Dealing with patients who decline to wear a face covering

There may be a small number of patients who will not follow government guidance on face coverings in NHS settings.

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, but they are not mandatory.

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 building, within waiting areas and on the organisation's website.

Not only will this help to remind patients and companions to put on their mask but will also ensure anyone arriving 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 or clinic, 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 you 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, you could be criticised.

To avoid any unnecessary confrontations, it is helpful to have a policy in place so all staff know what action needs to be taken if they encounter this situation.

Get advice from the MDU if questions remain about treating a patient who declines to wear a face covering.

A version of this article first appeared on GP online.

This page was correct at publication on 10/09/2020. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Dr Kathryn Leask

by Dr Kathryn Leask BSc (Hons) MBChB (Hons) LLB MA MRCPCH FFFLM DMedEth MDU medico-legal adviser

Kathryn has been a medico-legal adviser with the MDU since 2007 and is a team leader, trainer and mentor in the medical advisory department. Before joining the MDU, she worked in paediatrics gaining her MRCPCH in 2002 and did her specialty training in clinical genetics. She has an MA in Health Care Ethics and Law, a Bachelor of Law and a Professional Doctorate in Medical Ethics. She is also a fellow of the Faculty of Forensic and Legal Medicine and has previously been an examiner and Deputy Chief Examiner for the faculty exam. Kathryn is currently a member of the faculty's Training and Education Subcommittee.

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