My patient is refusing to wear a mask – what should I do?

NOTE: The information within this article was correct at the time of publishing. However due to the fast-evolving nature of the pandemic, we strongly advise you to check all governmental and regulatory guidance for the latest updates.

Dr Heidi Mounsey, Medicolegal Consultant at Medical Protection, looks at your obligations regarding treatment for patients who refuse to wear a face mask

The dilemma

A practice manager contacted the Medical Protection advice line on behalf of the GP partners at the practice.

A number of patients have been refusing to wear face coverings when attending GP and practice nurse appointments, and the partners want to know if the practice can refuse to see these patients unless they wear face coverings.

Medical Protection advice

At the present time, there is no legal requirement for a patient to wear a face covering in a healthcare setting, although it is advised and recommended that they do.

This can clearly be a frustrating situation for a practice to find itself in, but a patient who refuses to wear a face covering must not be denied care on this basis.

NHS England and NHS Improvement’s Guidance and standard operating procedures: General practice in the context of coronavirus (COVID-19), published 10 August 2020, highlights that practices should be open for face-to-face care but, where possible, undertake triage of patients remotely in advance. An online consultation system should be in place and remote consultations conducted where appropriate.

The guidance from NHS England offers specific advice on managing patients who do not follow the government guidance on face coverings, and this states:

The safety of both our staff and our patients is of paramount importance and face coverings or face masks should be worn by patients in a practice setting, in-line with government guidance. We expect that all patients who are able to do so will follow these recommendations.

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 should undertake a risk assessment which should consider, for example:

• Offering the patient a mask, if the patient is willing to wear one
• Booking the patient into a quieter appointment slot, or in a separated area
• Providing care via a remote appointment

Symptomatic patients may be given a surgical face mask to minimise the dispersal of respiratory secretions and reduce environmental contamination, as per infection prevention and control guidance.

Exploring patient concerns

It may be worthwhile exploring with the patient their decision not to wear a face covering, and establishing whether they have any concerns about the use of face coverings. It may be that they are aware of social media posts alleging that face coverings reduce oxygen levels, for example.

In the event that a patient continues to refuse to wear a face covering, then it would be advisable for the practice to consider whether the patient can be seen immediately on their arrival, to reduce potential exposure to other patients and staff members, or whether a separate waiting area is available.

It may be possible to conduct a remote consultation instead of a face-to-face appointment, but the clinical needs of the patient, such as requirement for examination, will need to be carefully considered and the decision to offer a remote consultation documented. If a face-to-face consultation is considered necessary for the care of the patient, this should not be declined because the patient refuses to wear a face covering.

Practices should also ensure they have conducted the relevant risk assessments for their own staff and may wish to consider whether higher risk individuals could avoid, where possible, reviewing those patients who refuse to wear a face covering.

It is also worth remembering the GMC guidance in Good Medical Practice, which states at paragraph 58:

You must not deny treatment to patients because their medical condition may put you at risk. If a patient poses a risk to your health or safety, you should take all available steps to minimise the risk before providing treatment or making other suitable alternative arrangements for providing treatment.

In the event a practice or clinician feels they cannot provide care to a patient due to the risk they perceive the patient poses to staff members, they should ensure that the patient is reviewed by an alternative provider. This decision must be carefully documented in the patient’s record, along with the details of the referral and the advice provided to the patient.