Classification: Official
Publication reference: PRN00288
To:
• All NHS acute, mental health, community and foundation trusts:
‒ chief executives
‒ medical directors
‒ directors of nursing/chief nurses
‒ chief financial officers
‒ HR directors/chief people officers
• All primary care networks
• All GP practices
• All infection prevention and control leads
• All pathology incident directors
• All regional scientific officers
cc.
• NHS England regional directors
• All local authority chief executives
• All directors of adult social services
• All integrated care boards chief executives
Dear All,
Re: COVID-19 testing policy update – changes to NHS use cases
Yesterday the government, acting upon advice from the UK Health Security Agency (UKHSA), published the approach to testing and surveillance for COVID-19 from 1 April 2023. The approach contains some changes to NHS use cases for patients and for staff.
The published guidance can be found at COVID-19: testing from 1 April 2023. This letter sets out the operational requirements from the NHS to deliver UKHSA’s advice in relation to staff and patient testing.
UKHSA has developed the guidance in association with the British Infection Association, which has sought the views of others in establishing the most appropriate set of NHS use cases for testing from 1 April.
Thank you for all you and your teams continue to do across the NHS to treat patients with COVID-19.
Patient testing
The NHS has had access to COVID-19 tests routinely as part of a diagnostic pathway if patients and staff are symptomatic. Although this will continue, there are some instances where the requirement to test with PCR will move to LFD testing from 1 April.
The following tables outlines the instances where testing should be undertaken and the types of modality testing that should be used.
- Table 1 shows where testing approach will not change from 1 April.
- Table 2 shows where the testing approach will change from 1 April.
Table 1: No change to patient testing approach
| Use case | Testing approach before 1 April | Testing approach from 1 April |
|
Symptomatic adults and children admitted for care or developing symptoms within hospitals where having COVID-19 will affect their clinical management eg to inform treatment. | PCR | PCR (or LFD where local practice dictates, eg acute respiratory infection hubs). |
|
Symptomatic adults and children in NHS non-hospital settings (including acute respiratory infection hubs, mental health settings, rehabilitation settings) where having COVID-19 will affect their clinical management eg to inform treatment. | LFD | LFD¹ |
Table 2: Changes to patient testing approach
| Use case | Testing approach before 1 April | Testing approach from 1 April |
| Emergency, elective pathway (day case and overnight), and transfer of care admissions in all settings where a diagnosis of SARS-CoV-2 will not change clinical management | PCR on site or LFD home testing depending on context. |
No routine testing. LFD where advised locally following risk assessment with appropriate advice from medical directors, nursing directors or directors of infection prevention and control (IPC), eg for placement on wards that predominantly care for patients who are severely immunocompromised² or to support pre-operative risk assessment for elective surgery. |
| Discharge of asymptomatic patients to other care settings, including care homes and hospices. | PCR (LFD if positive for COVID-19 within previous 90 days). |
A single LFD test within 48 hours before discharge from hospital to care homes and hospices. LFD testing on discharge to other care settings at local discretion following risk assessment with appropriate advice from medical directors, nursing directors or directors of IPC. |
| Outbreak testing in healthcare settings. | Both PCR and LFD in specified protocols. |
PCR for clinical diagnostic purposes for symptomatic patients where having COVID-19 will affect their clinical management. LFD testing for asymptomatic contacts is appropriate to support outbreak management in line with local IPC guidance. |
|
Release from side room/cohort isolation for patients in acute settings. | Isolation/cohorting for 10 days unless two negative LFD tests from day 5 onwards. |
Symptomatic individuals and those testing positive for SARS-CoV-2 should be isolated or cohorted together where possible from others for a minimum of five days with release from isolation guided by clinical judgement when well and free of fever for 48 hours (maximum 10 days isolation if not immunocompromised). Local discretion to extend isolation and test to release for the immunocompromised. |
|
Symptomatic high risk patients identified for COVID-19 monoclonal antibody and antiviral treatment. | PCR or LFD |
All testing LFD – symptomatic adults and children eligible for antiviral treatment or in NHS non-hospital settings to inform treatment. |
| Early release from self-isolation for patients in acute settings. |
LFD testing from day 5 onwards to get two negative tests. | No routine testing. |
|
Symptomatic or immunocompromised patients who are admitted for maternity or emergency care. | PCR on site. | No routine testing. |
|
Symptomatic or immunocompromised elective care patients prior to acute day case/overnight pre-admission. | LFD home testing. | No routine testing. |
|
Transfers into or within hospital for immunocompromised patients. | PCR on site. | No routine testing. |
Local healthcare organisations, with appropriate advice (including from medical directors, nursing directors or directors of IPC), may also exercise local discretion to continue testing for specific individuals or cohorts in line with broader infection prevention and control measures.
