In the week when face coverings became compulsory on public transport in England, it seems incredible that there’s still confusion over whether face masks are mandatory for patients in GP surgeries. The guidance from Public Health England (PHE) and NHS England is muddled and, if the thread on our Practice Index Forum is anything to go by, open to interpretation.

While comments on the thread – check it out here – very much point to practices making individual calls around mandatory face coverings or masks, the confusion is clear. Can the rule be enforced? Can patients be refused treatment? What about staff and social distancing? Plenty of questions remain unanswered.

Despite NHS England detailing their position on use of surgical masks, the BMA question the clarity of the message. In this briefing from NHS England, to all GP practices, it states:

“As announced by the Secretary of State for Health and Social Care, from the 15 June, the recommendation will be that all staff in hospital wear a surgical face mask when not in PPE or in a part of the facility that is COVID-secure in line with the workplace definition set by the government. The guidance will also apply to other NHS healthcare settings, including primary care, and will be published this week by Public Health England. We therefore ask that you make the necessary changes to implement that advice and help reduce any further risks of transmission, by 15 June at the latest.”

However, BMA Council chair Dr Chaand Nagpaul said in a recent statement: “It is imperative that we do all we can to prevent the spread of infection in healthcare settings, so that patients and visitors can attend hospital and GP practices without fear of contamination. The wearing of masks by staff and face coverings by the public will be key to enabling this.

“It is clear though that the Government has failed to properly plan for these changes which are now in effect and have left providers of NHS services confused and unprepared for how this will be implemented on the frontline. Furthermore, it is still unclear as to whether mandatory face coverings will extend to patients attending GP practices.”

Confusion remains over clear, succinct policy on use of masks in primary care.

Second guessing

As one practice manager told us, the lack of clarity results in people reading more into messaging or actions than perhaps they should – or would do if clear policies were laid out.

“This week I read the number of face masks that GPs can order from the Government’s emergency PPE portal has doubled from 50 to 100 per week. Is this a reaction to the rules changing? We don’t know – we’re trying to second guess all of the time,” the PM said.

“We’re also forever trying to interpret what guidelines are out there. Talking to PMs from nearby practices we had all read the advice from PHE in different ways, resulting in different policies. It’s a mess.”

Another PM pointed out that where there’s room for interpretation, people will choose their own path, potentially confusing patients.

“Our practice group covers two different sites. At one, the GPs are insisting on face masks, the other isn’t (mainly because they think it hinders the personal touch of face-to-face consultations). One patient ended up visiting both sites and ended up being totally confused! I felt sorry for them and, despite my best efforts, I haven’t been able to introduce a common policy. We need clear, guidance from the powers at be. Quickly.”

There are also calls for the NHS to communicate clear do’s and don’ts of wearing masks. Critics of mandatory mask wearing says that they can make staff complacent and less aware, so it’s worth repeatedly sharing some basic do’s and don’ts. Some NHS Trusts and CCGs have shared posters and online resources – if not there is plenty of advice out there, including NHS advice about beards and face masks.

Communication

It’s clear talking to practice managers that communication is vital whether mandatory face mask policies are being put in place or not.

Telling people when they book an appointment or pass through the telephone triage system, text messages, notes on appointment reminders, website updates and newsletters are just some of the methods being used to share the policy updates. What’s more, a selection of posters and screen ready images have been made available to Practice Index PLUS members covering off the following key messages:

• Please wear a face covering
• Please wear a mask
• Please stay 2m apart
• Please keep your distance

“I think communication is definitely the key and we’ve had no problems enforcing our mandatory face mask policy by making it unambiguous,” a PM commented. “Somebody on the Forum suggested that if it’s mandatory in hospitals then it’s reason enough for us! That’s actually the message we’ve been using, and people understand. We’ve also made it a fixed policy, with no exceptions, unless they are in a category that doesn’t have to wear one. And so far, nobody has objected.

“I think it’s interesting to add that we’re also asking patients to attend appointments alone wherever possible.”

Positive message

Another PM suggested practices can use face masks as an opportunity to raise money for a local charity or tie in with community groups who are making face masks.

“We’re in the process of turning our face covering policy into something fun – encouraging patients to make their own mask and send us a photo via our Facebook page. We’ve used guidance on how to make a mask published by the government and we’ve taken photos of some of the designs staff have come up with.

“We’ll pick a winning design and send out some gift vouchers as an incentive. It’s a creative way of sharing our policy and making people’s lives a bit better during these strange times. Some will argue that there’s no evidence to suggest face coverings make a difference, but we’re finding that patients feel safer when wearing them. If we can then involve an element of fun, why shouldn’t we?”

A practice that has very much taken up this idea and delivered it with success is Frome Medical Practice, which helped to set up Mask Force Frome – a community group that has made thousands of masks.

The practice added a news story to its website promoting homemade face masks and sharing the views of Dr Rebecca Hall, one of the GPs at the practice and a staunch advocate of the idea.

“The homemade masks have been fantastic,’ said Rebecca in the news story. “It demonstrates once again the energy and generosity of so many local people in and around Frome. The mask that I wear when I work as a GP protects you and the mask that you now wear protects me.

“Our Mask Force group has been excellent in helping us to deliver to Care homes, the town council, care agencies, local Frome pharmacies as well as to workers in shops and supermarkets. Mask Force has been so successful that it has spawned other groups both locally and further afield in the country.”

Another good idea is to share a face mask making video via a practice’s social media channel. There are loads out there – our quick search on YouTube found some good ones and there have been numerous short but good ones circulating on social media.

While it’s plain to see that official advice remains as clear as mud and policies are being set up on a practice by practice basis. Whether guidance and rules will change – and when – is anybody’s guess, but it’s really encouraging to see practices are finding ways to effectively communicate their policies.

However, we’ll conclude with the thoughts of one PM who told us: “The face mask debate should be secondary to keeping as many patients and visitors out of the practice as possible – it’s by far the best way to reduce risk!”

What’s your policy on face coverings/masks? How are you managing communication? Do you expect further guidance to be shared shortly? Let us know by commenting below or take it to the Practice Index Forum.