GPs can’t refuse patients who will not wear a face covering, says NHS England

GPs cannot refuse to treat patients who present at their practice without a mask, NHS England has said.

It also said that practices must now offer face-to-face appointments, while continuing remote triage.

In a bulletin to GPs sent on Friday, NHS England said patients ‘should not be refused entry to a premises or access to care if they are unable to or refuse to’ wear a face mask.

The email said: ‘It is not a legal requirement in health care settings for people to wear a face covering. Government advice says you should wear a face covering in enclosed spaces if you can, including places such as primary care services. 

‘However, a patient should not be refused entry to a premises or access to care if they are unable to, or refuse to, wear a covering. This should be clearly communicated to all patients.’

It added that verbal communication of exemption is ‘good enough’, although some patients ‘may feel more comfortable showing something that says they do not have to wear a face covering’. 

Dr Grant Ingrams, a GP in Leicestershire, said: ‘It is barmy to state that practices must not only see patients who just refuse to wear a face covering but must advertise that they will do this. Practices have a duty of care to other patients, carers and staff in the practice.

‘In addition it seems to breach government advice regarding wearing face coverings in enclosed spaces, and also making the practice as a workplace Covid safe.’

Meanwhile, the latest system letter to practices from NHS England, also sent on Friday, said that practices must ‘restore activity to usual levels where clinically appropriate’ from 1 August, including offering face-to-face appointments.

Outlining ‘phase three’ in the restart of services after lockdown, the letter said: ‘All GP practices must offer face-to-face appointments at their surgeries as well as continuing to use remote triage and video, online and telephone consultation wherever appropriate – whilst also considering those who are unable to access or engage with digital services.’

It added that practices should work with CCGs to increase the range of services to which patients can self-refer in order to ‘free up clinical time’.

GPs should also ‘reach out proactively’ to clinically vulnerable patients and those ‘whose care may have been delayed’, including through ‘catch-up initiatives’ for immunisations and cervical screening, the letter said. 

It said: ‘In restoring services, GP practices need to make rapid progress in addressing the backlog of childhood immunisations and cervical screening through specific catch-up initiatives and additional capacity and deliver through their primary care network (PCN) the service requirements coming into effect on 1 October as part of the Network Contract DES.’

NHS England added that practices should work with consultants to care for patients in primary care who would otherwise have had outpatient appointments.

It said: ‘To reduce infection risk and support social distancing across the hospital estate, clinicians should consider avoiding asking patients to attend physical outpatient appointments where a clinically-appropriate and accessible alternative exists. 

‘This means collaboration between primary and secondary care to use advice and guidance where possible and treat patients without an onward referral, as well as giving patients more control over their outpatient follow-up care by adopting a patient-initiated follow-up approach across major outpatient specialties.’

Practices and trusts should ‘between them’ ensure that patients whose planned care has been ‘disrupted’ by coronavirus receive ‘clear communication about how they will be looked after and who to contact in the event that their clinical circumstances change’, it added. 

The letter also outlined:

• All cancer screening programmes should be ‘fully’ restarted;
• The number of people referred with suspected cancer should be restored to ‘ at least pre-pandemic levels’;
• Trusts must ensure their e-Referral service is ‘fully open’ to referrals from GPs;
• PCNs should begin their programme of structured medication reviews in care homes;
• Preventative programmes that target those at risk of poor health outcomes should be accelerated, including ‘more accessible’ flu vaccinations and obesity reduction programmes;
• Practices should ensure all those with a learning disability are identified on their register, their annual health checks are completed and access to to flu vaccinations and screening is ‘proactively arranged’.

It added: ‘Having pulled out all the stops to treat Covid patients over the last few months, our health services now need to redouble their focus on the needs of all other patients too, while recognising the new challenges of overcoming our current Covid-related capacity constraints.’

It comes as health secretary Matt Hancock announced on Friday that unless there is a ‘compelling clinical reason’ to see a patient face to face, all GP consultations should be carried out remotely going forward.

In the speech, he also signalled that he wants GPs to continue to consult patients who would typically be seen in secondary care – with specialist help – after the Covid-19 pandemic comes to an end.

Last month, Public Health England guidance said that GPs, all clinical and non-clinical staff as well as patients should wear a face mask in practices if they are not ‘Covid secure’.

It followed widespread confusion around whether staff and patients should be wearing face masks in practices.