South East Region: Guide to Covid-19 Testing - Edition 7 March 2021 - Medway Care ...
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South East Region:
Guide to Covid-19 Testing
Edition 7
March 2021
Updates since previous edition all shown in blue text.
1
Contents
Introduction – Regional strategy ................................................................................................................................................................................................... 4
Introduction – National strategy ................................................................................................................................................................................................... 6
Different Covid-19 tests ................................................................................................................................................................................................................. 9
Testing pathway – for PCR antigen testing - Do I have Covid-19?.............................................................................................................................................. 12
Patient PCR testing (pillar 1) ........................................................................................................................................................................................................ 14
Patient PCR Rapid Diagnostics testing (pillar 1) .......................................................................................................................................................................... 16
Patient Rapid testing using Early Decision Assist Tests (pillar 1) ............................................................................................................................................... 18
Staff PCR testing (pillar 1) – symptomatic staff .......................................................................................................................................................................... 19
Staff PCR testing (pillar 1) – non-symptomatic staff – outbreak/untoward incident/high prevalence .................................................................................... 20
General Population PCR Testing – Self Referral (pillar 2) ........................................................................................................................................................... 21
Eligible Population PCR Testing – Employer Referral (pillar 2) ................................................................................................................................................... 22
Eligible Population PCR Testing – Schools and further education (pillar 2) ............................................................................................................................... 23
Elective Care Covid Home Testing Service (ECCHTS) – (pillar 2) ................................................................................................................................................. 24
Care Home PCR & Lateral Flow Devices (LFD) Testing – (pillar 2) .............................................................................................................................................. 26
Care Home PCR Testing – Residents testing on discharge from hospital (pillar 1) .................................................................................................................... 29
Care Home PCR & Lateral Flow Testing – Staff & Residents: Covid-19 suspected or diagnosed (pillar 2 and pillar 1 by exception) ...................................... 31
Care Home PCR Testing – Pathway: Covid-19 suspected or diagnosed (pillar 2) ...................................................................................................................... 32
Care Home PCR Testing – Staff and Residents: When requested (pillar 2) ................................................................................................................................ 34
Care Home PCR Testing – Staff & Residents: Regular Testing (pillar 2) ..................................................................................................................................... 36
Care Home PCR Testing – Other areas......................................................................................................................................................................................... 38
Care Home Lateral Flow Testing of Visitors................................................................................................................................................................................. 40
Hospices – Non-symptomatic testing for staff and patients (pillar 2)........................................................................................................................................ 42
Domiciliary Care ........................................................................................................................................................................................................................... 43
2
Extra Care and Supported Living.................................................................................................................................................................................................. 44
The 90-day window after a positive test ..................................................................................................................................................................................... 46
Mobile Testing (pillar 2) ............................................................................................................................................................................................................... 47
GP PCR Testing (pillar 2) ............................................................................................................................................................................................................... 50
PCR Testing complaint process (pillar 2) ..................................................................................................................................................................................... 52
Outbreaks ..................................................................................................................................................................................................................................... 53
Antibody Testing (pillar 3) – Have I had Covid-19? ..................................................................................................................................................................... 54
Patient Antibody testing (pillar 3 – NHS labs) ............................................................................................................................................................................. 55
NHS Staff Antibody testing (pillar 3 – NHS labs) ......................................................................................................................................................................... 56
Social Care Staff Antibody Testing (pillar 3) ................................................................................................................................................................................ 57
Test and Trace (pillar 4) ................................................................................................................................................................................................................ 58
SIREN: (Sarscov2 Immunity & REinfection EvaluatioN) (pillar 4) ............................................................................................................................................... 63
NHS non- symptomatic staff lateral flow testing (pillar 4) ......................................................................................................................................................... 64
LAMP - Loop mediated isothermal amplification ....................................................................................................................................................................... 66
Testing methods 2020 – pillar 5 ................................................................................................................................................................................................... 67
Reporting ...................................................................................................................................................................................................................................... 68
Outstanding Queries .................................................................................................................................................................................................................... 69
APPENDIX 1: Pathology Networks ............................................................................................................................................................................................... 70
APPENDIX 2: Points of contact: Email addresses ........................................................................................................................................................................ 71
APPENDIX 3: SE meetings to support testing .............................................................................................................................................................................. 72
APPENDIX 4: Glossary and Definitions ........................................................................................................................................................................................ 73
APPENDIX 5: Coronavirus Testing Call Centre ............................................................................................................................................................................. 79
APPENDIX 6: Rapid Testing Deployment and Use Cases ............................................................................................................................................................ 83
3
Introduction – Regional strategy
1. The government has made public commitments as to who is eligible for testing. Our regional responsibility is to
use the resources we control to support that access, to communicate and give clarity on the operating model and
in particular how eligible individuals access testing, to monitor and collect information about unmet demand for
testing and finally to analyse the results of the testing including coverage achieved and testing results so that local
patterns can be deduced and areas for further investigation be identified.
2. This document aims to give clarity on the current approach to Covid-19 Testing in the region. It covers who is being
tested, arrangements, responsibilities, purpose and resulting actions.
3. It also references areas on which we are seeking clarity or where we could consider a SE approach. Areas for
clarification are noted in the queries section, at the end of the main document.
4. Feedback is welcomed where there are omissions or insufficient clarity. Please send any comments to
england.sepathologycovidresponse@nhs.net.
5. This document will be updated as and when new decisions are made, or new testing arrangements are put in
place.
