AN AGENDA FOR CHAPERONING

By The Parliament
Contact the author via the editor by e-mail at christopher.johnstone@ntlworld.com

The Ayling and Shipman enquries have suggested that all procedures, intimate examinations and consultations performed by GPs and Practice Nurses should be supervised by an appropriately trained chaperone. the definition of intimate is not clear, so health professionals will have to err on the side of caution. Therefore simple examinations, even with the patient fully dressed, or a comprehensive medical history may be deemed intimate and give cause forsignificant concern. A trained chaperone will require considerable expertise to determine what is appropriate behaviour. This will probably mean a trained nurse in the first instance.

So practices will have to get their nurses to chaperone GPs during any possibly intimate examinations, this will obviously include same sex consultations. The practice nurse will also required to be chaperoned. As practice nurses perform numerous intimate examinations, it will almost be a full time job to chaperone the practice nurse alone.

Most medium practices will need two full time chaperones if they are to conform to European Working Time Directives. The Kings Fund have welcomed this innovation and have called for the speedy across the board introduction of Approved Chaperones. It is envisaged that initially there will be a one year HNC in chaperoning, followed by a diploma, accredited by the RCN in the first instance. Chaperoning will become a recognised profession, degree courses becoming oversubscribed and already Abertay University has created its first chair in chaperoning and Masters degree.

Chaperones will soon have the same status as GPs with their own college and similiar training and accreditation systems. A lot of practical experience will be required by registrar chaperones (RCs), however time will be also devoted to the theory and evidence base of chaperoning. They will have small group work, videos to watch and some simulated surgeries with actors playing both doctor and patient. However the mainstay of their training will be experiential, ie in GP surgeries. Obviously as they are not fully qualified at this stage their tutor will have to be present too. The university departments will have to be validated and often a central chaperone teaching evaluator from the joint committee on chaperoning will require to be present to check on the teaching the RC is receiving. As with all these checks a member of the public will have to be present to ensure there is no professional collusion. Let us hope that MSPs will take up their right to monitor the chaperoning training.

Proper chaperoning demands the chaperone being able to see everything that goes on and must not be screened by a curtain. The risk of silent inappropriateness must be minimised. As there may be up five people behind the curtain with the GP and the patient most surgeries and curtains will be hopelessly inadequate. Following further recent European health and safety directives it appears that most GP consulting rooms will be too small. This means that billions will have to be spent on an urgent rebuilding programme.

The government has produced a consultation paper to examine the implications of this exciting devopment in patient care. The consultation document will explore how curent health spending can be redistributed to meet this challenge. and ensure value for money.

One innovative suggestion is to have all consulting rooms with glass walls. This would enable 360^o chaperoning.

Another option being piloted is for all consultations and examinations to take place in the waiting room, thereby promoting social inclusion and community involvement. The redundant consulting rooms will be used for debriefing and the chaperoning secretariat. The advantage of this system is that if it publicly acceptable it would actually make the building of new surgeries very cheap, ie one very big consulting/waiting room.

A third option, said to be favoured by the younger cabinet members, is to have all consultations on line with a live webcam feed. Therefore every consulting room would be on the net. TheTreasury is also said to look favourably on this option on the grounds that it could generate a lot of money from people subscribing to be on-line chaperones and selling highlights to cable television.

A department of health spokesman said that the goverment is committed to the success of this ground-breaking innovation. GPs and their staff will get the first SIGN guideline soon. Protocols have already been developed for performance appraisal, reaccreditation and revalidation of Chartered Chaperones.

You can find out more by accessing www.chaperoning.scot.nhs.uk.

Other hoolet online articles by The Parliament can be found at:
hoolet edition 45 - Somerled Fergusson Tribute
hoolet edition 43 - An Agenda For Chaperoning

hoolet is the magazine of RCGP Scotland. It is supported intellectually, financially and emotionally by RCGP Scotland.

This issue maintained by Robert Hallam.