GPs urging patients to follow guidance on wearing masks in practices

GPs around the UK are urging patients to continue wearing face masks when visiting practices to reduce the risk of spreading Covid-19.

GPs in Northern Ireland have reported a rise in the amount of patients and visitors who are not wearing a mask, the BMA has warned.

Patients in primary care settings in Northern Ireland are still being asked to wear a mask, as they are in other public indoor places where social distancing cannot be maintained.

Deputy chair of BMA Northern Ireland’s consultants committee Dr David Farren said it has been ‘extremely challenging’ for healthcare staff, as they then ‘have to treat these patients as if they have Covid, but we cannot mix them with other Covid patients as that would risk actually giving them Covid if they don’t have it’.

Some patients in England are also refusing to wear masks in GP practices, despite NHS England telling people they should continue to wear face masks in healthcare environments after restrictions in other settings ended on 19 July.

While masks are mandatory in healthcare settings in Northern Ireland and England, the regulation is not legally enforceable.

Some GP practices have been threatened with legal action for asking patients to wear a face covering.

The current IPC guidance for England is that in primary care settings, ‘patients/individuals and accompanying persons [are] asked to wear a mask/face covering at all times’.

The BMA said it was ‘encouraged’ by the Government’s advice, which came after GPs advocated for clearer Government guidelines on mask-wearing in practices.

However, local GP leaders have expressed frustration that the Government went ahead with a total relaxing of Covid restrictions elsewhere.

Doncaster LMC chief executive Dr Dean Eggitt said: ‘We’ve had a few patients refuse point blank to wear a mask, even when asked, and that has resulted in complaints being sent through. Anecdotally, most patients are not keen on wearing a mask but do so because they’re asked to.’

He told Pulse it is ‘unfair’ that GPs practices are having to request people to wear masks as it ‘puts pressure on GP practices and the relationships with patients’.

He said: ‘It would be really helpful if NHS England came up with a firm stance on what should and shouldn’t happen. I like the idea of flexibility, but on these sorts of topics, actually all it does is put us in a position of potential conflict.’

He added that mask-wearing in GP practices should have been mandated by the Government, rather than made flexible through IPC guidance.

Essex LMC chief executive Dr Brian Balmer said he would refuse to see a patient who was not wearing a face covering.

‘This is our surgery and we’re protecting our staff, so you’re not coming in,’ he said. ‘We’re generally against compromising if you’re talking about staff safety. The NHS has guidelines and I think practices should have rules to say, this is how we treat people and this is to keep you safe. I’m personally not into bending the rules constantly just because somebody wants to complain. I think it’s a very dangerous road to go down.’

Tower Hamlets LMC chair Dr Jackie Applebee said it is ‘ridiculous’ that wearing masks in practices is only advised by the Government and not mandated, and that it ‘polarises’ the situation between what the Government and GP practices are asking for.

‘Covid-19 is still out there ­– we’ve got the Delta variant and people getting Covid-19 even though they have been double-vaccinated,’ she said.

‘Like with GP practices, I don’t think it’s right that Transport for London have had to have their own policy of telling people to wear masks on public transport. If the Government aren’t saying that then people can just turn around and say, the Government haven’t said we have to, so we’re not going to. Masks are part of the very important arsenal of decreasing transmission of Covid. It’s not a big ask to get people to wear masks and I think the Government should have kept masks are mandatory in public places.’

In Wales, wearing a mask in healthcare settings is still a legal requirement, and so only patients under the age of 11 or a patient with a medical exemption are legally able to enter general practices without a mask.

Dr Phil White, chair of BMA Cymru’s GP committee said: ‘This legislation has helped us to successfully enforce the wearing of masks in our premises and crucially keep patients and practice staff safe whilst Covid-19 remains in our communities.

‘In our experience and perhaps because of this continued requirement we have found most patients are very understanding of this. Anyone considering not wearing a mask in a healthcare setting should think about protecting themselves and others as there is now strong evidence to suggest that ventilation and face coverings are the best way to prevent the spread of Covid-19.

‘This is of particular importance in healthcare settings full of patients vulnerable to the virus’s more harmful effects.’

In Scotland, people are asked to wear a mask in enclosed settings, including GP surgeries.

Dr Andrew Cowie, deputy chair of the BMA’s Scottish GP committee, said patients in Scotland are declining to wear masks in healthcare settings for many reasons, including ‘confusion around regulations, anxiety, or they simply don’t want to’.

He said: ‘Unless medically exempt we encourage everyone to wear a face covering when visiting their GP practice or a hospital to reduce the risk of Covid-19 transmission. It is also important to remember that healthcare settings are working to a different set of guidelines when it comes to face coverings, than what applies to society at large.

‘GPs and practice staff are following that particular Scottish government guidance to ensure the safety of themselves, their patients and everyone else around them, and so should not be subjected to unacceptable behaviour as a result.’