such as clinical visits
• Details and records about your treatment and care
• Results of x-rays, laboratory test etc.,
• Relevant information from people who care for you and know you well, such as health professionals and relatives

It is good practice for people in the NHS who provide care to:

• discuss and agree with you what they are going to record about you
• give you a copy of letters they are writing about you; and
• show you what they have recorded about you, if you ask.

We will only store your information in identifiable form for a long as in necessary in and in accordance with the NHS England’s Rules found here: –

Records Management Code of Practice 20201 – NHSE (updated May 2024)

How your records are used

The people who care for you use your records to:

• Provide a good basis for all health decisions made by you and care professionals
• Allow you to work with those providing care
• Make sure your care is safe and effective, and
• Work effectively with others providing you with care

Others may also need to use records about you to:

• check the quality of care (such as clinical audit)
• protect the health of the public
• keep track of NHS spending
• manage the health service
• help investigate any concerns or complaints you or your family have about your health care
• teach health workers and
• help with research

Some information will be held centrally to be used for statistical purposes.  In these instances, we take strict measures to ensure that individual patients cannot be identified.

We use anonymous information, wherever possible, but on occasions we may use personally confidential information for essential NHS purposes such as research and auditing.  However, this information will only be used with your consent, unless the law requires us to pass on the information.

The legal Part

You have a right to privacy under the UK General Data Protection Regulation 2016 (UK GDPR) and the Data Protection Act 2018.  The Practice needs your personal, sensitive and confidential data in order perform our statutory health duties, in the public interest or in the exercise of official authority vested in the controller in compliance with Article 6 (e) of the GDPR and

for the purposes of preventive 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 on the in compliance with Article 9, (h) of the GDPR.

You have the right to ask for a copy of all records about you.

• Your request should be made to the practice holding your information
• We are required to respond to you within one Month
• You will need to give adequate information (for example full name, address, date of birth NHS number etc.)

To Access your record contact:

If you think anything is inaccurate or incorrect, please inform the Practice as soon as possible. For other rights about the use of your information pleases see our website.

The Practice Data Protection Officer is Paul Couldrey PCIG Consulting Ltd, and is available via email: Couldrey@me.com Tel: 07525 623939

Who are our partner organisations?

We may share information with the following main partner organisations:

• NHS England
• Our Commissioners
• NHS Trusts / Organisations (Hospitals, ICB’s)
• Ambulance Service
• Social Services

We may also share your information, with your consent and subject to strict sharing protocols about how it will be used,

With:

• Education Services
• Local Authorities
• Voluntary Sector Providers
• Private Sector

Anyone who receives information from us also has a legal duty to:

KEEP IT CONFIDENTIAL!

If you believe the Trust has breached any of your Data Protection Rights.

You have a right to complain to the UK supervisory Authority as below.

Information Commissioner:

Wycliffe house
Water Lane
Wilmslow
Cheshire
SK9 5AF
Tel: 01625 545745
https://ico.org.uk/

Information about you is used in a number of ways by the NHS and Social Care services to support your personal care and to improve health and social care services for everyone.

The Health and Social Care Information Centre (HSCIC) is the national NHS organisation with a legal responsibility to collect data as people make use of NHS and social care services. The data is used both at a local level and nationally to help with planning, managing your care, supporting research into new treatments, identifying trends and issues and so forth, and is used to try to make services better for all.

You can, however, choose not to have information about you shared or used for any purpose beyond providing your own treatment or care.

Your right to opt out

You can choose not to have anything that could identify you shared beyond your GP practice (Type 1 objection).

You can also choose for the HSCIC not to share information it collects from all health providers any further (previously known as Type 2 objection, now National Data Opt-out).

The National Opt Out

It is a service that enables the public to register to opt out of their confidential patient information being used for purposes beyond their individual care and treatment. It was introduced for the health and social care system in England on 25 May 2018. The public can change their national data opt-out choice at any time via www.nhs.uk/your-nhs-data-matters or by calling NHS Digital contact centre on 0300 3035678 or via the NHS App.

National data opt-outs apply to a disclosure when an organisation e.g. a research body confirms they have approval from the Confidentiality Advisory Group (CAG) for the disclosure of confidential patient information held by another organisation responsible for the data (the data controller), such as an NHS Trust or GP practice.

The CAG approval is also known as a section 251 approval and refers to section 251 of the National Health Service Act 2006 and its current Regulations, the Health Service (Control of Patient Information) Regulations 2002. The NHS Act 2006 and the Regulations enable the common law duty of confidentiality to be temporarily lifted so that confidential patient information can be disclosed without the data controller being in breach of the common law duty of confidentiality.

In practice, this means that the organisation responsible for the information (the data controller) can, if they wish, disclose the information to the data applicant (e.g. research body) with section 251 approval without being in breach of the common law duty of confidentiality.

National data opt-outs do not apply where:

• information being disclosed is anonymised in accordance with the Information Commissioner’s Office anonymisation code of practice
• the individual has given their consent for their information to be used for a particular purpose, (e.g. a specific research study).
• there is an overriding public interest in the disclosure, (i.e. the public interest in disclosing the data overrides the public interest in maintaining confidentiality), also referred to as the ‘public interest test’.
• there is a legal requirement that sets aside the common law duty of confidentiality or the information is required by a court order

A good example is that for COVID-19 pandemic response there is no right to op-out in which is covered by point 3:-

Patients cannot opt out of receiving COVID related texts, which is explained in the nHSD notice which states:-

What if I have opted-out of my data being used (national data opt-out)?