4
6. The future direction of testing nationally and regionally is outlined along with areas we will be taking forward as
part of the next edition of the strategy.
7. The draft communications/meetings schedule in the SE is included at the end of the pack to give clarity on how and
where to feed in issues, suggestions and questions.
5
Introduction – National strategy
National Testing Strategy.
8. The national strategy (4 April 2020) states:
a. ‘Testing is a key pillar of our strategy to protect the NHS and save lives. We are focused on two types of tests:
'swab tests' for people with symptoms to see if they have coronavirus; and 'antibody tests', which test for the
presence of antibodies that will demonstrate whether you have had the disease.
b. The Government is committed to mass testing: our overall ambition is to provide enough swab tests for
everyone that needs one. In the 'contain' stage, our focus was on testing to support contact tracing and
investigating outbreaks. At present, whilst we seek to 'delay' the spread of the virus through social distancing,
this means:
i. continuing to provide tests for patients who need them; and
ii. providing tests for NHS, social care and then wider critical key workers and their families who are in self or
household isolation, to support them to return to work as soon as possible, if they are well enough to do
so.’
9. There are 5 pillars to the National Testing strategy as set out in the diagram below.
6
National Testing Strategy; Coronavirus (Covid-19) Scaling up our testing programmes dated 04 April 2020;
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878121/coronavirus-covid-19-testing-
strategy.pdf
10. As at 8 December 2020, there are three methods of testing available to the NHS:
a. The main method at this time is detection of viral genetic material (RNA) by a method called RT-PCR (‘PCR
tests’) (for fuller explanation see appendix).
b. Lateral flow assay devices (LFDs) on nasal swab samples with immediate effect.
c. Direct LAMP technology with saliva samples.
7
11. The publication of the policy paper ‘Breaking chains of COVID-19 transmission to help people return to more
normal lives: developing the NHS Test and Trace service’ on 30 July 2020 states one of the key objectives to be:
i. double our capacity to test for COVID-19 from almost 200,000 daily tests today to 500,000 by the end of
October
a. The exact allocation from each pillar was not detailed, however, we worked on the understanding that this target
included 100,000 tests to be delivered by NHS labs (pillar 1) through PCR testing capacity.
b. As at 15 March 2021, we currently have a theoretical (unconstrained) pathology network platform capacity
across 5 pathology networks, through NHS labs (pillar 1) of 23,000 PCR tests per day, and through DHSC led sites
(Pillar 2) of an estimated further 33,000 PCR tests per day (based on capacity for swabbing in pillar 2 in the South
East region, excluding home tests). At 15 March 2021, the current total capacity across the 5 pathology networks
was 14,900 tests per day.
c. As at 15 March 2021, SE laboratory and platform theoretical capacity is at circa 24,330 serology tests per day
with total tests processed to date equating to 304,549.
8
Different Covid-19 tests
912. In addition to the swab test to determine if an individual currently has COVID-19, two new tests have been
introduced:
a. Lateral flow assay devices (LFDs):
i. Lateral flow antigen testing detects the presence of the COVID-19 viral antigen from a swab sample. The
test is administered by handheld devices producing results in 30 minutes and can be self-administered.
Lateral flow antigen testing has a lower sensitivity than qRT PCR and LAMP technology. However, studies
to date suggest that, similar to LAMP, these tests are better at returning positive results for individuals
who are infectious rather than individuals who may have had COVID-19 recently and are no longer
infectious (qRT PCR will detect both). (Standard Operating Procedure for the rollout of lateral flow devices
for asymptomatic staff testing (Phase 2 – trusts), 16 November 2020).
ii. LFDs were first introduced to test non-symptomatic NHS patient facing staff in November 2020. They are
available for staff who are site based and have been rolled out to NHS trusts, independent providers and
primary care.
iii. NHS trusts can also use LFDs as an EDAT (early decision assist test) within the Emergency Department to
assist with flow, but diagnosis must be confirmed with a confirmatory PCR test.
iv. LFDs are also available for testing of maternity patients and their supporting partners.
b. OptiGene RT-LAMP technology with saliva samples
i. LAMP technique using OptiGene is being rolled out nationally although not widely available yet. Recent
studies have shown that salivary glands are the first tissue that coronaviruses infect. This means saliva
viral loads tend to be higher than those in oropharyngeal and nasopharyngeal swabs prior to symptoms
and early in the infection cycle making it a powerful method of testing individuals who may be
asymptomatic or pre-symptomatic.
ii. LAMP, is the acronym used for the term Loop-mediated isothermal amplification.
10iii. The technical and clinical evaluation of the OptiGene RT-LAMP technology was published on 1 December
20201.
1
Clinical evaluation confirms accuracy of LAMP test - GOV.UK (www.gov.uk)
11Testing pathway – for PCR antigen testing - Do I have Covid-19?
12South East COVID-19 Testing Coverage - who is tested & where?
