Mask advice for GP practices to remain unchanged from 19 July

Although infection prevention and control (IPC) guidance agreed by the four UK nations – with support from organisations including Public Health England (PHE) and NHS England – remains ‘under constant review’, there are no plans to update it on 19 July, PHE has confirmed. Confirmation that the advice will remain unchanged means that GP practices can continue to ask non-exempt patients to wear a face covering – and that practices can maintain 2m social distancing rules. The GMC has also confirmed to GPonline that there is ‘nothing to prevent’ GP practices from continuing to ask patients and staff to wear masks after legal restrictions are lifted – and at least one LMC has told practices that it believes they can tell patients who refuse to wear face coverings that they will be seen remotely if it is clinically safe to do so.

Face coverings

Meanwhile, NHS England’s 8 July primary care bulletin said: ‘Following the PM’s announcement that face coverings will be optional and social distancing will not be necessary from 19 July, it is important to note that current IPC guidance remains in place at this time.’ Current IPC advice says: ‘The use of face masks or face coverings across the UK remains as an IPC measure. In addition to social distancing, hand hygiene for staff, patients/individuals, and visitors are advised in both clinical and non-clinical areas to further reduce the risk of transmission. ‘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. The physical distancing of 2m remains in place as standard practice in all health and care settings, unless providing clinical or personal care and wearing appropriate PPE.’ PHE COVID-19 strategic response director Dr Susan Hopkins said: ‘There is current IPC guidance in place in healthcare settings and both patient and staff safety must remain the highest priority. The guidance, which includes measures for both staff and visitors, covers appropriate use of face-covering and social distancing. The guidance is under constant review based on available and emerging evidence.’

GMC advice

GMC medical director and director of education and standards Professor Colin Melville said: ‘There is nothing to prevent GP practices from choosing to introduce safety measures, which may include patients and staff being encouraged to continue wearing face masks, once any legal requirements are lifted. ‘Throughout the pandemic, we have encouraged doctors to take precautions to protect their own safety and will continue to encourage doctors to consider how they can stay safe while providing patient care safely once legal restrictions ease.’ The regulator also pointed to its Good Medical Practice guidance, however, which says: ‘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. ‘Doctors are expected to use their professional judgment and expertise to apply the principles in the guidance to the various situations they face.’

Patient expectation

Nottinghamshire LMC chief executive Michael Wright told GPonline that doctors were ‘looking for a national steer from the BMA or NHS England’, but that the LMC anticipated that patient expectation for practices to allow ‘more walk-ins’ would rise from 19 July. Health and social care secretary Sajid Javid said this week in parliament that he expected face-to-face GP access would be ‘better’ after 19 July – although half of all appointments delivered in the pandemic have already been face-to-face, in addition to tens of millions of COVID-19 jabs delivered in person by general practice. Mr Wright said he believed practices could continue to insist on mask-wearing ‘both as responsible employers and from a public liability perspective’ – adding that the relaxation of rules changed little apart from patient expectation. He added: ‘In terms of how strongly they can insist on this, I think it’s difficult and honestly wouldn’t advocate practices outright refusing treatment to people because they refuse to wear face coverings, hence us helping with comms/patient info on why the practices would still request that patients wear masks. ‘It may be that a patient refusing to wear a facemask is told that they will be consulted via phone or video if clinically safe to do so – in order to protect staff. That I believe we could defend as long as there was a clinical rationale behind it.’ A recent YouGov poll found that the vast majority of the general public were in favour of rules on mask-wearing continuing on public transport and in enclosed public spaces. Plans to relax COVID-19 restrictions from 19 July come as cases of coronavirus and hospitalisations continue to rise. BMA leaders have called plans to press ahead with relaxing rules ‘irresponsible’. Source: gponline.com