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This publication is available at https://www.gov.uk/government/publications/coronavirus-covid-19-testing-in-adult-care-homes/testing-for-professionals-visiting-care-homes
Applies to: England
Health, social care and other professionals may need to visit residents within care homes to provide services. This guidance sets out the testing policy for these ‘visiting professionals’.
This guidance should be implemented as soon as possible but we also understand that professionals and their employers will need time to get to grips with practical issues, such as how they will provide evidence to care homes. Therefore this guidance should be implemented by care homes and professionals by 22 March 2021 if not before. This provides care homes and professionals with time to put the necessary measures in place following the publication of the guidance.
Many visiting professionals work in a variety of different settings per day, including care homes. Given the substantial risks to care home residents if COVID-19 is introduced to the home, it is essential that professionals and all staff are tested regularly before visiting care homes to reduce the risk of transmission across different settings and to help keep residents and staff safe.
Care home managers have ultimate responsibility for the safety of their care home, including the residents and staff. This includes ensuring policies are followed, including infection control measures and testing.
For example, where care home staff complete their rapid lateral flow tests (LFTs) at home, the care home should have processes in place for staff to evidence they have been tested and what the result is.
The below provides further clarification regarding the policy for testing professionals who visit care homes and outlines how professionals visiting care homes can provide care homes with the necessary assurances.
Testing is, however, only one part of the approach to reduce risk. It will not identify every individual who is infected, and therefore a negative result does not prove someone is not infected with COVID-19. However, testing plays an important role by enabling the identification of a greater number of infectious individuals without symptoms who could be unknowingly passing the virus onto others, therefore helping keep care homes safe and safeguarding residents.
It is critical that visiting professionals put on and take off personal protective equipment (PPE) appropriately and follow the relevant infection control measures when visiting a care home, including hand hygiene and distancing, in order to help keep care home residents and staff safe.
NHS professionals visiting care homes who are part of regular staff testing
This includes all patient-facing NHS staff entering care homes, including for example community services, ambulance services and GPs.
Given the risks, the default position is that a visiting professional should not be allowed entry to a care home without proof of a negative test within the last 72 hours – demonstrating they are following the testing regime for NHS staff.
In emergency visits such as a 999 response, it is not appropriate to ask for or provide proof before entry to a care home, given the potential delay this could cause and the implications for prompt management of the emergency situation. Further guidance is given below. However, all NHS professionals visiting care homes must follow the NHS testing regime and be testing twice a week.
Care homes must ask the NHS professional when they were last tested and see proof of the result and date of the relevant professional’s test.
Proof may include:
- an email or text from NHS Test and Trace
- a screenshot of where the professional has to upload their test result
- a date-stamped photo of the test cartridge itself
- signed confirmation from their manager
- the NHS signed log included with the test kits provided to NHS staff
If it has been more than 72 hours since the NHS professional was tested, the care home should test the individual before entry to the care home.
If the individual has not been tested (or is unable to provide proof) and it is not possible to test prior to entry, the care home will need to make a risk-based decision regarding whether to permit entry, taking into account the reason and urgency of the visit. The default position is that without proof of a recent negative test or a negative rapid LFT on the door of the care home, the professional should not be admitted. Visiting professionals can, of course, conduct a test at home prior to visiting a care home if this would make better use of their time in the working day.
As detailed above, testing is only one part of the approach to reduce risk. Where the manager makes a risk-based decision to allow entry of someone without evidence of a negative test, all infection prevention and control (IPC) measures must continue to be followed in order to mitigate the risk, including correct use of PPE, cleaning, ventilation and distancing.
The majority of NHS professionals will be using rapid LFT testing for their regular testing regime. However, if a professional falls under a different NHS testing regime which uses PCR or LAMP testing, the individual will also need to demonstrate that they are testing in line with NHS policy for that testing technology. Given the importance of NHS staff testing regularly to ensure the safety of their patients, and the role of care home managers to keep their care homes safe, if care homes have any problems with NHS staff not following this policy, they should contact their clinical commissioning group (CCG) chief nurse.
Testing for CQC inspectors visiting care homes
Like NHS staff, Care Quality Commission (CQC) inspectors have a regular testing regime. In addition to their current weekly PCR testing, CQC inspectors should be tested using rapid LFT on the day of their visit to a care home or care setting (including extra care or supported living settings). This should be conducted at home by the CQC inspector, in line with the MHRA’s recommendations on use of such tests as close as possible before their visit to the care home or care setting.
As above, the CQC inspector should provide evidence to the care home or care setting of the negative rapid LFT result from earlier in the day when they arrive. This evidence could be the text or email from NHS test and trace or a photo of the rapid LFT cartridge with the time and date stamp.
As CQC inspectors by law have a right to enter a care setting as part of an inspection, they should not be denied access if they do not provide this evidence.
CQC policy is that inspectors are only allowed to visit care homes or other settings if they have been tested as per this policy, and adhering to the testing policy is a requirement of the risk assessment carried out prior to a visit to a care home or care setting.
Professionals not regularly tested through NHS or CQC staff testing
As detailed in previous guidance, professionals who are not part of a regular testing regime (that is, those who are not included in NHS staff and CQC inspectors) should be tested on the door of the care home. Professionals who have to visit multiple care homes per day do not need to be tested at a care home more than once a day.
Professionals should be tested, using rapid LFT testing, on the door of the first care home they visit on that day. The testing process is set out in the visitor testing guidance (‘On-site testing for adult social care services’). These professionals should then use the email or text they receive from NHS Test and Trace with their result and show this as proof at each care home they visit.
As above, care homes should ask professionals when they were last tested and request to see proof of the result and date of the relevant professional’s test. If the professional is unable to provide proof, they should be tested at the care home door.
If the individual has not been tested (or is unable to provide proof) and it is not possible to test prior to entry, the care home will need to make a risk-based decision regarding whether to permit entry, taking into account the reason and urgency of the visit. The default position is that without proof of a recent negative test, the professional should not be admitted, unless entry is required by law.
This guidance is not exhaustive and there are other categories of professionals who, like CQC inspectors, have a legal right of entry to the care home as part of discharging their duties. This guidance does not prevent their entry to a care home if they are unable to evidence a negative test result. Of course, anyone who has tested positive (or who has symptoms) must self-isolate as per the guidance. There is also guidance on return-to-work criteria for health and social care staff.
Professionals who have recently tested positive for COVID-19 using a PCR test should not be retested within 90 days unless they develop new symptoms. This means that some professionals will not need to be tested regularly because they will still fall into this 90-day window.
These professionals should use evidence of their positive PCR result to show that they are currently exempt from testing until the 90-day period is over. Once the 90-day period is over, professionals should then continue to follow their relevant testing regime.
See full details of the 90-day window policy in the document ‘care home testing guidance for residents and staff: PCR and rapid lateral flow (England)’ in the getting tested guidance.
Void or invalid results
Void or invalid results are uncommon. If there is a void lateral flow result, retest using a spare rapid LFT kit to receive a conclusive result. If the re-test also comes back as void or invalid, the professional should continue to work as normal and undertake a further rapid LFT on the next day, and in the meantime show evidence of their void results.