(Please note: this section is under review and may be subject to some amendments).
Patients who are to undergo a pre-arranged hospital procedure or operation are required to take a coronavirus test before they are admitted to hospital.
Patients who are being admitted as part of their elective (pre-arranged) care for at least an overnight stay in hospital, and day-case patients (patients in and out of hospital on the same day) who are not fully vaccinated should use a lateral flow device (LFD) test. Patients should take the test 3 days (72 hours) before admission and patients should minimise contact with others between taking the test and attending hospital.
Wherever possible, patients should be given 10 days' notice, by letter, of the test and order their LFD test via the Gov.UK testing portal. Once taken patients should report their test result online at the Gov.UK COVID-19 result portal or by telephoning 119. Patients should bring proof of their recent negative test with them when they attend for their elective (pre-arranged) procedure or operation.
Positive test results should be reported immediately to the hospital/ward using the contact details provided in the letter confrming the elective (pre-arranged) procedure. The relevant clinical team can then assess the risk and the appropriate action to be taken and the patient will be notified accordingly.
Patients unable or failing to test in advance of admission will be tested on arrival at the hospital and the results logged in accordance with hospital procedures.
All patients requiring critical care following thier elective procedure, or other patients who are considered by their clinicians to be more at risk, should have a PCR test prior to admission. In these cases, the PCR test will be sent to the patient by the hospital and undertaken 3 days prior to admission. These patients will be strongly advised to isolate between taking the PCR test and their admission to hospital.
No COVID-19 test will be required for fully vaccinated day-case patients considered by their treating clinician to be low-risk.
All patients undergoing emergency admittance to hospital are PCR tested for coronavirus. If the test is negative, an LFD test will be undertaken 3 days after admission and another LFD test between 5-7 days following admission.
Patients without symptoms of coronavirus requiring emergency admission to a mental health unit, and NHS patients in mental health and learning disability units returning from a period of planned leave, should be tested using LFDs.
Women admitted to a labour ward or maternity unit should be tested as soon as is practical at the hospital site using PCR or rapid PCR tests. Birth partners should not be tested.
All NHS patient, including paediatric patients, requiring a test by a clinician to support clinical decisions should be offered a PCR test as part of their usual diagnostic assessment. This includes patients who become symptomatic during a period of care.
Inpatients who have no symptoms of coronavirus should be tested on day 3 and days 5-7 of their stay using lateral flow devices. This also applies to asymptomatic patients in mental health and learning disability settings.
NHS patients in independent sector hospitals will also receive tests.
All patients on discharge to other care facilities, including care homes or hospices, should be tested by PCR and receive a test result within 48 hours before discharge from hospital. PCR testing is not required for patients previously testing positive with COVID-19 and who are within 90 days of symptoms onset or testing positive and have no new COVID-19 symptoms.
Inpatients with COVID-19
For inpatients with COVID-19, isolation should continue until 10 days after the onset of symptoms (or their first positive COVID-19 test if they do not have any symptoms), provided the clinical criteria below are met.
clinical improvement with at least some respiratory recovery
absence of fever for 48 hours without the use of medication
no underlying severe immunosuppression
A cough or a loss of, or change in, normal sense of smell or tasts (anosmia) may persist in some individuals for several weeks, and are not considered an indication of ongoing infection when other symptoms have resolved.
For clinically suspected COVID-19 patients who have tested negative and whose condition is severe enough to require hospitalisation, the isolation period should be measured from the day of admission.
Severely immunocompromised patients
It is possible for severely immunocompromised patients (patients with a weakened or poor immune system) to remain infectious for prolong periods, even if they do not display any symptoms of COVID-19. The isolation period for these patients whilst in hospital should be at least 14 days.
In severely immunocompromised patients the end of symptoms does not mean there is a decreased infectiousness and these patients should be isolated in side rooms, cubicles or grouped together until they have a negative PCR test. Staff should strictly adhere to recommended infectious prevention control measures throughout the inpatient stay.