The national data opt-out does not apply to disclosure of confidential patient information if it is being used to protect public health, for example to:

• diagnose communicable diseases
• control or prevent their spread
• deliver and monitor vaccination programmes
• manage risks of infection from food or water supplies or the environment

Read a full explanation of the lawful basis of such disclosures in 6.2:Communicable diseases and risks to public health in the operational policy guidance document.

As such we can only give assurance that if the Type 1 and National Opt out have been applied by the patient we will respect that in terms of adding the opt-out (type 1) code to the record and this will at system level block inappropriate sharing from the GP system with the limitations above, and if she has applied for the national opt-out NHDS and the hSCIC will not extract data unless:-

• information being disclosed is anonymised in accordance with the Information Commissioner’s Office anonymisation code of practice
• the individual has given their consent for their information to be used for a particular purpose, (e.g. a specific research study).
• there is an overriding public interest in the disclosure, (i.e. the public interest in disclosing the data overrides the public interest in maintaining confidentiality), also referred to as the ‘public interest test’.
• there is a legal requirement that sets aside the common law duty of confidentiality or the information is required by a court order

That is the only assurance we can give.

Opt Out Form

Click here to download the opt out form

Patient Privacy Notice

You have a right to expect a high standard of care from our practice and we will try at all times to provide this to you.

In order to assist us in this we require that you take responsibility for ensuring that you do not abuse the service. For example, it is your responsibility to ensure that you keep appointments and follow medical advice given.

We aim to treat all our patients courteously at all times and expect our patients to treat our staff in a similarly respectful way.

Rights:

• Patients aged 16 to 75 who have not seen a doctor/nurse in the previous 3 years may request a health check with a HCA.
• Patients aged over 75 and have not seen a doctor/nurse in the previous 12 months may request a health check with a HCA.
• Patients have the right to see their own health records subject to limitations.

Responsibilities:

• Arrive on time for your appointments
• Inform the practice of your intention to cancel an appointment in good time.
• Show the courtesy to staff you would yourself, expect to receive.
• Violent or aggressive patients may be removed from the list and referred to a specialist service.
• All patients are entitled to have a chaperone present for any consultation, examination or procedure where they consider one is required.

You have the right to know what information we hold about you. If you would like to see your records, please speak to the locality manager or reception staff who will be able to provide you with information on how to do this, and any charges that may be applicable.

A Summary Care Record is a way of telling health and care staff important information about a person.

Read this easy read photo story about adding additional information to your summary care record.

It tells staff caring for someone about their medicines and allergies.  This means they can look after the person if they are not at their usual doctor’s surgery.

For people with a learning disability, autism or both a doctor might ask if they can add some additional information to the summary care record. This will mean if a person needs treatment by other services like emergency or urgent care they will have more information about them.

More information about the Summary Care Record, including an easy read leaflet, is available on the NHS Digital website.

Information for health professionals

You can help people with a learning disability by asking if you can add additional information to their summary care record.

Any information from the person’s GP record which could help staff support the person better will be automatically added.  This could be things like how they want to be communicated with or any reasonable adjustments that need to be made.

To make sure other NHS services can access this information you need to opt in to adding additional information to the Summary Care Record. There is a question on the annual health check national template to encourage more people to agree to having additional information added to their Summary Care Record.

More information for GPs about using summary care records to make more information available in care settings is available on the NHS Digital website.

Opting out

The purpose of SCR is to improve the care that you receive, however, if you don’t want to have an SCR you have the option to opt out. If this is your preference please inform your GP or fill in an SCR opt-out form and return it to your GP practice.

Regardless of your past decisions about your Summary Care Record consent preferences, you can change your mind at any time. You can choose any of the following options:

1. To have a Summary Care Record with Additional Information shared. This means that any authorised, registered and regulated health and care professionals will be able to see a enriched Summary Care Record if they need to provide you with direct care.
2. To have a Summary Care Record with core information only. This means that any authorised, registered and regulated health and care professionals will be able to see information about allergies and medications only in your Summary Care Record if they need to provide you with direct care.
3. To opt-out of having a Summary Care Record altogether. This means that you do not want any information shared with other authorised, registered and regulated health and care professionals involved in your direct care, including in an emergency.

To make these changes, you should inform your GP practice or complete the SCR patient consent preferences form and return it to your GP practice.

Chapel Street Surgery has a Zero Tolerance Policy towards aggressive behaviour.

Shouting, swearing or being abusive will not be tolerated under ANY circumstances.

Patients who display any of the following behaviour could be asked to leave the premises and could be removed from our patient list:

• Using bad language or swearing
• Acting in a physically aggressive or intimidating way
• Verbal abuse towards the staff in any form including insulting the staff
• Racial abuse and sexual harassment
• Abuse related to a person’s religion, sexuality, gender, age or disability
• Any physical violence
• Persistent or unrealistic demands that causes stress to staff
• Causing damage or stealing from the Practice’s premises, staff or patients
• Obtaining drugs and/or medical services fraudulently
• Any other episode in which an employee is abused, threatened or assaulted in circumstances relating to their work

We are here to help and aim to be as polite as possible, even during difficult times.

We are a Zero tolerance practice and do not tolerate any form of verbal or physical abuse, bullying or any other form of intimidation. Any patient displaying behaviour of this nature towards staff, doctors or other patients, will be removed from the list with immediate effect, and if appropriate the matter will be reported to the police & the Black Country ICB.