13Patient PCR testing (pillar 1)
Purpose: Eligibility:
The reason for patient testing is to Per the latest letter on guidance2 updated by the latest guidance on infection
determine whether they currently prevention and control3, testing programme includes:
have the Covid-19 virus. It will then 1. all patients at emergency admission whether or not they have symptoms;
allow clinicians to determine the 2. those with symptoms of COVID-19 must be retested at the point symptoms
appropriate hot or cold patient arise after admission;
care pathway. 3. those who test negative upon admission must have a second test 3 days
High throughput PCR testing is used after admission, and a third test 5-7 days post admission;
ideally for non-urgent patients as 4. all patients must be tested 48 hours prior to discharge to other care
results are expected to be received settings, including to care homes or hospices (see later page on “Care Home
within 24hrs. outbreaks and care home PCR Testing – Residents testing on discharge from
Rapid PCR testing is designed for hospital”);
use in emergency departments but 5. elective patient testing prior to admission (please see: Elective Care Covid
can also be used for on-the-day Home Testing Service section within Pillar 2 section).
assurance. Results are typically
available within 4 hours. See use
cases in Appendix 6.
Rapid Early Decision Assist Testing
(EDAT) is not considered quite as
reliable as PCR testing but gives a
strong indication of Covid-19
positivity. The test result is much
quicker (typically under 2 hours)
and is used to support patient flow
2
https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/Healthcare-associated-COVID-19-infections--further-action-24-June-2020.pdf
3
key-actions-boards-and-systems-on-infection-prevention-control-testing-23-december-2020.pdf (england.nhs.uk)
14and care whilst PCR results are
awaited.
Pillar: Pillar 1 Process for items 1, 2, 3 and 5 above:
• Patients will be swabbed by the admitting NHS Trust.
Pillar Owner: Owner is the • Requests for testing will be initiated on OrderComms with PCR samples sent
National NHSE&I Pathology Team. to pathology reception. Rapid and EDAT testing is typically performed in or
Owner of testing lab is NHS. close to ED.
• Samples will typically be processed by the local NHS Pathology Network
laboratory (capacity constraints may require support via referrals to another
lab). Some rapid samples are now processed by staff outside of pathology.
• Lab Turnaround times should not be any more than 15 hours for patients to
receive results within 24 hours. Rapid tests are expected to be completed
within 4 hours.
• Lab results are then processed through the LIMS and connected to the EPR
and then to the GP.
15Patient PCR Rapid Diagnostics testing (pillar 1)
13. Definition
a. Rapid diagnostics PCR tests, often referred to as point of care tests, are often available close to patient
treatment areas which enables faster turnaround times, usually enabling results within 1-2 hours of the time
the sample (usually a swab) is taken from the patient. The complexity of some Rapid PCR testing requires
processing to be completed by trained lab staff and may, therefore, be conducted within labs. Results are
expected within 4 hours.
14. DHSC has led work to centrally procure rapid testing capacity. Roll out of rapid PCR testing is now complete with
the focus over coming months on improving reliability.
15. Draft use cases – see Appendix 6
16. Samba, DNA Nudge and Primer Design are the chosen suppliers for the DHSC roll-out and basic metrics have been
included in the table below.
17. Many labs already have rapid testing capabilities using additional platforms such as Cepheids. These have also
been included in the table below for completeness.
16Platform POCT/Lab Time to result Samples Samples per day (depends Sensitivity Specificity
per run on supply restrictions and
operating hours)
Samba Near c.90 mins 1 7-13 98% 100%
Patient/Lab (positives)
100 mins
(negatives)
DNA Nudge Near c.60 - 90 mins 1 10 97% 100%
Patient/Lab
Q16 Lab c.90 mins 16 (2 for 150 >96% 100%
controls)
Q32 Lab c.90 mins 32 (2 for 300 >96% 100%
controls)
Cepheid – e.g. Near 45 mins 1 c. 10-40/day (Restricted
GeneXpert patient/Lab pandemic supplies to UK)
Biofire Near c. 60 mins >12 >288 (if 24/7 with sufficient
patient/Lab supplies)
18. Images of Rapid testing platforms
17Patient Rapid testing using Early Decision Assist Tests (pillar 1)
19. Definition
a. Early Decision Assist Tests (EDAT) are designed as a relatively easy testing solution to be used outside of the lab
setting (e.g. within emergency departments) and allow for ‘rapid’ decision making. Whist they are not
considered to be quite as reliable as PCR testing, they give a strong indication of Covid-19 positivity. Trusts are
required to follow up results with confirmatory PCR tests.
b. EDATs typically offer faster turnaround times than other rapid diagnostics PCR tests and enable results within
1-2 hours of the time the sample (usually a swab) is taken from the patient. In some instances, when using
EDATs such as lateral flow devices, the swab can be taken by the patient themselves which can allow for testing
at home.
20. DHSC and the national team has led work to centrally procure EDATs and deploy them to priority sites that require
quick decision making to assist with patient flow.
21. LumiraDx, Abbott ID Now and lateral flow devices are the chosen platforms for the current national roll-out.
Lumira and ID Now are used as EDATs for patient screening within emergency departments. Lateral flow devices
can be used as an EDAT, but the use case also includes twice weekly staff surveillance testing and screening of
maternity patients and partners.
18Staff PCR testing (pillar 1) – symptomatic staff
Purpose: The reason for staff Eligibility: All symptomatic NHS staff / household index case (family member
testing is to determine whether with suspected COVID) within NHS England guidance:
they currently have the Covid-19 https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#who-can-be-tested
virus and thus allow staff back to
work if negative and prevent
nosocomial spread if they are
positive
Pillar: Pillar 1 Process:
• NHS Trusts have established staff testing facilities where samples are taken.
Pillar Owner: Owner is the • Requests for testing in the NHS will be initiated on OrderComms and
National NHSE&I Pathology Team. samples sent to pathology reception.
Owner of testing lab is NHS.
