Publication approval reference: C1386
Lateral flow antigen tests for asymptomatic staff testing
Frequently asked questions – NHS trusts (organisations and staff) including community interest companies.
8 September 2021, Version 2
Updated in line with NHS England and Improvement’s letter setting out changes to the PHE guidance for NHS staff and students around self-isolation and return to work following COVID-19 contact.
From July 2021 all NHS staff will be able to order lateral flow device (LFD) testing kits from the GOV.UK website.
If you are currently using LFD tests boxed in 25s (distributed by NHS England and NHS Improvement to trusts for their staff), please refer to:
Any remaining supplies of LFD tests boxed in 25s should be used before ordering from the GOV.UK website.
For information on HR processes following a positive test and related isolation questions, please refer to the NHS Employers’ website.
Asymptomatic staff testing is an important component of Infection Prevention and Control, which all organisations and staff have a duty to adhere to. Continued efforts are required to keep staff and patients safe from potential transmission of COVID-19 in healthcare settings, and other places where care is provided, by ensuring that all staff continue to participate in this important programme.
The FAQs within this document aim to provide responses to the questions that are most commonly asked by staff and organisations about asymptomatic testing using a lateral flow device (LFD). This document should be read alongside the Standard operating procedure for use of LFDs for asymptomatic staff testing (all NHS staff).
What is changing?
From July 2021 all NHS staff will move to a new system where they will be able to order their own LFD testing kits from. The testing kits will enable colleagues to carry out regular testing for COVID-19 at home.
The test kits provided via the new system may be different type, it is important that staff familiarise themselves with the tests and the instruction leaflet each time they receive a new box.
This move will not only make best use of LFDs currently available to Test and Trace but will also provide a greater level of assurance by organisation that devices are routinely being ordered and used.
Please note, the statutory requirement to report all test results has not changed and staff must report all results in line with their organisation’s policy.
Before moving to the new system trusts are to use up their existing stock of Innova 25s and should continue to provide staff with boxes until they have run out.
- How can I order tests?
Test can be ordered at: www.gov.uk/order-coronavirus-rapid-lateral-flow-tests. When ordering, follow the instructions and select ‘yes’ to the question ‘Do you work for the NHS in England and take part in the asymptomatic staff testing programme?’ It may be helpful to create an account when you first use the site. This should only take a few minutes and means your details and preferences are saved for future orders.Please note, you should order more tests when you are near the end of your current pack and your Trust has advised you that they do not have any further boxes to issue to you.Most orders are delivered next day.
- Can I get more tests from another route that is more convenient for me (eg a local community pharmacy, or as a parent of a school age child)?
If you are able to order tests through the route described above, then you should do so, as this assures your organisation that its staff are compliant with testing requirements. If you do access LFDs through a different route, please ensure that your organisation is aware that you are participating fully in a twice a week LFD testing regime.
- How frequently should I carry out an LFD test?
You should carry out LFD testing twice weekly, so every three to four days to fit with shift patterns and leave requirements: for example, Wednesday and Sunday, or Monday and Thursday.
- When and where should I do the test?
You should perform the test at home before attending work, leaving enough time before the start of your shift to alert your employer if the test is positive.
- What are the reporting requirements?
The result, whether it is positive, negative or void/invalid, should be reported every time you complete a self-test. It is a statutory requirement to report all results.It would be helpful to familiarise yourself with and follow your trust’s local policy for reporting – this may be directly to your trust, or they may direct you to the national reporting method at www.gov.uk/report-covid19-result.You should only report the results through one route to avoid duplication.
- If my trust my policy is to report results on the gov.uk website, how do I do this?
- Click on the following link www.gov.uk/report-covid19-result and follow the steps below.
- Select who you are reporting the result for, either ‘myself’ or ‘someone else’.
- If you haven’t already, it is advised you create an account, you will only have to do this once and it will remember your personal details. You may also report without an account if you wish.
- Select the date you took the coronavirus test.