Severely immunocompromised patients can end their isolation after a single negative PCR test result taken no earlier than 14 days after the onset of symptoms (or their first positive COVID-19 test if they do not have symptoms).
Severely immunocompromised patients who move beds within a hospital should be PCR tested prior to movement/transfer.
Inpatients to be Discharged to the Care Sector:
A PCR test will be undertaken within 48 hours prior to an individual's discharge into a care home, or a lateral flow test if the individual has tested positive for COVID-19 in the last 90 days.
The test result should be shared with the individual themselves, their key relatives or advocate and the relevant care provider before discharge takes place.
If an individual tests positive prior to discharge, they can be admitted to the care home if the home is satisfied they can be cared for safely. The should be isolated on arrival for 10 days in their own room and follow the supplementary guidance on infection prevention and control for adult social care. Residents should be closely monitored and consideration given to their eligibility for COVID-19 treatments, including antivirals or monoclonal antibodies.
A patient being discharged home who has not been in hospital for COVID-19 or who has previously tested negative whilst in hospital, may be tested 48 hours prior to discharge if they will require repeated hospital day care or if a member of their household is clinically extremely vulnerable.
Hospitals, mental health trusts, hospices and other healthcare inpatient settings must risk assess what visiting is possible in their circumstances. In most cases, visitors to hospital (including women and their birth partners attending for routine antenatal care, and end of life visitors) should not be tested. Before visiting, visitors should contact the ward department the inpatient is on to confirm visiting is permitted and should be informed about what to expect (i.e., social distancing, PPE and handwashing). The wearing of surgical face masks remains obligatory for all patients and visitors in all areas of all health settings.
NHS staff with symptoms of a respriatory infection and a high temperature or who does not feel well enough to go to work, is advised to stay at home and avoid contact with other people.
They should follow the guidance for people with symptoms of a respiratory infection including COVID-19.
Patient-facing healthcare staff who have symptoms or a respiratory infection and who have a high temperature or do not feel well enough to attend work, should take an LFD test as soon as they feel unwell. If the result is of this LFD test is positive, staff should follow the advice below (staff isolation after testing positive for COVID-19).
If the LFD test is negative, they can attend work if they are clinically well enough to do so and they do not have a high temperature. No further test is required.
If the staff member works with patients whos immune system meant that they are at higher risk of serious illness despite vaccination, they should discuss this with their line manager, who should undertake a risk assessment.
All patient-facing staff should resume asymptomatic LFD testing when they return to work, taking the first of these 48 hours after the LFD test that was teakn when they developed symptoms.
Staff isolation after testing positive for COVID-19
All healthcare staff who test positive, using LFD tests, regardless of whether they have symptoms, are advised not to attend work for 5 days. They should follow the guidance for people with symptoms of a respiratory infection including COVID-19
Patient-facing healthcare staff can return to work when they have had 2 consecutive negative LFD test results (taken at least 24 hours apart). The first test should only be taken 5 days after their symptoms started or the day their first positive was taken if they do not have symptoms (day 0).
If both the fifth and sixth-day LFD test results are negative, they may return to work on day 6 under the following conditions:
- the staff member feels well enough to work, and they do not have a high temperature
- if the staff member works with patients whose immune system means that they are at higher risk of serious illness, despite vaccination, a risk assessment should be undertaken and consideration given to redeplyment until 10 days after symptoms started (or the day of their positive test if they did not have symptoms)
- the staff member must continue to comply with all relevant infection control precautions and person protective equipment (PPE) must be worn properly throughout the day.
- on days the staff member is working, the LFD test should be taken prior to beginning their shift, as close as possible to the start time.
The staff member should resume twice-weekly asymptomatic LFD testing when they return to work.
