Lateral flow antigen test FAQs: roll out in primary care
- Frequently asked questions
- Administering the test
- Reporting the test result
- Acting on the test result
- Ordering and delivery of test kits
Publications approval reference: 001559 / C0964
UPDATED Version 2, 28 January 2021 – Additional questions highlighted in yellow.
Frequently asked questions
These are the specific FAQs related to the roll out of lateral flow antigen tests in primary care. For some general advice, including some questions on HR processes, please refer to NHS Employers’ FAQs on asymptomatic staff testing: https://www.nhsemployers.org/covid19/health-safety-and-wellbeing/asymptomatic-testing
Administering the test
Q1. What type of test are we rolling out?
The Innova SARS-CoV-2 Antigen Rapid Qualitative Test uses a swab which has been in contact with the nostril of the person being tested. The swab is inserted into the extraction tube with the extraction fluid and then rotated and pressed to make sure that the sample from the swab is released into the extraction fluid (swab is then discarded at this point).
The person testing then takes the extraction tube with the nozzle cap and places 2 drops of extraction fluid into the sample well of the LFD testing device cartridge and waits for the results on the test device.
Q2. What is the specificity and sensitivity of this particular test?
The government has published its latest research on these tests. This can be found here https://www.ox.ac.uk/news/2020-11-11-oxford-university-and-phe-confirm-high-sensitivity-lateral-flow-tests-following
Q3. Who administers the test?
The test is self-administered. An HEE instruction video and written instructions, including on interpretation of results, are available for staff to learn to self-administer their test.
Q4. Is the test mandatory or voluntary?
Tests are voluntary, but staff should be encouraged to be involved in regular testing to benefit their colleagues and patients.
Q5. Which staff members in primary care will have access to lateral flow antigen tests?
All asymptomatic, patient-facing staff delivering NHS services in primary care across all four primary care contractor groups (Medical, Dental, Optometry, and Community Pharmacy) in England should be offered lateral flow antigen testing.
This should include temporary patient-facing staff who provide NHS services through the contractor, but are employed through an agency or other kind of temporary arrangements (eg locums).
Q6. Doctors on their foundation programme move NHS organisations, how should their testing programme work?
All foundation year doctors working for primary care contractors should be included, as they are patient facing. If they move to another NHS organisation and still have a supply of tests, they should keep these tests and use them while working at the next NHS organisation. For new starters, if they don’t already have tests from a previous employer, they should be provided with tests.
Q7. Should staff members continue testing after they’ve received the COVID-19 vaccine?
Yes, staff should continue to test even though they have had the vaccine.
Q8. Can these tests be used for patients?
No. These lateral flow antigen tests are solely for asymptomatic patient-facing staff delivering NHS services.
Q9. Can staff use the tests for their symptomatic family members?
No. Staff and family members who have symptoms should access PCR tests in the normal way.
Q10. How frequently should staff be tested?
Staff should test themselves twice weekly every three to four days to fit with shift patterns and leave requirements; for example, Wednesday and Sunday, or Monday and Thursday.
Q11. When should staff test?
Staff should be asked to perform the test before attending work, leaving enough time before the start of their shift to alert their employer who may need to arrange cover, should their lateral flow test be positive.
Q12. Where should staff test?
Staff should conduct the test at home if possible.
Q13. Should staff continue swabbing during annual leave?
Staff may continue to swab while on annual leave of longer than a week, but it is not a requirement.
Q14. What should staff do with the used test kits?
Staff can safely dispose of the test items in their normal household waste but should pour any residual buffer solution away first.
Q15. What happens if the buffer solution is accidentally consumed?
As set out in the manufacturer’s safety instructions, the buffer solution is not hazardous; however, if accidentally ingested, a medical practitioner should be informed.
Q16. What is the shelf life of the extraction (buffer) solution once opened?
The shelf life of extraction solution is 2 years, even after it is opened.
Q17. How do I get additional bottles of extraction (buffer) solution as I don’t have any left (due to spillage etc.) but I still have kits left in my box of 25 kits?
Additional bottles of extraction solution are not available for distribution, if you have run out of extraction solution your practice will need to order a replacement box of 25 test kits.