• Samples will be processed by the local NHS Pathology Network laboratory
on High Throughput PCR platforms (capacity constraints may require
support via referrals to another lab).
• Lab turnaround times should not be any more than 15 hours for results to be
received within 24 hours.
• Lab results are then processed through the LIMS and connected to the EPR.
Staff will be notified of their results by the requesting physician.
To note:
• Staff testing only occurs in NHS labs where there is spare capacity.
• Whilst Pillar 2 testing is available for this cohort, Pillar 1 remains the
preferred option should capacity allow it.
19Staff PCR testing (pillar 1) – non-symptomatic staff – outbreak/untoward
incident/high prevalence
Purpose: The reason for staff Eligibility:
testing is to determine whether Surplus NHS testing capacity should also be used for testing non-symptomatic
they currently have the Covid-19 staff working in situations where there is an untoward incident, or outbreak, or
virus and thus allow staff back to high prevalence (these terms are all explained in APPENDIX 4: Glossary and
work if negative as well as prevent Definitions).
nosocomial spread if, they are See link to full guidance letter at the bottom of the page.
positive. Note the first line testing of non-symptomatic NHS staff for staff surveillance
purposes is using Lateral Flow devices (pillar 4 page 62). Staff that return a
positive Lateral Flow result must subsequently take a confirmatory PCR test.
Pillar: Pillar 1 Process:
• NHS Trusts have established staff testing facilities where samples are taken.
Pillar Owner: Owner is the • Requests for testing in the NHS will be initiated on OrderComms and
National NHSE&I Pathology Team. samples sent to pathology reception.
Owner of testing lab is NHS. • Samples will be processed by the local NHS Pathology Network laboratory.
(capacity constraints may require support via referrals to another lab).
• Lab turnaround times should not be any more than 15 hours for results to be
received within 24 hours.
• Lab results are then processed through the LIMS and connected to the EPR.
Staff will be notified of their results by the requesting physician.
https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/Healthcare-associated-COVID-19-infections--further-action-24-June-
2020.pdf
20General Population PCR Testing – Self Referral (pillar 2)
Purpose: Testing the population who Eligibility:
have coronavirus-like symptoms to • The self-referral portal is a secure portal that allows all symptomatic people
see if they currently have the virus. to register their details and book a coronavirus test.
Pillar: Pillar 2 Process:
• User guide link provided at the bottom of the page.
Pillar Owner: Owner is the National • All symptomatic population can request a drive through, mobile unit or
DHSC Testing Lead. postal swab (you need an email address for the postal swab option).
• Booking is through the self-referral portal (https://www.gov.uk/get-
coronavirus-test) or by phoning ‘119’ between 7am and 11pm. There are
two portals available for self-referral: Public and Key Worker. For those
with hearing or speech difficulties please use 18001 0300 303 2713.
• The symptomatic person will be asked to attend a Regional Testing Site,
Satellite Testing Site, Local Testing Site, Mobile Testing Unit location or
wait for the home test kit to arrive in the post depending on the option
selected. Not all sites can test under 12s, this is highlighted during booking.
• Samples are collected at the centres or home collected. Samples at the
centres are then dispatched to the National ‘Lighthouse’ labs or the
individual posts them.
• Results are communicated by email or text.
• Essential workers are requested to inform their employers of their results.
• Results are now linked to patient records.
• NHS Digital has developed a Pillar 2 Testing Dashboard to provide
anonymous counts of Covid-19 tests completed and positive results.
User guide can be found here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882654/Self_referral_portal_user_guide_v1.6.pdf
21Eligible Population PCR Testing – Employer Referral (pillar 2)
Purpose: Testing essential Eligibility: The employer referral portal is a secure portal that allows employers to refer
workers who have eligible essential workers. Eligible people include (full list see glossary):
coronavirus-like • All essential workers including NHS and care workers with symptoms
symptoms to see if they • Anyone over 65 with symptoms
currently have the virus • Anyone with symptoms whose work cannot be done from home
has been a priority. • Anyone with symptoms of coronavirus who lives with those identified above
• Care workers and residents in care homes (with or without symptoms)
• NHS workers and patients without symptoms where there is a clinical need in line with
NHS England guidance (as noted in previous section – guidance not yet received)
Pillar: Pillar 2 Process:
• For most employees, only symptomatic people in the household can be tested. If the
Pillar Owner: Owner is employee works in social care, however, the employee can be tested whether
the National DHSC Testing symptomatic or asymptomatic.
Lead. • It is a secure portal for employers to use to upload the full list of names and contact
details of self-isolating essential workers.
• If referred through this portal, essential workers will receive a text message with a
unique invitation code to book a test for themselves (if symptomatic) or their
symptomatic household member(s) at a regional testing site.
• Results are then added to the patient’s record.
• Per Government guidelines to employees, while employees do not have to share
results with their employer, “we strongly recommend that you inform your employer”:
https://www.gov.uk/government/publications/coronavirus-covid-19-testing-privacy-information/testing-for-
coronavirus-privacy-information
Employer guide can be found here: https://www.gov.uk/guidance/coronavirus-covid-19-getting-tested#arrange-a-test
22Eligible Population PCR Testing – Schools and further education (pillar 2)
Purpose: Anyone who Eligibility:
experiences any COVID-19 • All schools and further education (FE) providers
symptoms can get a test • Pupils, teachers and staff
at a testing site or at • These should only be used in the exceptional circumstance that a student, teacher,
home. This includes all or staff member becomes symptomatic and the school/further education provider
pupils, teachers, and staff. believes there may be barriers to accessing testing elsewhere.