- Enter or scan your test ID number. You will find the ID number under the QR code on the LFD.
- Select the result of the test whether that be ‘positive’, ‘negative’ or ‘invalid/void’. Check your answers.
- Receive confirmation of registration via email.
- What happens if I get a positive result?
You should inform your employer of a positive result. A PCR test will then be arranged as per your organisation’s current process.You should follow government guidance: Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection.
- What happens if my test is negative, but I have coronavirus symptoms?
If you have coronavirus (COVID-19) symptoms, please follow the NHS guidance at: www.nhs.uk/conditions/coronavirus-COVID-19.
- If I have had a positive COVID-19 PCR test, when should I start the LFD tests again?
If you tested positive, you should recommence home testing 90 days after your positive PCR test was taken.
- If I have been identified as a contact and have had a positive PCR test in the last 90 days, what type of testing should I undertake?
As described in the updated 1Public Health England Guidance COVID-19: management of staff and exposed patients or residents in health and social care settings, in the circumstances detailed, if you have had a SARS-CoV-2 infection in the past 90 days, you should not have a PCR test and should undertake daily LFD antigen tests for a minimum of 10 days.1 Please note that references to guidance are accurate at time of writing and should be referred to for updates periodically
- Should I continue testing after a COVID-19 vaccine?
Yes, everyone who has been vaccinated should continue to test.Vaccinated people will have more protection from COVID-19, and there is some early evidence that it can prevent a person’s ability to transmit the virus, but it does not yet guarantee that you cannot transmit the virus to patients and staff.
- If I am already regularly being tested through existing regimes – eg professionals visiting care homes, SIREN testing, PCR testing in Tier 3 areas, etc – should this be replaced by LFD tests?
If you are already enrolled in another testing regime through your NHS organisation, this should not be replaced by LFD tests unless agreed by your organisation.If you are participating in research studies (such as SIREN) where the frequency of testing is not weekly (eg monthly) you should undertake twice-weekly LFD self-testing if you are a patient-facing member of staff or are an essential office based worker.
- 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’.
- What about LAMP testing – I thought this was being used for asymptomatic staff testing?
In some trusts, Loop mediated isothermal amplification (LAMP) testing is being used for asymptomatic staff testing, as is PCR. Local asymptomatic testing policy for the trust should be followed.
- Should I continue testing during annual leave?
You can continue to test while on annual leave, but it is not a requirement.
- Is it acceptable for me to share a test kit or reuse the tests?
You should not share tests with other people; all seven tests in the kit should be used by the same person. You can only use each item in the test kit once and test components should not be reused.The LFD testing kits that you order on behalf of yourself as an NHS employee should be used by you and are for asymptomatic testing.If members of your household are showing symptoms of COVID-19 they should follow the government guidance and obtain a PCR test at www.gov.uk/get-coronavirus-test.
- 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, you should contact a medical practitioner for advice.
- What is the protocol for informing and testing patients who have had contact with a staff member who has had a positive LFD test?
Your organisation’s protocols for tracing contacts should be followed.
- Can 10-day isolation following contact tracing be shortened through use of this testing?
Not currently. Ten-day isolation following notification that you have been in close contact with a COVID-19 case without relevant personal protective equipment (PPE) should be followed in line with government advice.
- What if I have been notified as a contact of a positive COVID-19 case?
As set out in NHS England and Improvement’s follow-up letter about the changes to PHE’s guidance on self-isolation and return to work following COVID-19 contact, from 16 August 2021, fully vaccinated staff and students who are identified as a contact of a positive COVID-19 case will no longer be expected to isolate and can to return to work.You should inform your line manager or employer immediately if you are required to work in the 10 days following your last contact with a COVID-19 case.