Q17. If staff are already regularly being tested through existing regimes – such as participation in COVID-19 studies – should this be replaced by lateral flow tests?
If staff are already enrolled in another testing regime, this should not be replaced by the lateral flow tests unless agreed by your organisation.
If they are participating in research studies where the frequency of testing is not weekly (e.g. monthly) they should undertake twice-weekly LFD self-testing.
Q18. Will this testing regime remove the need for staff who have been exposed to a positive Covid-19 case to self-isolate?
No. Government self-solation advice should be followed at all times. This test does not remove the need to self-isolate.
Q19. Can tests be used as a response to Covid-19 outbreaks?
Should an outbreak be declared in your organisation, testing regimes should be discussed in line with your normal organisational response.
Q20. Is there advice on giving staff time back from undertaking the test at home?
The test should take no longer than 5 minutes to undertake, with a 30-minute wait for results.
Q21. Why is the testing method different from that described in the manufacturer’s original instructions for use?
We are recommending the swab is used and the sample taken in a different way to the instructions for use, with more rotation of the swab at a lower level of penetration, to enable easier self-administration of the test. This is based on advice from experts. The manufacturer has been informed of the planned use of the tests for self-administered asymptomatic staff testing within the NHS.
Q22. Can we get the lateral flow guidance leaflet in other languages?
There are no plans to translate the lateral flow guidance leaflet.
Q 23. Do I have to share my result if I am going into a care home?
Yes, please share your result. If you are unable to do this you may be asked to undertake an LFD before entering the care home.
Reporting the test result
Q24. How should the results of these tests be reported?
Recording of all results (positive, negative, invalid) from lateral flow devices is a statutory requirement. The results from the lateral flow antigen test for primary care staff will be documented at home by the individual using the NHS Digital online platform. Staff can access the NHS Digital platform on www.gov.uk/report-covid19-result
Q25. Is there any action regarding reporting test results for primary care employers?
There is no action for primary care employers to report results, as these will be reported to Public Health England by each member of staff individually, in line with statutory requirements for COVID-19 reporting. Primary care contractors should encourage their staff members to test twice weekly and report their results.
Q26. Are there any indemnity implications of the roll out of lateral flow antigen testing for primary care contractors?
For the majority of NHS staff, the HEE training video and information leaflet describing ‘how to self-test’ will be sufficient for staff to become proficient in self-testing independently. Some staff, where English is not their first language, or who have dexterity or other issues, will require practical support which may include hands-on demonstrations/training.
Asymptomatic COVID-19 testing, including lateral flow antigen testing, of NHS primary care staff by other NHS primary care staff will be covered under the Clinical Negligence Scheme for Coronavirus (CNSC).
Acting on the test result
Q27. What happens if staff get a positive result?
Staff should inform their manager of a positive result in the normal way. Staff should arrange a confirmatory PCR test via the established testing routes. They and their household should self-isolate as set out in government guidance:
Q28. What happens if a test is negative, but staff have coronavirus symptoms?
If you have coronavirus (COVID-19) symptoms, please refer to NHS guidance online: nhs.uk/conditions/coronavirus-COVID-19.
Q29. At what stage is NHS Test and Trace informed of the result?
At the point the confirmatory PCR test result is known, and this is a positive result, test results will, as normal, be referred to NHS Test and Trace.
Q30. Should patients who have been in direct care of a staff member who tests positive with lateral flow be tested while the confirmatory PCR test result is pending?
Your organisation’s protocols for tracing contacts should be followed.
Q31. If a staff member has a positive PCR COVID-19 test, when should they start the lateral flow antigen tests again?
A staff member who tested positive would recommence home testing 90 days after their positive test was taken. The staff member will need to liaise with their primary care contractors to track the date at which the retesting should start.
Q32. Do we treat two positive lateral flow antigen test results as an outbreak?
Lateral flow antigen positive test results should be confirmed through PCR testing; if the confirmatory tests are also positive, then normal outbreak protocols would apply.
Q33. Can the period of isolation following contact tracing be shortened through use of this testing?
No. Ten day isolation following notification that a staff member has been in close contact with a COVID-19 case without relevant PPE should be followed as per Test and Trace advice. Please refer to government guidance here. Testing with lateral flow antigen tests are being used in pilot sites to verify whether daily testing might lessen the need to isolate, but this is not currently the advice and isolation should be followed as per instructed by Test and Trace.
