Measures to protect female patients from being sexually abused by doctors should be strengthened, a report says.
Clifford Ayling worked as a GP in Folkestone until October 2000
The recommendations emerged from an inquiry into how Kent GP Clifford Ayling was able to continue working despite complaints spanning 30 years.
Ayling was jailed for four years in December 2000 on 13 counts of indecent assault between 1991 and 1998.
The report says trained chaperones should be available to all patients who are having intimate examinations.
Ayling repeatedly convinced women they needed intimate examinations, and then sexually abused them.
The report says that a catalogue of complaints made against him - including some from nursing staff - were not properly investigated.
Doctors are currently advised they should offer patients a chaperone if they are carrying out an examination of the breasts, genitalia or rectum.
But the report said there was a need for all NHS trusts to set out clear policies on chaperones to end the current confusion over what their role was, when they should be present, and who they should be.
It said no family member or friend, or untrained NHS administrative staff member should be expected to act as a formal chaperone.
The report added all trusts should make their chaperone policy explicit to patients and ensure there is enough funding to implement it.
The report was published on the day a group of 31 women abused by Ayling said they had settled their legal action against Kent and Medway Strategic Health Authority which employed him.
Sarah Harman, solicitor for the women, said they had agreed to accept £350,000, which will be shared out between the women. Some will receive as much as £20,000.
She said there had been "28 missed opportunities" where the GP could have been stopped between 1971 and 2000.
She added: "Often other doctors explained away the complaints, saying women had misunderstood the situation, and that it wasn't as serious as the women had supposed."
Ms Harman said the settlement was not perfect, but it did constitute a victory. "It's a compromise but a good compromise."
The report said that, since the inquiry into Clifford Ayling was set up in 2001, there had been improvements within the health service including an emphasis on patient safety.
But it called for more consideration to how trusts and primary care practices should deal with "sexualised behaviour".
Many of Ayling's patients complained that he was "overtly sexual" in his behaviour, and colleagues were aware of the concerns.
But the report said there was little guidance as to how the NHS should deal with such concerns.
It called on the Department of Health to convene an expert group to draw up guidance on the issue for the NHS.
It also called for improvements to the way in which complaints against individual doctors are recorded, particularly if they are working in several different parts of the NHS at the same time.
28 'missed opportunities'
In a written response to the report, Health Secretary John Reid said: "It is completely unacceptable that the events described in this report were allowed to happen."
He added: "The systems in place in the NHS to helps and support these patients who raised concerns about Clifford Ayling's behaviour and treatment let them down.
"No patient should be left in a position where those in charge of their care are able to abuse their trust and take advantage."
Dr Maureen Baker, Honorary Secretary of the Royal College of GPs, said: "Chaperoning is a complex role that needs specific training, resources and safeguards in place in order to be effective.
"Patients should be offered a chaperone wherever possible but the choice should always remain with the patient.
"However it should also be noted that there may be situations where an intimate examination is urgently required and a chaperone may not be available.
"We look forward to discussing how the service can be taken forward in a practical and accessible fashion."
The Medical Protection Society, a medical defence body, said it was pleased the report called for NHS trusts to the discretion to determine their own chaperone policy.
A spokesman said: "It does not demand that chaperones are present at every examination and recognises a patient's right to decline to have a chaperone present."