All schools and further
education providers can Note that, from 8 March 2021 all secondary pupils/further education will be offered
apply for a small number testing where they are asymptomatic (see Pillar 4, page 60).
of testing kits to
complement these main
access routes.
Pillar: Pillar 2 Process:
• In exceptional circumstances when the school/further education provider do not
Pillar Owner: Owner is think a symptomatic child or staff member would be able to access testing by the
the National DHSC Testing usual routes, they should consider providing a test kit to improve the chances that
Lead. the individual will get tested.
• Schools and colleges will not be expected to administer testing, and testing should not
take place on site (with the exception of residential settings).
• Schools and FE providers should order additional test kits if they have run out or are
running out of test kits. Additional tests kits can be ordered online. Full guidance
available at: Schools coronavirus (COVID-19) operational guidance - GOV.UK (www.gov.uk) (see section
10)
23Elective Care Covid Home Testing Service (ECCHTS) – (pillar 2)
22. The Elective Care Covid Home Testing Service (ECCHTS) is an online service for NHS trusts to digitally order Covid-
19 tests for patients on Elective Care pathways and to directly view their results prior to treatment.
23. This service provides a designated digital platform for NHS Trusts to submit suitable patients on the pre-elective
pathway to be tested within a determined timeline to ensure safe for treatment. Use of the service is voluntary.
24. 20,000 tests are available daily. Initially tests were processed through a dedicated Lighthouse lab in Cambridge. In
January 2021, the service moved to a regionalisation model where tests are sent to the nearest Lighthouse lab but
are prioritised for testing over other home testing kits.
25. The service was initially piloted nationally with nine NHS trusts who trialled the home testing service with select
patient cohorts. During September and October 2020, the service was expanded with all remaining trusts that
provide elective care invited to onboard.
26. Although use of the service is not mandatory, all trusts are encouraged to complete onboarding to ensure they can
access the capacity if needed.
27. Patients must have access to a mobile phone. Suitable patients for the service are:
a. Adults and children, tertiary, remote, elective day case and inpatient.
28. Parents/guardians accompanying children into hospital may also be tested through the service, as well as
supporting partners for maternity patients.
24ECCHTS overview
25Care Home PCR & Lateral Flow Devices (LFD) Testing – (pillar 2)
2627
29. There are four times when we undertake care home testing:
a. On discharge from Hospital
b. When Covid-19 is suspected
c. When care home staff and care home residents ask for testing of whole home or individuals (which can be at any
time)
d. Regular testing of staff and residents of care homes
DHSC has also provided a helpful visual guide to adult social care testing.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/fi
le/936894/Care_Home_Testing_Guidance_visual_v1911.pdf
28Care Home PCR Testing – Residents testing on discharge from hospital (pillar 1)
Purpose: The purpose of Eligibility:
testing care home All care home residents on release from NHS acute provider.
residents is to enable
appropriate treatment
and support IPC.
Pillar: Pillar 1 Process:
• Requests for tests should be made at least 24 hours prior to discharge, most will be
Pillar Owner: Owner is swabbed 48 hours before discharge.
the National NHSE&I • Requests for testing will be initiated on OrderComms and samples sent to pathology
Pathology Team. Owner of reception.
testing lab is NHS. • Samples will be processed by the local NHS Pathology Network laboratory.
• Lab results are then processed through the LIMS and connected to the EPR. Results
will be passed to the resident and their family (where appropriate) and to their
respective care home manager.
• For all admissions to a care home, whether returning residents or new residents, from
a hospital or from a community setting, the resident should be managed in isolation
for 14 days, regardless of any test result, and regardless of whether they are showing
symptoms or not
• No one will be discharged into or back into a registered care home setting with a
COVID-19 test result outstanding or without having been tested within the 48 hours
preceding their discharge
• The Hospital Discharge Service and staff will clarify with care homes the COVID-19
status of an individual during the process of transfer from a hospital to the care home
29• Anyone with a COVID-19 positive test result being discharged into or back into a
registered care home setting must be discharged into appropriate designated setting
(see below resource)
• Risk Assessments should be carried out in line with current guidance and
recommendations. See example risk assessments and templates
• The care home’s registered manager should continue to assure themselves that all
admissions or readmissions are consistent with this requirement.
Resources
Stepdown of infection control precautions and discharging COVID-19 patients: Guidance
COVID-19: Adult Social Care Action Plan Designated Settings Admission
and care of people in Care Homes
•
30Care Home PCR & Lateral Flow Testing – Staff & Residents: Covid-19 suspected or
diagnosed (pillar 2 and pillar 1 by exception)
Purpose: The purpose of testing care home Eligibility:
residents at the point of notification of an • All care home staff and residents (regardless of symptoms) on
outbreak is to confirm whether the outbreak is notification of outbreak/ cluster to PHE HPT
caused by SARS-CoV-2. PHE HPT will arrange for • Any staff members or residents testing negative need to be
testing of all care home staff and residents at retested within 4-7 days.
point of notification of the outbreak whether • Latest guidance from DHSC:
symptomatic or not. https://www.gov.uk/government/publications/coronavirus-covid-19-testing-in-
adult-care-homes
Pillar: Pillar 2 Process:
Pillar Owner: Owner is now DHSC. PHE HPT • Pillar 2 – initial testing and re-test after 4-7 days:
triggers the care home to test all care home staff o See next page
and residents, and any re-testing required
between 4-7 days and 28 days later for those with • Pillar 2 – re-test after 28 days post last case:
negative results. o After 28 days from the last suspected case, care home to
arrange testing through pillar 2 DHSC portal.
