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.

While the legal requirement to wear a face covering has ended in England, infection control measures remain in force. In the rest of the UK, face coverings are still required in some indoor settings

The infection prevention and control guidance, which applies throughout the UK, means GP practices can continue to ask non-exempt patients to wear a mask.

Healthcare providers can remind 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 non-exempt 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. Certain groups are exempt from wearing a face covering such as those who have health problems or a disability.

The infection prevention and control guidance states, "Patients in all care areas should still be encouraged and supported to wear a face mask, providing it is tolerated and is not detrimental to their medical or care needs."

Patients who refuse to comply

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 them 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 if 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.

  • 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 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.

A version of this article first appeared on GP online.

This page was correct at publication on 03/08/2021. 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 MRCPathME 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. Kathryn is currently a member of the faculty’s training and education subcommittee and a member of the Royal College of Pathologists (medical examiner).