Updated UK Health Security Agency guidance – confirmatory PCR tests to be temporarily suspended for positive lateral flow test results



Classification: Official

Publication approval reference: C1536


  • ICS and STP leads
  • All CCG Accountable Officers
  • All NHS Foundation Trust and Trust Chief Executives, Medical Directors, Chief Nursing Officers and Chief People Officers/HR Directors
  • All PCNs and all GP practices
  • All Community Pharmacy
  • All NHS primary care dental contract holders
  • All Primary Care Optometrists and Dispensing Opticians
  • All Pathology Incident Directors

Copy to:

  • Chairs of ICS and STPs
  • All CCG Chairs
  • Chairs of NHS trusts and foundation trusts
  • All Local Authority Chief Executives
  • NHS Regional Directors
  • NHS Regional Directors of Commissioning

8 January 2022

Dear colleague

We are writing to provide you with an update in the light of further changes for the general population announced by the UKHSA on testing, and the implications for the NHS.

Staff testing

This letter provides a summary and applies to all staff including substantive clinical and non-clinical roles, bank staff, contractors and suppliers; students working in all facilities, settings and organisations delivering NHS care and volunteers working in settings with patients.

From 11 January, those who receive positive lateral flow device (LFD) results for COVID-19 will be required to self-isolate immediately and will not be required to take a confirmatory PCR test. This is because the vast majority of people with positive LFD results will have COVID-19 at current high prevalence rates.

Lateral flow tests are taken by people who do not have COVID-19 symptoms. Anyone who develops one of the three main COVID-19 symptoms should stay at home and self-isolate even if a lateral flow test is negative and take a PCR test as soon as they are able to. They must self-isolate if they get a positive test result – these rules have not changed.

Under this new approach, anyone who receives a positive LFD test result and does not have symptoms should report their result on gov.uk and must self-isolate immediately but will not need to take a follow-up PCR test. Staff should report their absence in line with the employer’s sickness absence policy. After reporting a positive LFD test result, they will be contacted by NHS Test and Trace so that their contacts can be traced and they must continue to self-isolate.

There are a few exceptions to this revised approach:

  • People who are eligible for the £500 Test and Trace Support Payment (TTSP) will still be asked to take a confirmatory PCR if they receive a positive LFD result, to enable them to access financial support.
  • People participating in research or surveillance programmes may still be asked to take a follow-up PCR test, according to the research or surveillance protocol e.g. SIREN.
  • Around one million people in England who are at particular risk of becoming seriously ill from COVID-19 have been identified by the NHS as being potentially eligible for new treatments. They will be receiving a PCR test kit at home by mid-January to use if they develop symptoms or if they get a positive LFD result. This group should use these priority PCR tests when they have symptoms as it will enable prioritised laboratory handling.

Patient testing

  • Patients with a positive LFD result in a healthcare setting (e.g. an Emergency Department or maternity setting) may require a confirmatory PCR test in line with clinical requirements and / or IPC guidance.
  • Patients with positive LFD tests at home who need to access healthcare settings should follow the testing guidance of that setting.

Self isolation

In line with the reduced self-isolation approach announced on 22 December, staff who test positive will be able to leave self-isolation and return to work, 7 days after the date of their initial positive test if they receive two negative LFD results, 24 hours apart, on days 6 and 7 and providing they are medically fit.

The likelihood of a positive LFD test in the absence of symptoms after 10 days is very low. Building on UKHSA advice if the staff member’s LFD test result is positive on the 10th day AND the person has no symptoms, they should have a local risk assessment with a view to return to work depending on the work environment. We are aware that with current staff absence levels organisations will at times need to risk assess isolating staff to allow them to return to work on a balance of risk basis (for those who remain LFD positive on or after day 10).

Staff who are contacts of someone confirmed COVID-19 positive:

  • must stay at home and self-isolate if not fully vaccinated
  • if fully vaccinated (i.e. have received two vaccine doses and are 14 days post second vaccination) should arrange a PCR test and can return to work if it is confirmed negative (if positive, isolate for 10 days). If negative, they should complete daily lateral flow tests before attending work each day for 10 days and immediately isolate in the event of a positive LFD or similar.

To support colleagues and to protect our patients and services, NHS providers and primary care organisations are asked to continue to ensure that:

  • 1:1 conversations continue with any member of staff or student who has not had both doses of the vaccine, to understand and address their questions and concerns
  • robust local monitoring processes are in place for regular staff and student LFD or where available, LAMP testing, with Board level assurance/organisational leadership and oversight
  • staff (even if vaccinated) continue to carry out asymptomatic (twice weekly) LFD or where available, LAMP testing, and report results so that cases of the virus can be identified and isolated early to help keep staff and patients safe
  • staff report the results of their twice weekly asymptomatic tests whether positive or negative at https://www.gov.uk/report-covid19-result
  • COVID-related sickness absence is recorded correctly using the drop-down options in ESR where that is available, to ensure we develop an accurate picture
  • staff are offered continuous learning regarding UKHSA’s IPC guidance with access to refresher education events for all staff and students including those colleagues who may not have access to traditional information cascades.

In addition to the crucial roll out of the vaccine booster programme and systematic patient and staff testing, the consistent application of IPC measures remains the most effective defence against the entry and spread of COVID-19 in healthcare settings.

Thank you for your ongoing support.

Yours sincerely

Professor Em Wilkinson-Brice | NHS Deputy Chief People Officer

Ruth May | Chief Nursing Officer, England

Dr Nikita Kanani | Medical Director for Primary Care

Professor Stephen Powis | National Medical Director