Certain areas may still be processing the initial o Use the process outlined on the pages titled:
testing on outbreak via pillar 1 by exception. “Care Home PCR Testing – Staff and Residents: When
requested (pillar 2)”
In tier 4, if there is a positive case in the care home from either
staff or residents with PCR or lateral flow testing, all staff should
test daily for 7 days.
31Care Home PCR Testing – Pathway: Covid-19 suspected or diagnosed (pillar 2)
3233
Care Home PCR Testing – Staff and Residents: When requested (pillar 2)
Purpose: Eligibility:
To accompany a range • Whole Care Home Testing through the National Testing Programme was initially made
of preventive measures, available to care homes who primarily look after older people or people with dementia.
with a particular focus • From 7 June 2020 the eligibility for this service has been expanded to all remaining
on larger care homes at adults care homes who will now able to access whole care home testing for all residents
greater risk of and asymptomatic staff through the digital portal.
outbreaks
Pillar: Pillar 2 Process:
• Local systems (NHS, LA DPH, DASS) to identify at risk care homes using prioritisation
Pillar Owner: Owner is framework.
DHSC. • Care homes can be referred to the national testing service by local authorities either
based on size (over 50 beds) or local knowledge. Directors of Public Health can inform
which care homes to prioritise by completing a care home testing referral form:
Care Home Testing
Referral Form.xlsx
and sending to:
COVIDcarehometestingreferrals@dhsc.gov.uk
• Care homes can request testing by registering via the DHSC:
https://www.gov.uk/apply-coronavirus-test-care-home
• Care homes can then book their swab returns by eCourier from the following portal:
www.carehomecollect.co.uk
• Where there are issues with accessing kits and test results. These should be reported to:
COVIDCareHomeTesting@dhsc.gov.uk
34What support is available:
• To support care home planning to carry out whole care home testing, DHSC are hosting
regular webinars on the whole home testing process. We strongly recommend them for
care homes carrying out testing so that they can understand the process and what they
need to do. Care Homes can register to access the webinar:
https://event.on24.com/wcc/r/2375949/724EF6345473A192F6B9C19334699A29/1077953
35Care Home PCR Testing – Staff & Residents: Regular Testing (pillar 2)
Purpose: To accompany a range of Eligibility:
preventive measures. • From January 2021, in all care homes without outbreaks, DHSC are testing:
o Care home staff every 7 days with PCR tests (weekly)
This approach is based on advice o Care home staff twice a week with lateral flow tests
from SAGE, the evidence from the o Care home residents every 28 days with PCR tests
initial round of whole home testing • Bank, agency and visiting professionals, such a social workers and Allied
and the results from our Vivaldi Health Professionals working in care homes should be included in the staff
surveillance survey. testing regime.
• This testing regime has now been rolled out to all care homes after having
initially been rolled out to care homes with residents over 65 and those
with dementia.
Pillar: Pillar 2 Process:
• By registering on the portal, care homes tell DHSC that they would like to
Pillar Owner: Owner is DHSC. carry out retesting and that they want to be sent test kits:
https://request-care-home-testing.test-for-coronavirus.service.gov.uk/
• Care homes will be divided into four even cohorts of care homes, with
each cohort starting its cycle in subsequent weeks.
• Each week, Pillar 2 will distribute test kits to one quarter of eligible homes.
They will distribute enough kits to the care home for one month of testing
(4x staff population and 1x resident population) each time an order is
placed.
• When a care home receives their test kits, they should carry out whole
home testing (staff and residents) in that same week.
36• For the following three weeks, the care home should test staff weekly with
PCR and twice a week with lateral flow devices.
• After these three weeks the cycle begins again. Cohort one begins
retesting in the first week, cohort two in the second etc.
• At the end of the four-week cycle, each home will have completed whole
home testing once, and staff testing a further three times (four in total)
with PCR.
37Care Home PCR Testing – Other areas
30. Care home portal is now live:
https://request-care-home-testing.test-for-coronavirus.service.gov.uk/
31. To apply for testing through the portal, the applicant will need:
a. the care home’s CQC registration number
b. total number of residents, including number of residents with coronavirus symptoms
c. total number of staff, including agency staff
d. your contact details
32. From 15 May 2020, each care home now has a dedicated GP link.
33. LA CEOs with social care responsibilities have worked with system partners to agree the following plans, which
were submitted to DHSC:
a. overview of their current activity and forward plan;
b. confirmation of the current level of access to the support offer
c. confirmation of the number of care homes in the area where these commitments are being delivered, including
homes that the local authority does not directly commission from, as well as details of issues and support
needs; and
d. confirmation that local authorities are carrying out a daily review of the local care market (including all relevant
data, especially on care homes), and taking actions immediately where necessary to support them.
