How to deal with patient requests for face covering exemption letters

MDU medico-legal adviser Dr Ellie Mein provides advice for GPs on dealing with patients requesting a letter to excuse them from wearing a face mask.

(Photo: coldsnowstorm/Getty Images)
(Photo: coldsnowstorm/Getty Images)

In England, face coverings are now compulsory on public transport, in shops, supermarkets, shopping centres, takeaways, transport hubs and banks. Following an announcement last week, they will also be compulsory in a significant number of other settings including museums, galleries, cinemas, hair and beauty salons and places of worship from 8 August.

In addition to those environments where face masks are mandatory, the government strongly encourages that they should be worn in other enclosed public spaces where social distancing might be difficult.

As a result of these new laws, GPs are receiving an increasing number of requests for letters excusing patients from wearing them.

Many of the requests come from people who are expected by their employers to wear masks to prevent the spread of COVID-19 within the workplace.

The reasons for such requests vary from patients having one of the legitimate reasons listed in the government guidance to patients with no known co-morbidities reporting they feel faint or short of breath if they cover their nose and mouth.

Face covering rules

At present the legitimate reasons for not wearing a face coverings in settings where they are mandatory include:

  • Children under 11 years of age.
  • If you have a physical or mental illness or impairment, or a disability that means you cannot put on, wear or remove a face covering.
  • If putting on, wearing or removing a face covering would cause you severe distress.
  • If you are with, or providing assistance to, someone who relies on lip reading to communicate.
  • If you are travelling to avoid injury or escape the risk of harm, and you do not have a face covering with you.
  • If you need to remove it to avoid harm or injury or the risk of harm or injury to yourself or others.
  • If you need to eat, drink, or take medication you can remove your face covering.
  • If you are asked to remove your face covering by a police officer or other official.

There is specific guidance available on the exemptions for each of the UK jurisdictions with the links listed in the government guidance here. The guidance makes it clear that ‘no person needs to seek advice or request a letter from a medical professional about their reason for not wearing a face covering’.

Face coverings in the workplace

With regard to face coverings in the workplace, there is no overarching guidance due to the variation between different work environments and industries. There are however, 14 guides available from the Department for Business, Energy and Industrial Strategy (BEIS), which advise on how to make workplaces secure.

These guides address different types of work environments. The majority currently conclude that ‘face coverings are not a replacement for the other ways of managing risk, including minimising time spent in contact, using fixed teams and partnering for close-up work, and increasing hand and surface washing. These other measures remain the best ways of managing risk in the workplace and the government would therefore not expect to see employers relying on face coverings as risk management for the purpose of their health and safety assessments.’

There is separate guidance from the Department of Education relating to education and childcare settings which is clear that ‘…Schools and other education or childcare settings should therefore not require staff, children and learners to wear face coverings.’

Patient requests for exemptions

For clarification, none of the guidance regarding mandatory or strongly encouraged face covering use currently suggests that a doctor’s letter is required to excuse the use of these.

If the patient’s request relates to a letter for their workplace they can be directed to the guidance specific to their industry as mentioned above. It is then for them to discuss with their employer and occupational health department how best to resolve a difference of opinion on this subject.

If the request relates to not using face masks on public transport, shops or supermarkets then they can be reassured that they are able to self-declare their legitimate reason.

Of course, if the legitimacy of their reason is challenged they may at some point require evidence of their condition. It is possible that at this point GPs would be asked for a brief letter or an excerpt of their notes to confirm the relevant diagnosis.

In this scenario, we would advise that any letter simply states the diagnosis the patient relied on without an opinion on how this might prevent face covering use.

The GMC is clear in Good Medical Practice that doctors must recognise and work within the limits of their competence. As such, doctors will need to be aware that if they offer an opinion that a medical condition prevents covering the face, they may be asked to justify their expertise in face coverings and their impact on various diagnoses.

In short, there is no reason for GPs or other doctors to produce letters to explain why a patient should be exempt from wearing a face covering.

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