Managing patients who decline to wear a face covering

There may be a small number of patients who will not follow government guidance on face coverings in NHS settings.

Although it's a rare occurrence, a few dental patients who decline to wear a mask or other face covering during the continuing coronavirus pandemic are responding to requests to do so with complaints and claims for compensation alleging discrimination.

Therefore, it's important to be alert to this remote possibility and know how to manage these patients carefully, with a view to reducing the risk of such complaints and claims.

Patients may refuse to wear a face covering because they have a medically diagnosed condition that prevents it, because they suffer from anxiety or a self-diagnosed condition, or because they hold strong views about the need for such precautions during the pandemic.

Whatever their reason, it is wise to treat them sensitively and not to operate a 'no mask, no treatment' policy. The GDC's Standards for the Dental Team requires you to treat patients fairly, as individuals and without discrimination, and to comply with the law.

The following points may help to prevent confrontation and protect patients and the dental team alike.

  • Have practice procedures and protocols in place, but it is preferable not to describe them as practice policies and suggest they apply to everybody, irrespective of their individual needs.
  • Make those procedures and the reasons for them known to patients by explaining them clearly and simply on your practice website, as well as when patients book appointments through reception and when they attend appointments.
  • Consider emailing or texting patients a copy of the practice processes for protecting patients, the dental team and other patients at the time they make their appointment.
  • Include in all explanations a clear invitation for patients who are unable to wear a face covering to inform the practice in advance, so that suitable alternative arrangements can be made for them.
  • Have in place an established, well-thought out written protocol for patients who decline to wear a face covering. Consider seeing such patients at the end of a session, when no other patients will be present, or having them enter the practice through another entrance which avoids them mixing with other patients. Be alert to the risk that other patients may complain if they encounter someone not wearing a mask in public areas.
  • Ensure that all patient-facing staff know what the practice protocols and procedures are, and how to manage patients who decline to wear a face covering, to avoid confrontation.
  • Consider whether an individual patient who declines to wear a face covering may be able to be treated remotely, without a face-to-face consultation.
  • Have clear signs outside the practice, and to assist the patient journey through the practice.
  • If a patient says at any stage that they cannot or will not wear a face-covering, avoid confrontation and refrain from suggesting that it is practice policy that every patient must wear a face covering. See if the patient will reconsider, but if they will not explain that you have procedures in place to accommodate them and what those procedures are.
  • Consider having a supply of masks for patients who do not possess one or have forgotten theirs on the day.
  • Do not quiz patients in public areas about their reason for declining to wear a face covering, to avoid appearing insensitive and allegations of a breach of confidentiality.
  • If a patient states they have a medical condition which has not been previously declared in their medical history, it is perfectly reasonable for the treating clinician to ask the patient for further information, in private. That further information should be sought simply to ensure you have a complete medical history for the patient's safe dental treatment, and not to make a judgement on whether the patient's refusal to wear a face covering is rational or otherwise.
  • If a patient refuses to give a full medical history, then as long as the patient understands the reason for bring asked for it and the consequences of not providing it, it would be reasonable to decline treatment - but only on the basis that it is required for their safe dental treatment and is totally unconnected to their refusal to wear a face covering.
  • If in doubt or if you are concerned, call the DDU's 24-hour dento-legal helpline on 0800 374 626.

This page was correct at publication on 10/05/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.