A chaperone is defined by the CQC as “an impartial observer, present during an intimate examination of a patient”. The chaperone plays an important role in protecting both patients and staff during intrusive and invasive examinations. They help to reassure the patient, protect their dignity, offer support and facilitate communication – this may be particularly important if there is a language barrier, for example.

Traditionally, chaperones have been used in face-to-face appointments, where the patient, medical professional and chaperone are in the same room together. But with the recent pandemic and the rise in virtual appointments, how should we view the role of a chaperone, and how should it work in practice?

Are chaperones needed for online consultations?

Many intimate examinations will not be suitable for a video consultation. But where it does happen, the CQC makes it clear that an online consultation does not negate the need for a chaperone. Indeed, “all patients should routinely be offered a chaperone during any consultation or procedure”. The NHS published guidelines in 2020 stating that the need is the same for virtual as it is for face-to-face settings: “If the patient (adult or child) is the subject of a video consultation, you should have an appropriately trained chaperone for any situation where you would do so in a face-to-face consultation”.

There has been a documented rise in the number of adverse outcomes and complaints from patients since the pandemic began, caused by remote consultations. “Communication is more difficult when you consult remotely, and the patient is not in the room with you, so it is therefore easier to be misunderstood, which can result in a complaint. So in certain circumstances, it would be prudent, before the appointment, to alert the patient of the possibility of having a chaperone, who could be present virtually,” said Diane Baylis, the Medical Protection Society’s (MPS) clinical risk educator.

Chaperones may be required for a variety of consultations – not just intimate examinations, but if the patient is vulnerable, or has a mental illness, then a chaperone can reassure them if they have to be in close proximity to someone they are not familiar with.

Where should a chaperone be in a virtual consultation?

The GMC advises that “a chaperone could be present with the practitioner (either virtually or in the same room) and could witness the nature and extent of the video examination that was undertaken. The chaperone should be visible to the patient. The chaperone should also be appropriately trained (you should consider whether the chaperone is competent and comfortable with conducting their role in these circumstances).”

Who can be a chaperone?

Although chaperones do not have to be medically qualified, they must be trained, DBS checked and, as a minimum, behave with a confident understanding of the role. They should be:

• sensitive to the patient’s confidentiality,
• prepared to reassure the patient,
• familiar with the procedures involved in an intimate examination,
• prepared to raise concerns about a doctor if misconduct occurs,
• able to record their presence in the patient’s medical record.

Ideally, family members or friends of both the patient and the doctor should not be a chaperone – they may not fully appreciate the nature of the physical examination performed, and they may not be completely impartial.

Utilising untrained or poorly trained team members as chaperones, whilst convenient, also has the potential to add unnecessary risk.

Female-specific guidance

The Royal College of Nursing has their own guidance on intimate examinations (which contains helpful guidance for both men and women). They also make the point that, in some cases, a woman may prefer to be on her own with the person doing the examination, and that should be respected too (and noted in the records).

We encourage you to review your chaperoning procedures and training for both in-person and online appointments. If you need a refresher or further advice, consider the Thornfields course on Chaperoning or contact us to discuss your needs.