Staff testing
The new approach also includes changes for symptomatic staff testing, as set out in the table below. For those staff who will continue to test under the new approach, the actions they should take on receipt of a positive test will not change, as per UKHSA guidance.
Routine testing for asymptomatic staff was paused in August 2022. This pause remains in place.
Table 3: Changes to staff testing approach
| Use case | Testing approach before 1 April | Testing approach from 1 April |
|
Symptomatic NHS staff and staff in NHS-commissioned independent healthcare providers (including return to work testing). | LFD home testing. |
Testing only for staff primarily working on wards focussed on treating severely immunocompromised individuals.³ No return to work testing. |
|
Symptomatic patient-facing healthcare staff (in NHS and NHS-commissioned independent healthcare providers), including return to work testing. | LFD home testing. |
Symptomatic patient-facing healthcare staff should follow advice for staff with symptoms of a respiratory infection or a positive COVID-19 test result.⁴ Local discretion to expand symptomatic staff LFD testing beyond this recommendation is possible if severe outcomes are identified on other inpatient wards or areas following risk assessment and direction from medical directors, nursing directors or IPC teams. Discretion for return to work testing for staff working on these inpatient wards. |
All staff should follow the ‘Managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result’ and COVID-19: information and advice for health and care professionals guidance.
Examples of local discretion could include asymptomatically testing staff or patients who are at higher risk of serious illness from COVID-19 and/or those staff who may be in contact with patients who are at higher risk of serious illness from COVID-19. Return to work protocols for COVID-19 positive staff will remain in place. Employers are encouraged to involve local health and safety representatives where local arrangements are being put in place for staff.
Financial arrangements
The use cases set out in this letter are consistent with the planning assumptions used to form the Integrated Care Board (ICB) allocations for COVID-19 PCR testing (schedule and supporting guidance available on ICB Provider Financial Monitoring System) and therefore no changes to allocations are required.
LFDs will continue to be procured and distributed by UKHSA until such point that NHS organisations are notified otherwise. In line with this policy, NHS organisations have received no funding for the procurement of LFDs and should continue to access supplies through UKHSA.
Ordering tests
There are no changes to the existing mechanisms for ordering tests. The online digital portal will still be available for those patients and staff who need to access tests as instructed by their clinician or manager via https://www.gov.uk/ordercoronavirus-rapid-lateral-flow-tests.
Tests will continue to be available to patients for pre-elective asymptomatic testing for the next six weeks, to allow organisations to update patient instructions. Organisations which order tests to test patients on site can continue to do so through current arrangements. We advise that systems should identify a lead organisation within their system to order stock for acute respiratory infection (ARI) hubs.
IPC and reporting of infections
Existing UKHSA guidance on the management of COVID-19 patients remains in place, and should be followed along with the appropriate IPC measures detailed in the IPC Manual for England. The Manual should be adopted as mandatory guidance for IPC measures in all settings where NHS services are delivered. Any IPC measures beyond those contained in these publications are a matter for local decision making based on local factors such as the type of services delivered and local epidemiology.
Providers should continue to self-assess the effectiveness of their IPC measures and compliance with national guidance using the IPC Board Assurance Framework.
Data on hospital onset COVID-19 infections should continue to be collected for the moment as part of the COVID-19 daily sitrep data collection. We intend to assess COVID-19 data requirements in the near future.
Research studies
SIREN queries and issues should be directed to UKHSA at SIREN@ukhsa.gov.uk.
Yours sincerely,
Professor Sir Stephen Powis
National Medical Director
Ruth May
Chief Nursing Officer
Dr Ursula Montgomery
Director of Primary Care
Professor Em Wilkinson-Brice
National Director for People
¹For patients who would be considered eligible for COVID-19 therapeutics presenting with a suspected COVID-19 infection, but in whom the LFD test result is negative, consider sending a PCR test to confirm diagnosis and support early access to COVID-19 therapeutics.
²Severely immunocompromised refers to patients who are unlikely to mount an effective vaccine response, such as haemato-oncology and solid organ or stem cell or bone marrow transplant patients.
³Severely immunocompromised refers to patients who are unlikely to mount an effective vaccine response, such as haemato-oncology and solid organ or stem cell or bone marrow transplant patients
⁴UKHSA, Managing healthcare staff with symptoms of a respiratory infection or a positive COVID-19 test result