If the day 5 LFD test is positive, staff should continue daily testing until they have two negative LFD tests, taken 24 hours apart. If the test result is still positive on the 10th day, staff should discuss this with their line manager who may undertake a risk assessment.
A positive LFD test within 90 days of a prior positive COVID-19 test means staff members should follow the guidance outlined above for a positive test again, unless a clinical risk assessment suggests that a re-infection is unlikely.
If they have been admitted to hospital they should be isolated in hospital (or continue to self-isolate on discharge) for 10 days from the onset of symptoms or their first positive PCR test result if they do not have symptoms, provided the clinical criteria below are met.
- clinical improvement with at least some respiratory recovery
- absence of fever (temperature greater than 37.8°C) for 48 hours without the use of medication
- no underlying severe immunosuppression
Immunocompetent and severely immunocompromised staff who have been hospitalised will follow the same procedures and protocols as other (non-staff) COVID-19 cases, as identified in the patients section above.
Patient-facing healthcare staff who are identified as a close contact should continue with twice-weekly asymptomatic testing. It can take up to 10 days for an infection to develop.
Staff who are identified as a household or overnight contact of someone who has had a positive COVID-19 test result should discuss ways to minimise risk of onwards transmission with their line manager.
This may include:
- redeployment to lower risk areas for patient-facing staff, especially if they work with patients whose immune system means that they are at higher risk
- immune limiting close contact with other people, especially in enclosed or poorly ventilated spaces
- working from home (non-patient-facing staff)
Staff should comply rigorously with all relevant infection control precautions.
Patient-facing staff in all NHS Trusts (hospital, mental health/community and ambulance trusts) are strongly encouraged to undertake weekly tests for Covid-19. Lateral flow tests are now the primary method for weekly asymptomatic testing and are done twice a week. Staff must order their own lateral flow test kits online using the Gov.UK testing portal.
There are several LFD test kits available and they may be nose and throat swabs or nose only. The different kits require varying processes and process times (ranging from 15 to 30 minutes). Staff should ensure they read the instuctions of any kits they are unfamiliar with.
Asymptomatic testing should be resumed 48 hours after an LFD test taken because staff feel unwell or have symptoms of a respiratory infection, including COVID-19.
The LAMP saliva testing programme ended on 31 March and is no longer available. Please see the saliva staff testing section of these webpages for more information.
The HiPRES app originally used to record saliva test results (see link at the bottom of this section) can now be used to record LFD test results, both for staff who used it previously and staff new to the app.
A healthcare staff guide to using Lateral Flow Devices (LFDs) for asymptomatic testing of patient-facing staff in NHS Trusts and a lateral flow training video have been provided to NHS Trusts. These contain operating procedures for using LFDs and FAQs for staff. The test is voluntary but remains a vital tool in keeping staff, their loved ones, and the patients they care for safe, and reducing the spread of the virus.
Asymptomatic lateral flow devices are also being used by patient-facing staff in all sectors in Primary Care (GPs, pharmacists, and dental practices). The staff guide for asymptomatic testing of primary care staff also contains a standard operating procedure, FAQs, and a supporting video.
It is really important that you continue to test yourself even after having the vaccine. Although vaccinated people will have more protection from COVID-19, not enough is known about the vaccine’s impact on a person’s ability to transmit the virus. Everyone who has received the vaccine should also continue to follow all infection prevention and control measures. Together, this will help manage infections in hospitals and help protect other staff, and patients, as well as your friends and family.
New guidance for testing professionals from NHS and other professions who visit care homes has been introduced. This requires all visiting professionals, including GPs, ambulance staff and community staff, to provide proof of a negative test within the last 72 hours (applicable to both LFD testing and saliva [LAMP] testing) or to have a negative lateral flow test taken at the care home, before being allowed to enter.