Q34. Is confirmatory PCR testing accessible through pillar 2, and if yes what field should be filled to avoid symptomatic questions?
You should use whatever PCR route is in use by your organisation. If this is through pillar 2, tick the box that indicates you are a key worker but not part of a pilot, you will then see an option to say ‘I’ve been told to take a Coronavirus test’ on the form.
Ordering and delivery of test kits
Q35. How do primary care contractors order test kits?
The ordering and delivery process for lateral flow antigen test kits to primary care contractors is managed by Primary Care Services England (PCSE), as agreed with NHS England and NHS Improvement. Primary care contractors were contacted directly by PCSE to invite them to order. Contractors can continue to order test kits on the PCSE online portal, if for example they have additional new staff or have not previously ordered.
Q36. How many boxes of tests should primary care contractors order?
Primary care contractors should order one box of tests for each patient-facing member of their staff delivering NHS services. For example if there are 10 patient-facing members of staff delivering NHS services within an organisation, the order should be for only 10 boxes of test kits – as one box of 25 tests is enough to test twice-weekly for 12 weeks. The maximum amount of boxes of tests that can be ordered on the PCSE portal is now 27. Contractors who need to place an order for more than 27 members of staff should email email@example.com. Contractors should ensure that they do not place duplicate orders on the portal, as these will be automatically removed.
Q37. How can staff at Local Vaccination Service sites get lateral flow tests?
Staff working at Local Vaccination Service (LVS) sites should receive their lateral flow tests through the primary care contractors that are part of that site. These primary care contractors should order one box of lateral flow test kits for each of their members of staff working at the LVS site, as part of their normal order on the PCSE portal and distribute the boxes to their staff.
If there are any staff working at the LVS site who have been brought in exclusively to work at the site, but do not normally work in any of the primary care contractors connected to the site, the primary care contractors should agree one contractor who will order boxes of test kits for these staff as well.
Q38. What if a primary care contractor is not registered with PCSE?
Most primary care contractors have an account with PCSE. Contractors should notify the person who manages their PCSE orders and / or their PCSE main contact that they will be contacted by email by PCSE in the next few weeks. If after having checked with the organisation’s manager, the contractor is certain they do not hold an account with PCSE, they should contact the team at PCSE at www.pcse.england.nhs.uk/contact-us.
Q39 How do I order tests if I am an extended access or IUC provider?
The PCSE portal is only available to primary care contractors. If you are an extended access or IUC provider who also holds a primary care contract, you should use the PCSE portal to also order LFDs for staff delivering extended access or IUC (who do not already have LFDs through another NHS route). If you do not hold a primary care contract, you should request lateral flow tests from your commissioner, who should raise through their regional testing lead. Queries can also be directed to the NHSE National Team via england.covid-LFD@nhs.net.
Q.40. When will primary care contractors receive their delivery of tests?
Delivery of test kits ordered up to 17 January 2021 has commenced and will continue to be delivered to primary care contractors as soon as possible, throughout January. Any orders placed after 17 January 2021 will be delivered to primary care contractors as part of the BAU orders to PCSE on their normal scheduled delivery date.
LVS sites that went live in December 2020 received 27 boxes each of lateral flow antigen test kits in December in line with their go live dates. Sites that went live after December have received and will continue to receive tests in line with the orders placed by the primary care contractors part of the LVS site.
Q41. When deliveries arrive what size of space should be allocated for them?
Each box of 25 tests has the dimensions: 7 by 4.5 by 5.5 inches.
Q42. Should the tests be kept in specific conditions; will they require security like Tamiflu did?
Tests can be stored in typical warehouse conditions; they do not need refrigeration but should be kept out of direct sunlight and not be exposed to heat. They are not expected to require any additional security than other items of NHS deliveries.
Q43. Can primary care contractors procure their own supply of lateral flow tests?
Lateral flow tests are purchased and provided centrally, and primary care contractors should not purchase them directly from suppliers.
Q44. Where should any enquiries be directed?
Email questions to england.covid-LFD@nhs.net.