34. The above request follows on from the Adult Social Care Action plan that was set out in April 2020:
38https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/879639/covi
d-19-adult-social-care-action-plan.pdf
35. Care home issues
a. DHSC has set up a contact email for Care Home issues, i.e. Test kits not picked up, Test kits not received, Test
results delayed or not arrived. This address is:
COVIDCareHomeTesting@dhsc.gov.uk
36. Care home guidance
a. DHSC, CQC, NHSEI and PHE have prepared guidance on the admission and care of residents in a care home
during Covid-19, it is held here:
https://www.gov.uk/government/publications/coronavirus-covid-19-admission-and-care-of-people-in-care-
homes
c. There is also a South East Care Home Resource pack, first published in August 2020:
SE Care Home
Resource Pack 1.0.pdf
39Care Home Lateral Flow Testing of Visitors
37. The National Testing Programme has started to roll-out visitor testing in care homes. This will enable care homes
to offer regular testing of visitors, and when combined with other infection prevention and control measures (such
as PPE), can support more meaningful visits with loved ones.
38. The test will be done using the Lateral Flow Device (LFD) test. Visitors will be tested before visiting to check if they
currently have Covid-19.
39. For this, visitors will be asked to do a throat and nose swab every time they visit and then they will know their
result in 30 minutes.
40. Full instructions will be provided to visitors upon their scheduled visit.
41. Further detail is in the guidance attached below:
https://www.gov.uk/government/publications/visiting-care-homes-during-coronavirus/update-on-policies-for-visiting-arrangements-in-care-homes
42. Lateral Flow Test result meaning for visitors:
a. Positive – The visitor will not be able to visit. They must go home immediately and self-isolate. They will have
to take a second test which is a confirmatory PCR test which we will provide and register for you. They will
receive their result in around 72 hours and will need to self-isolate until they get their result. If their test
positive, NHS Test & Trace may contact the visitor to ask for their contacts.
b. Inconclusive – the visitor will be asked to do another LFD test. If this is inconclusive too, the guidance says to
not allow the visit.
40c. Negative – the visit will be able to go ahead, as long as the visitor complies with all other infection prevention
and control measures (see below). This does not guarantee that they definitely do not have Covid-19, so there
is still a need to make sure visits take place in a safe way, such as ensuring the visitor wears PPE at all times.
41Hospices – Non-symptomatic testing for staff and patients (pillar 2)
43. Since 2 December 2020, asymptomatic staff and patients in hospices will be regularly tested for Covid-19 using PCR
tests.
44. Eligible hospices are those registered with the CQC and Hospice UK.
45. The aim is to allow asymptomatic testing of all patients admitted from community settings on or prior to admission
(patients admitted from hospitals should already have been tested).
46. Weekly asymptomatic testing is introduced for all staff who provide or support direct patient care, within or out of
the hospice. This includes volunteers and agency staff who have contact with patients.
47. Supplies are provided on a 28-day cycle. All samples will be collected by courier.
48. Details on the process to follow to register for supplies and the ordering process is set out in the annex to the
letter below:
20201201 Hospice
Testing Letter FINAL.pdf
49. There is the aim to introduce Hospice Visitor testing in the near future.
42Domiciliary Care
50. Since November 2020, asymptomatic homecare workers in adult social care will be regularly tested for Covid-19
using PCR tests.
51. Eligible homecare organisations are those registered with the CQC and defined as ‘Community based adult social
care services’ or Domiciliary care service’.
52. The aim is to identifies homecare workers who currently have Covid 19 so they are able to self-isolate if their result
is positive, protect those receiving care from infection passed to them by homecare workers who are confirmed
positive and to prevent and control the spread of the virus by identifying asymptomatic cases.
53. Every 7 days a care worker (including personal assistants and Live-in carers) should take a test, register it online,
and return it by post between Thursday and Sunday.
54. Supplies are provided on a 28-day cycle to the homecare agency.
55. Details on the process to follow to register for supplies and the ordering process is set out in the guidance below:
Weekly_homecare_wo
rker_testing_guidance_for_homecare_agencies.pdf
43Extra Care and Supported Living
56. Since February 2020, asymptomatic staff residents in Extra Care and Supported Living will be regularly tested for
Covid-19 using PCR tests.
57. There are two different testing programmes available to extra care and supported living settings which we will
refer to as “HighRisk Settings” and “Wider Settings”.
58. The testing programme for a setting will be determined by the below eligibility criteria:
a. The setting is a closed community with substantial facilities shared between multiple people
b. Where the majority of residents (more than 50%) receive the kind of personal care that is CQC
regulated (rather than help with cooking, cleaning and shopping)
59. All settings need to be referred by their Local Authority who will use these criteria to make any final decisions
about whether a setting is high-risk or wider EC/SL.
60. If your setting meets both criteria you are classified as a “High Risk” setting:
a. All staff should conduct one PCR test per week
b. All staff should conduct two rapid lateral flow tests every week ideally before their shift begins:
1. One on the same day as their weekly PCR
2. One midweek, 3 4 days later
c. All residents should conduct one PCR test every month
d. In the event of a positive test result all staff should use rapid LFT for seven days
4461. If your setting meets one of the criteria you are classified as a “Wider” setting:
a. All staff should conduct one PCR test every week
62. Details on the process to follow to register for supplies and the ordering process is set out in the guidance below:
https://www.gov.uk/government/publications/coronavirus-covid-19-testing-service-for-extra-care-and-supported-living-settings/testing-service-for-extra-
care-and-supported-living-settings
45The 90-day window after a positive test
63. Following a substantial clinical review of the latest evidence and testing data, DHSC have now changed the advice
for retesting within 90 days of a positive.
64. From now on, if someone tests positive with a PCR test, they should not be tested using PCR or LFD for 90 days,
unless they develop new symptoms during this time, in which case they should be retested immediately using PCR.
This 90-day period is from the initial onset of symptoms or, if asymptomatic when tested, their positive test result.