NHS professionals who are part of a regular testing regime should use this process to provide proof of a negative test. This can be done in a variety of ways, outlined in the guidance. If it has been more than 72 hours since the NHS professional was tested or the NHS professional is unable to provide proof, the care home should test the individual before entry to the care home. If for any reason this is not possible, it is the decision of the care home whether or not to admit the professional, taking into account the reason and urgency of the visit, unless the professional is required to enter by law.
Professionals who are not part of a regular testing regime will be given a rapid lateral flow test by the care home and must have a negative test result before gaining entry to the care home. If more than one care home is being visited on the same day, the test result from the first visit can be used as proof for any subsequent visits on that day.
This requirement does not apply in the case of an emergency or 999 visit to a care home, but all NHS professionals must follow their regular testing regime to reduce any risk from these visits.
This new testing regime is being introduced due to the substantial risks to care home residents if COVID-19 is introduced to the home. It is essential that professionals and all staff are tested regularly before visiting care homes to reduce the risk of transmission across different settings and to help keep residents and staff safe.
All staff at vaccination sites should be provided with access to LFD testing, including volunteers. All NHS staff already accessing LFD testing through their employer (primary care or secondary care) should continue to follow the routine testing already in place. NHS staff on temporary contracts at primary care network or community pharmacy-led vaccination centres should be given a box of 25 LFD tests and follow the primary care standard operating procedure for taking the tests. NHS staff on temporary contracts in hospital hub or large-scale vaccination centres should be given a box of 25 tests and follow the secondary care standard operation procedure for taking the tests.
Volunteers at any setting (PCN/pharmacy-led/hospital hub/large-scale site) should be tested on site at the beginning of their shift, either as an observed self-test or by trained vaccination centre staff. Reporting the results of tests is a statutory requirement and should be done immediately, using the NHS Digital online platform or, where access is available, via the host hospital trust's recording system. Positive tests require self-isolation and a confirmatory PCR test. Tests should be ordered through the relevant primary care or secondary care lead for the vaccination centre. The full operating procedures can be accessed here.
Hospice staff, including patient-facing volunteers, should take an LFD test at the beginning of each working week and another LFD test 3 or 4 days later. Staff returning from leave or sickness should ensure they restart the weekly testing programme.
Staff who have symptoms of COVID-19 or any other respiratory infection and a high temperature should staff off work and take an LFD test on the day they feel unwell.
If the test is negative they should continue to stay off work and take another LFD test 48 hours later. If this test is negative they can return to work.
If any test is positive staff should stay at home and avoid contact with others and take an LFD test 5 days after they first tested positive or developed symptoms (day 0). If this test is negative and they have a second negative test 24 hours later they can return to work.
If they continue to test positive after 10 days they should continue taking LFD tests but can return to work after one negative test. If they remain positive after 14 days they can stop testing and return to work on day 15.
Managers can undertake a risk assessment for those testing positive after day 10 who are no longer unwell and do not have a temperature to assess whether they can return to work.
A positive test within the hospice for a member of staff or patient requires the hospice to order 'outbreak kits' and test all staff for 5 days, and the hospice manager should contact their local health protection team.
Patients who are scheduled for admission form the community or a care facility are elgible for a PCR test, to be taken 72 hours before admission. They should also have an LFD test on the day of admission. Where an admission is urgent or unplanned and LFD test on the day of admission is sufficient.
Hospices must use their unique organisation number (UON) to order test kits - this includes LFD tests for asymptomatic and symptomatic testing, outbreak kits and PCR tests for admissions.
Hospices should use Royal Mail priority post boxes to return PCR tests. They can view recorded webinars to support their testing.
Visitor testing is no longer required apart from visitors who provide close personal care for patients. These visitors must take an LFD test upon arrival at the hospice and show proof of a negative test before proceeding with the visit. The guidance provides the information in full, with all relevant links to ordering, webinars, testing, results etc. Hospices can call 119 with any queries or concerns.
