Guidance

NHS Test and Trace: how we test your samples

Updated 20 November 2020

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An overview of the largest diagnostic network in British history, including what happens after you have submitted your sample and how the laboratories process your test.

The national laboratory network

Since the start of the pandemic, we have vastly expanded the nation’s testing capacity, more than doubling the capacity of the NHS and Public Health England laboratories as well as setting up an entirely new nationwide network of testing sites and new Lighthouse Laboratories and partner laboratories to process COVID-19 swab samples.

The COVID-19 swab samples are sent to our laboratories from across the country for analysis. We receive samples from the NHS on the front line and other testing sites, such as COVID-19 drive-through testing centres.

NHS Test and Trace is now the largest diagnostic network in British history. Our laboratories are processing over 2 million tests a week and we recently announced new facilities and technology to process results even faster.

The importance of the national laboratory network

The laboratory network has been established to dramatically increase the number of coronavirus tests that can take place each day to support the national effort against the coronavirus pandemic; it has been key in enabling the rapid increase in testing capacity over a short period of time.

1 in 8 people have now received a coronavirus test at least once since the launch of NHS Test and Trace on 28 May. This work is absolutely crucial in the effort against COVID-19 and enabling the return of more normality to our lives.

We are working around the clock to make sure everyone who needs a test can get one, including by bringing in new laboratories that can process tens of thousands of tests a day, opening new test sites and trialling new rapid tests that will give results on the spot.

Types of laboratory: the different arrangements

There are different types of laboratories processing COVID-19 swabs. At the same time as expanding NHS and PHE capacity as quickly as possible – which forms pillar 1 of the testing programme – the government has set up a growing network of Lighthouse Labs and testing sites (pillar 2) in partnership with a variety of suppliers, including NHS trusts, commercial suppliers, academia and not-for-profit organisations, in order to process test samples from an entirely new network of testing sites across the UK and from new routes such as home testing and mobile units.

This new network of laboratories is additional to the rapid expansion of NHS/PHE laboratories, and was set up in order to ramp up UK testing capacity as quickly as possible in the face of the global pandemic.

Lighthouse Laboratories

A Lighthouse Laboratory is a high throughput facility that is dedicated to COVID-19 testing for the National Testing Programme.

The Lighthouse Laboratories were set up by experienced scientific executives and technical leaders with decades of experience. The rapid and sustained growth and independent quality assessments is evidence of this.

Each Lighthouse Laboratory has been reviewed by experts, and each has a clinical virology advisor.

The Lighthouse Laboratories are managed through the Department of Health and Social Care, NHS trusts, commercial suppliers, academia and not-for-profit organisations.

Partner laboratories

A partner laboratory provides a high volume of testing for the national testing programme alongside its usual activities.

These laboratories are different to Lighthouse Laboratories. The laboratories can be acquired through partnership agreements with the public, private and academic sectors and can help to grow capacity by tens of thousands of tests.

The journey of a swab: what happens to your swab

Testing plays a vital role in our effort to fight and contain coronavirus; helping to mitigate the spread of the disease and preventing further transmission.

With hundreds of thousands of swabs processed in our laboratories every day, the experience of taking a coronavirus test at home or at a test site is now familiar to many people in the UK, but the next steps in the process are far less visible.

Here is a summary of what happens ‘behind the scenes’ after your sample enters one of our laboratories for testing. Please note that the processes will vary slightly between laboratories.

  1. Samples arrive at the lab double-bagged and in sealed plastic containers. Each one has its own unique barcode.

  2. A lab operator in protective clothing removes the sample from its bags, inside a biosafety cabinet. These cabinets have negative air pressure such that no aerosol particles can escape into the room and harm the lab operators.

  3. The operator makes sure the sample is viable: that there is enough liquid in the tube and the barcode is in the right place.

  4. Next, the liquid is removed from the sample tube and mixed with a chemical that kills any live virus so it can be handled safely. The sample is then prepared for RNA extraction, where any genetic material found in the sample is removed.

  5. The samples are added to a machine that uses magnets to extract and wash the RNA. The purified RNA is then placed on ice inside an insulated container to keep it stable.

  6. Plates of purified RNA are removed from the ice and mixed with a number of chemicals called ‘reagents’. These are placed into a PCR machine.

  7. PCR testing works by cycling the RNA samples through a variety of different temperatures, a number of times. Each cycle triggers a chain reaction that causes the genes (if present) to replicate and release a detection chemical which tells us if coronavirus RNA is present in a sample.

  8. Once the PCR reaction has been run, the results are carefully checked before being released and uploaded to the lab’s Laboratory Information Management System (LIMS), and then sent on to the National Pathology Exchange (NPEx).This is where the result from the lab is matched to the sample barcode (originally scanned) and subject record.

  9. All results are sent to the NHS Business Services Authority (BSA) who send email and SMS results to the person who took the test. For results relating to England, NPEx matches them to an NHS number and GP record if possible. NPEx also sends all the data to NHS Digital, who split out which results need to go to England, Scotland, Wales and Northern Ireland for public health responses, who then share the information with local authorities.

Locations of the laboratories

We have 5 Lighthouse Laboratories operating with a range of partners across the UK (Milton Keynes, Alderley Park, Glasgow, Cambridge and Newport). We have additional Lighthouse Laboratories in Charnwood, Newcastle, Brant’s Bridge and Plymouth coming online over the coming months. The Newcastle, Brant’s Bridge and Plymouth laboratories will be operated by NHS trusts.

In addition to the growing Lighthouse Lab network, there are partnership agreements with the public, private and academic sectors. This includes Antrim Laboratory in Northern Ireland, and laboratories at Birmingham University, Imperial College London, Queen Mary University of London, Kings Health Partners and a partnership between Health Services Laboratories and University College London.

Automation and technology

As well as announcing new laboratories that are joining the network, we are investing in new technology to process results faster, we are automating parts of the process and we are installing new machines in the laboratories.

Lighthouse Laboratories and partner labs continue to maximise capacity through mobilising additional equipment and optimising workflows. For example, we have mobilised new liquid handling robots.

The people behind your swab

A skilled workforce from across the scientific community, with the relevant expertise and experience needed to carry out COVID-19 testing, is working tirelessly to process the samples received. We are extremely thankful for their support and dedication at this time of national need.

The expansion of the laboratory network has resulted in a number of exciting new roles, from junior positions utilising a broad skill base, through to senior positions requiring experienced specialists or those able to oversee entire laboratories.

We will continue to run a rolling recruitment campaign to support the laboratories network and build new jobs and careers in science and the diagnostics industry.

Further information

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