Covid-19 Patients refusing to wear face coverings

We have been asked on a number of occasions if practices can refuse to see patients that will not wear a face covering in a face to face consultation.

One of our Medical Directors, Dr Laura Edwards, recently sent the following reply to a practice that asked just this question and we feel it may help others to see this.

This is really, really tricky.

We feel, and the national position is, that you can’t refuse to see someone on that basis.

I believe that we are expert negotiators. Try to see what can be negotiated and otherwise minimise exposure.

Factors that you could control:

• Everything to be done remotely that can be.
• Patients to be seen at times that minimise exposure for others as other patients are at increased risk as well eg in waiting room
• Can you see the patient outside?
• Can you social distance effectively in a room – ie biggest room for these patients
• Would they accept wearing a scarf if not a mask? Would they accept covering their mouth/ nose for the most close part that is needed only with the understanding that the health care professional can step away if the patient needs a break from covering their mouth/ nose
• Can they face in a different direction esp for anything that involves close contact – there is evidence that direct face to face as in standing opposite each other is the highest exposure vs side by side
• Can you maximise ventilation of the space where they are seen
• The health care professional wears appropriate PPE for the risk
• Which health care professional they are seen by – risk assessment

Viral exposure seems to depend on ventilation, occupancy and exposure time - https://www.bmj.com/content/370/bmj.m3223 - this article is an interesting read.

So if a patient declines then I think it is reasonable for the practice to alter some of these other factors. This may result in an appointment that is less convenient for the patient and may persuade those who are simply reluctant to put up with temporary discomfort.

You cannot refuse to see them though.

The PC Webinar of 28th Jan 2021 also revisited this issue and had this to say: -

Seeing patients who are not wearing face coverings
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.
However, not all patients are able to wear a face covering and a patient should not be refused access to care if they are unable to, or refuse to, wear a covering. For these patients, practices should ensure that they can take all reasonable steps to identify practical working solutions with the least risk to all involved.
For example: offering the patient a mask, if the patient is able to wear one;

• booking the patient into a quieter appointment slot,
• or in a separated area
• or providing care via a remote appointment.