An updated standard operating procedure (SOP) for general practice published on Thursday makes clear that NHS England 'expects all patients who are able to do so' to follow government advice that patients should wear a mask or face covering on practice premises.
The revised advice says: 'For the small number of patients who may not follow this guidance we fully support practices in ensuring that they can take all reasonable steps to identify practical working solutions with the least risk to all involved.'
Practices are advised to 'undertake a risk assessment' when patients refuse to wear a mask or face covering, and can consider 'offering the patient a mask, if the patient is willing to wear one'.
GPs can also consider further options including 'booking the patient into a quieter appointment slot, or in a separated area', or 'providing care via a remote appointment', the NHS England advice confirms.
The latest SOP reiterates official calls for GP practices to 'restore activity to usual levels where clinically appropriate' and to reach out to at-risk patients whose care may have been delayed during the COVID-19 pandemic.
Practices 'should be open for the delivery of face-to-face care, whilst triaging patients remotely in advance wherever possible', the guidance says.
It calls for infection prevention and control guidance to be 'followed rigorously' for all face-to-face consultations, with staff and patients using masks or face coverings in line with government advice, care co-ordinated carefully to avoid 'the need for multiple visits' if possible.
Practices are also urged to 'use careful appointment planning to minimise waiting times and maintain
social distancing in waiting areas' - and to consider measures such as 'asking patients to wait in private vehicles, where possible, to reduce numbers in communal spaces'.
GPonline reported last month that face-to-face GP consultations had risen 70% compared with the start of lockdown - although the majority of consultations continue to be delivered via telephone.
GP leaders have called repeatedly for masks or face coverings to be mandatory for patients on practice premises, in line with rules for hospitals or public transport.