If you are fully vaccinated, in most cases you will be able to continue in your usual role subject to the implementation of the following safeguards to enable you to safely do so:
- you should not have any COVID-19 symptoms
- have a negative PCR test prior to returning to your NHS workplace. You should not attend work while awaiting the PCR test result
- You have had two doses of an approved vaccine, and are at least two weeks (14 days) post double vaccination at the point of exposure
- provision of subsequent, daily negative LFD antigen tests for a minimum of 10 days before commencing a shift (with test results reported to Test and Trace via the web portal and to your duty manager or an identified senior staff member). Any contact who has a positive LFD test should self-isolate and arrange a PCR test
- you are, and remain asymptomatic
- continue to use IPC measures, in line with the current UK IPC guidance.
If the above criteria cannot be met, or if the staff member/student has not had both doses of the vaccine, or they are living directly (same household) with a positive COVID-19 case, they will be asked not to come to work. This will remain under review. There may be times when it is appropriate for the staff/student living with a positive COVID-19 case to return to work, in line with government guidance, in a risk-assessed way, but this should be through a process agreed with an appropriate senior decision maker (eg DPH/DIPC). All staff and students must have an up to date individual risk assessment and be working in an appropriate setting for their risk status.
Additional information for organisations
- How do these tests from gov.uk differ from the boxes of 25s provided by employers?
The main differences between these tests are:
- The number of swabs, extraction tubes, extraction buffer volumes, test cartridges.
- The method of swabbing.
Staff should self-administer the test in line with manufacturer’s instructions which are issued with a box of tests (this will differ slightly depending on the manufacturer). Confirmation of positives by PCR test will be through the employing organisation’s local procedure.
- If staff still have available tests within the supply of 25s provided by the trust should they use those before ordering a further supply from Gov.uk?
Yes, all existing tests should be used before ordering from www.gov.uk/order-coronavirus-rapid-lateral-flow-tests.
- How often can staff re-order to ensure they have sufficient LFD supply?
It is recommended that staff order 1 box at a time. This provides enough for twice weekly testing for a three-week period. Delivery is usually the next day.
- Can staff chose where to have tests delivered to?
Deliveries should be requested to the member of staff’s home address.
- Can hospitals procure their own supply of lateral flow tests?
Lateral flow tests are purchased and provided centrally by the Department of Health and Social Care (DHSC). Trusts should not purchase them directly from suppliers.
- Should a contractor/temporary worker be working in a trust be included in testing?
Yes. Staff who are patient facing or unable to work from home and are regularly working in your trust should order LFD tests from: www.gov.uk/order-coronavirus-rapid-lateral-flow-tests. They should test themselves twice weekly.
- How should the testing programme work for doctors on their foundation programme who move hospitals?
All foundation year doctors in your trust are patient facing and should take part in regular testing.
- How will trusts access LFD tests for patient use cases (maternity patients and their partners, visitors to end of life patients and emergency department)?
Trusts should continue to order LFD tests for patients via email@example.com and report their results to Public Health England (PHE) via NHS Digital’s Strategic Data Collection Service (SDCS) as they currently do.
- Can you give guidance on whether staff working for community interest companies and independent sector organisations are included in the testing?
Yes, staff delivering NHS services in community interest companies can order tests at: www.gov.uk/order-coronavirus-rapid-lateral-flow-tests.
There is more information on the GOV.UK website about how independent sector providers, who are commissioned to provide NHS services, can access tests.
- Are 111 and 999 call handler staff included in the testing?
Yes, 111 and 999 call handler staff who are unable to work from home are considered a high-risk group because of the way in which they work and the impact of staff absence on the service should an outbreak occur. They should therefore be included in asymptomatic testing.
- Can these LFD tests be used for patients?
There are several approved use cases for LFD tests, where a quick test result is needed. There is specific guidance for each use case:
- Lateral flow device testing for emergency department patient pathways standard operating procedure
- Visiting healthcare inpatient settings during the COVID-19 pandemic: principles
- Supporting pregnant women using maternity services during the coronavirus pandemic: Actions for NHS providers
- Lateral flow antigen test for pregnant women and support people: Frequently asked questionsHowever, PCR tests should continue to be used for all other elective and non-elective patients. Patients who wish to test themselves may order tests for personal use from www.gov.uk/order-coronavirus-rapid-lateral-flow-tests.