65. The previous policy to continue LFD testing following a positive PCR result was because although very unlikely, it is
possible to be reinfected within 90 days. However, based on the latest testing data and clinical advice, the policy
has now changed.
66. The clinical view is that during this 90-day window from a positive test, given the low rate of reinfection during this
window it is significantly more likely that a positive LFD test would be a false result, rather than someone being
reinfected, causing people to isolate unnecessarily. Therefore, we are now stopping the regular testing using LFD
during this 90-day period. The individual should return to the regular LFD and PCR regime once 90 days has passed.
67. This means that the policy for retesting within 90 days for Adult Social Care is now the same as the policy for NHS
staff.
68. The policy also applies to professionals visiting a care home who have received a positive PCR result in the last 90
days.
46Mobile Testing (pillar 2)
69. Mobile testing is a DHSC-led programme delivered through Mobile Testing Units (MTUs) operated by commercial
providers. 32 MTUs are available in the SE, each with the capacity for 500 tests a day.
70. The South East Region has established a Regional Coordination Group (RCG). The RCG is chaired by Directors of
Public Health (DPH), working alongside, NHSE/I, DHSC and representatives from Local Outbreak Control Plan
stakeholders, within the region.
71. The purpose of the RCG is to plan and coordinate the deployment of MTUs across the South East. This includes:
a. Ensuring all areas within the regional are adequately covered by MTUs, with sites identified and permissions
agreed;
b. There is a minimum of 5 days forecast in place for MTU deployment;
c. Coordinating the deployment of any ‘surge’ requests from Directors of Public Health;
d. There is a regional reserve available to be deployed to support outbreaks management;
e. Testing services provided by MTUs are in line with DHSC contracted requirements;
f. Reviewing testing undertaken by Regional Test Sites and Satellite sites; and
g. Liaison with key stakeholders involved in delivering other testing workstreams, for example pillars 1, 2 and 3.
72. Following the publication of Local Authority Local Outbreak Control Plans, the RCG is now focussed on ensuring
alignment of existing and emerging testing modalities. This includes how MTUs supplement/interface with new
innovations, including Local Test Sites, Voluntary Testing Networks and potentially any whole population initiatives
that may emerge.
4773. MTUs can be broken down into three main groups:
a. Regionally Allocated MTUs – MTUs allocated by Region for routine scheduling by RCGs under the auspices of
the Directors of Public Health (DPHs).
b. Regional Reserve MTUs – MTUs kept in Reserve by the RCG to meet Local Outbreaks and to provide immediate
Resilience in case of MTU failure
c. Strategic Reserve MTUs – c30 MTUs nationally, regionally dispersed but scheduled and operated centrally by
the DHSC. They may be deployed in support of Local Outbreaks when requested to provide surge capacity.
d. Surge MTUs – sub-regional allocation epidemiologically led. Local placement by RCG and DPHs.
74. Where a DPH has identified a need for mobile testing in response to an outbreak, a request should be submitted to
the RCG via the DHSC Regional Demand Team. The co-ordination flowchart below details the processes to be
followed for booking and escalation of operational issues.
4849
GP PCR Testing (pillar 2)
75. Following on from demand from GPs, NHS Test and Trace launched a pilot in mid-July to enable swab testing in
general practice settings. Following the success of the pilot, the offer has been extended for PCR swab testing
capability to all GP services in England. The service is voluntary and on an opt-in basis. There is no change to public
messaging on the ordinary routes for accessing a test (for example, through regional testing centres, home delivery
kits etc).
76. These tests are be for use with patients who present with Covid symptoms. It is intended to increase access to
testing for patients who would otherwise be unlikely to get a test via the primary testing routes (due for example
to barriers around language, disability or digital inclusion) and where appropriate to streamline the patient
pathway.
77. Following on from demands from GPs to have increased access to testing, these tests are also be available for
symptomatic GP staff and their household members where needed to complement existing testing capacity.
78. The model is accommodating different GP needs, depending on the level of demand. Most GPs are able to order
up to one box of 40 test kits per week, but those with greater demand are able to order more (up to 200 test kits
per week).
79. Mitigations have been put in place to ensure GPs do not become overwhelmed by the demand for testing,
including minimising public messaging and timing the roll-out to coincide with increasing lab capacity within the
National Testing Programme.
5051
PCR Testing complaint process (pillar 2)
80. A helpline has been set up for anyone tested through the national portal booking process who has not received
their results (Coronavirus Testing Call Centre 0300 303 2713). Please note there is no email address to contact the
helpline.
81. In the first instance key workers and stakeholders should take this route to escalate issues that they might have.
82. The next step is for the service user to escalate to the DHSC Ops Hub to investigate and resolve the service-user’s
issue: NTPHub@dhsc.gov.uk.
83. If the Ops Hub are unable to do this the service-user will be advised that they can make a formal complaint. They
can either make their complaint directly to this dedicated complaint mailbox: scas.Covid-
19TestingComplaints@nhs.net or the Ops Hub can send it through on their behalf.
84. The South Central Ambulance Service (SCAS) will manage the complaints process. They will triage complaints and
identify the type of investigation required. They will acknowledge the complaint and forward the issues and
questions from the complainant to the appropriate part of the wider business for investigation. Once the
investigation is complete and the findings returned to the SCAS team, they will prepare a response letter for sign
off by the nominated manager. Where they can, SCAS will respond to complainants if the issues have been
raised/investigated previously and resolutions are known to them.
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