How to deal with patients who refuse to wear face coverings

The MDU's Dr Kathryn Leask offers advice on what to do if someone entering the practice says they will not wear a face mask.

Practices should display clear signage (Photo: Mike Kemp/Getty Images)
Practices should display clear signage (Photo: Mike Kemp/Getty Images)

Face masks or coverings are now mandatory in certain places such as on public transport and in shops and supermarkets although the rules vary slightly in different parts of the UK. Face coverings are also needed in NHS settings, including hospitals and primary or community care settings, such as GP surgeries, however they are not mandatory.

GP practices and other premises where face coverings are required are expected to take reasonable steps to promote compliance with the law, according to government guidance.

This means reminding patients and any companions of the requirement to wear a face covering when appointments are made for a face-to-face consultation. Signs can help to reinforce the message at the entrance to the practice, within the waiting room and on the practice website.

Not only will this help to remind patients and companions to put on their mask but will also ensure anyone arriving at the practice without an appointment knows that a face covering is required. Be aware that certain groups are exempt from wearing a face covering such as those who have health problems or a disability.

Patients who refuse to comply

The GP standard operating procedure for coronavirus acknowledges that there may be a small number of patients who will not follow the government’s guidance.

Where a patient who could wear a face covering chooses not to do so, explain the reason for its importance in protecting patients and staff. Remind them the virus can be carried by asymptomatic people.

If the patient does not have a mask, the situation might be resolved by offering to provide one.

If the patient continues to decline to wear a mask, you may wish to consider whether a face-to-face appointment is absolutely necessary or whether another way of carrying out the consultation would be more appropriate.

However, by the time a patient arrives at the surgery, you may have already judged that a face-to-face consultation is required. With this in mind, there are steps you can take to try to minimise the risk to yourself, colleagues and to other patients including:

  • Maintain social distancing as far as this is possible, observe hand hygiene measures and ensure members of staff wear appropriate PPE.
  • Consider booking the patient into a quieter appointment slot, if they don’t need to be seen urgently, or allow them to wait in an area separate to the main waiting area or where there tends to be fewer staff and patients.

There is currently no power to enforce mask wearing by patients and GPs should be cautious about declining to provide necessary care to a patient on the basis of their decision not to wear a mask.

If a patient was not treated on this basis and came to harm as a result, the practice could be criticised. To avoid any unnecessary confrontations, it is helpful to have a policy in place so that all staff know what action needs to be taken should they encounter this dilemma.

You can get advice from the MDU or your own medical defence organisation if questions remain about treating a patient who declines to wear a face covering.

  • Dr Kathryn Leask is medico-legal adviser at the MDU

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