- Is it mandatory for staff to now report results to GOV.UK, or can trusts continue to use local reporting systems if these are working well?
All test results must be reported whether they are positive, negative or invalid/void. It is a statutory requirement to report results every time a self-test is completed. Staff may report online at www.gov.uk/report-covid19-result. Alternatively, trusts may continue to use local reporting systems if they are working well and enable trusts to have a thorough understanding of their staff testing and reporting activity.Should trusts continue to use their own system test results should be submitted weekly via SDCS (as per current process). Staff should not dually report, test results should be reported at gov.uk or via the local reporting systems.Trusts should clearly set out and ensure staff are aware of their reporting policy either to the gov.uk website or using local trust systems.
- How will trusts know if their staff are testing and reporting?Management information (MI) will be provided from the GOV.UK ordering and reporting systems.
Organisations are required to ensure that they have local systems in place for patient-facing staff to demonstrate that they are compliant with their organisation’s asymptomatic staff testing regime when attending their workplace.
- What about reporting results for other approved use cases?
Tests carried out in trusts for the other use cases should be reported weekly by trusts to PHE via the SDCS NHS LFD Test Results data collection.
- If a staff member has a positive LFD, how will the trust be informed?
Staff should be instructed to inform their employer of a positive result. A confirmatory PCR test will be arranged. The staff member should follow the government guidance: Stay at home: guidance for households with possible or confirmed coronavirus (COVID-19) infection.
- Are we asking potentially positive staff to come to hospitals for a confirmatory PCR test?
Trusts should use their normal processes to access tests for staff members who have symptoms of COVID-19, whether that be through Pillar 1 or 2. These processes assume that staff may be infected with COVID-19 and therefore, suitable infection prevention and control (IPC) and PPE will be in place. Staff should continue to isolate until they have the results of the PCR test.
- At what stage is Test and Trace informed of the test result?
Test and Trace will be informed once the confirmatory PCR test result is known. If this is a positive result, the result will be referred to Test and Trace.
- Can LFD 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. Two positive LFDs would be treated as an outbreak. Positive LFD test results should be confirmed through PCR testing; if the confirmatory tests are also positive, then normal outbreak protocols would apply.
- Is asymptomatic testing mandatory or voluntary?
Regular asymptomatic testing is voluntary, but staff should be strongly encouraged to be involved in LFD testing to protect themselves, colleagues and patients. Asymptomatic staff testing is an important component of Infection Prevention and Control, which all organisations and staff have a duty to adhere to.
- How effective are LFD tests in detecting COVID-19?
The government has published research on LFD tests and analysis of lateral flow tests.
- Is ethylene oxide is used in the sterilisation of LFD tests and is this safe?
Lateral flow tests have been certified safe to use both in the EU and UK by the Department of Health and Social Care. Ethylene oxide is used in the sterilisation of swabs only.
Ethylene oxide is one of the most used sterilisation methods in the healthcare industry – it is an important sterilisation method that manufacturers widely use to keep medical devices safe.
Any traces of ethylene oxide remaining in the lateral flow device or packaging after sterilisation are below limits that would be considered hazardous for health and comply with international standards.
- Will there be information in other languages available for the self-test kits?
A step-by-step guide for COVID-19 self-testing is available in a number languages at: www.gov.uk/guidance/covid-19-self-test-help#self-test-instructions.
Translation services are available by calling 119 and can provide access to around 200 languages and British Sign Language (BSL), easy read and large print. This is to support people throughout the testing process.
- For queries and further information relating to LFD tests boxed in 25s, including questions about this document should be directed to firstname.lastname@example.org or in writing to the address below. For queries about LFD kits ordered from the GOV.UK website, please call 119.
NHS Testing Programme
NHS England and NHS Improvement
80 London Road