Independent Health Providers in England can order lateral flow device testing kits (LFDs) directly using the national testing portal to support the asymptomatic testing of patient-facing staff, in the same way as NHS staff. Staff should undertake twice-weekly testing. Positive tests require self-isolation for a minimum period of 5 days, with LFD tests on day 5 and day 6. If these are both negative, staff can return to work as long as they feel well enough, do not have a temperature, follow full IPC guidance and do not with those most at risk without a risk assessment by their line manager. The link below is used for staff to order their own test kits.
There are no longer any restrictions or testing requirements for nurses or anyone travelling to England from abroad. The red list for countries from which travel is banned no longer applies.
New guidance has been issued by the UK Health Security Agency to support all users to provide feedback about test kits, to report any damaged or missing elements of test kits or to report any harm or reaction from using the test kits. This applies to all types of home test kit - PCR, rapid lateral flow or saliva (LAMP) test kits. Each type of test kit has a feedback link within the guidance. Alternatively, you can provide feedback by calling 119. Feedback will be investigated by the UK Health Security Agency, the test kit manufacturer or a medical specialist, depending on how serious the feedback is.
New guidance has been issued for people aged 12 and over whose immune system means they are at greater risk of serious illness from COVID-19. Immunosuppression means they have a weakened immune system due to having a particular health condition or because they are on medication or treatment that suppresses/weakens their immune system. The guidance is intended to keep people in these groups safe and identifies the conditions and circumstances that make someone eligible for an additional dose of vaccine or the new treatments for the immunosuppressed who have tested positive for COVID-19.
Most people in this group will receive a letter from the NHS nationally or from their care team, confirming they might benefit from treatments and what steps to take. If you are in this group a PCR test kit will be sent to your home, which should be kept in the event that you develop symptoms of COVID-19. Anyone in this group who has not received a PCR test kit by 10 January should contact 119. If the PCR test is positive, you will be contacted to determine whether you will benefit from the new treatments. There is supporting guidance and instructions for using the PCR home test kit for people eligible for the new treatments is below right.
For international travel people who live in England will be able to demonstrate their COVID-19 vaccination status to others, as proof of having received the full course of 2 doses of any approved vaccine - this is now called the NHS COVID Pass. This can be in:
· digital form, either via the NHS website (you must log in) or by using the NHS app (which is free but different to the COVID app)
· or in paper form, by requesting a letter via NHS.UK website or by calling the NHS helpline at 119 and requesting a letter.
You should wait at least 5 working days after receiving your second dose before calling 119 and expect the letter to take up to 7 working days to reach you.
Your NHS COVID Pass can be scanned to check and validate your COVID-19 vaccination status in venues in over 60 countries, including those in the EU. Booster vaccinations will show on the COVID Pass within 5 days. The NHS app can now also show test results in addition to your vacciantion status.
From 12 May 2022 the NHS COVID Pass ceased to be available. This means that venues or events can no longer request it as a condition of entry.
Children aged 12 or over can get an NHS COVID Pass for travel, but should follow the entry requirements of the country they are travelling to. The NHS COVID Pass for international travel can be stored in an Apple Wallet or Google Pay, even if the device is offline. Some children aged 5-15 who have had a primary course of COVID-19 vaccination can get an NHS COVID Pass letter for international travel.
There is additional guidance for if you cannot get an NHS COVID pass letter, which includes a BSL video about what to do if you cannot get a post-vaccination letter has now been added to the website. You should always check the Gov.UK foreign travel advice pages to see which countries may be requesting proof of vaccination or other requirements, such as testing, to travel abroad. The NHS app will now show COVID test results in addition to your vaccination status.
Organisations registered with the National Testing Programme (NTP), such as GP practices and care homes, will be issued with a Unique Organisation Number (UON) which will allow better quality data to be produced. Organisations will need to use this number going forward to order new tests kits, book a courier and to register completed test kits for results. The NTP will issue the UON to organisations. See below the links to the UON guide and the spreadsheet that allows 50 tests to be registered at the same time.