[Withdrawn] Testing in extra care and supported living settings

Question 1

Introduction

Accepted Answer

This document is for managers to set out the testing guidance for extra care and supported living services (ECSL). It is part of a suite of measures to prevent outbreaks and save lives.

This guidance applies to asymptomatic individuals – anyone that is symptomatic can get a test.

See further infection prevention and control (IPC) guidance for extra care and supported living settings.

Why testing is important

Testing is important because:

identifies if you are likely to have COVID-19 so you can stay at home and avoid contact with other people if positive
reduces the risk of those receiving care contracting the virus from those who care for them
prevents and controls the spread of the virus by identifying asymptomatic cases

Summary of testing programmes for extra care and supported living settings

There are 2 different national testing programmes available for ECSL settings. We refer to them in this guidance as:

‘high risk settings’
‘wider settings’

The testing programme for a setting will be determined by the following eligibility criteria:

the setting is a closed community with substantial facilities shared between multiple people
it is a setting 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)

If your setting meets both criteria above, you are classified as a high risk setting.

If your setting meets one of the criteria above you are classified as a wider setting.

If you do not currently have access to testing, but meet a definition above, you should use the self-referral portal to request an extra care or supported living testing account. To do this, the manager should complete the following steps:

On the portal, enter ‘DHSC Referrer Unique Organisation Number’, which is 99874802. You will only need to use this code once and it cannot be used to order test kits.
Complete the eligibility questions.
Enter the information for your setting, including delivery address and contact details.
Submit referral.

Once your referral is submitted, the following happens:

the referral is sent to the local authority for approval
the local authority assesses if the setting meets the eligibility criteria, and approves or denies the referral request
if eligible, the setting is on-boarded onto the system and will be eligible to place an order for test kits
a confirmation email will be sent to the email address registered on the self-referral portal once your setting has been onboarded – and will include a unique organisation number (UON) you will be able to use to order test kits

Summary of testing regime for high-risk ECSL settings:

all staff should conduct daily rapid lateral flow tests (LFTs) on the days they are working before their shift begins
all residents should conduct one PCR test every month
LFTs are also available for visitors – see the guidance on supported living for more information.

Further testing may be required for visits in and out extra care and supported living settings, on admission or if someone is exposed to COVID-19.

Summary of testing regime for wider ESCL settings

all staff should conduct daily LFTs on the days they are working before their shift begins.
rapid lateral flow testing is also available for visitors – see our guidance on supported living for more information

Further testing may be required for visits in and out extra care and supported living settings, on admission or if someone is exposed to COVID-19.

Summary of testing process in ECSL settings

Step 1

Testing coordinator receives UON and orders test kits every 21 days.

Step 2

Testing coordinator ensures setting is prepared for testing, it carried out on site.

Step 3

Testing coordinator takes delivery and distributes the test kits and books a courier if testing 9 or more people by PCR on the same day.

Step 4

In all settings: staff complete daily rapid LFT every day they are working before their shift begins.

In ‘high risk’ settings: residents complete monthly PCR tests.

All ECSL settings can distribute LFTs to visitors, and the tests can be undertaken on-site or at home. LFTs can also be used for people being supported in line with government testing guidance.

Step 5

All LFT and PCR test results must be registered online. If for any reason you are unable to register using the online portal; you can contact 119 where they will be able to register the result on your behalf. This includes resident, staff, and visitor tests results.

Step 6:

All resident PCR kits must be packed ready for courier collection or postal returns correctly by following the instructions included with the kit.

If you have 9 or more PCR tests: courier collects completed PCR test kits.

If you have 8 or fewer PCR tests, these can be returned via your nearest priority post-box.

Rapid LFTs can be disposed of as detailed in the instruction leaflet contained within the kit pack and do not need to be returned.

Step 7

Results are received via email and text message (SMS).

Follow the testing schedule each week.

In the event of a negative result, remember to report your result and continue to follow all relevant IPC guidance.

Question 2

If you have an outbreak

Accepted Answer

All ECSL settings must alert their local health protection team (HPT) immediately if a confirmed (or clinically suspected) case of COVID-19 is identified in the setting.

Once alerted, your local HPT will conduct a risk assessment and may conduct outbreak testing on all staff and residents.

Staff with symptoms should not be in work and should not come into work for testing. They should order PCR tests online via the government website to conduct at home.

Find out which public health team covers your area

Find information on what to do if a positive case is found in your setting

Question 3

Testing within 90 days of a positive result

Accepted Answer

If an individual has tested positive with a LFT or PCR test, the testing they undertake in the following 90 days may be different. Full guidance on what testing an individual should do within 90 days of a positive PCR or LFT result can be found in the management of staff guidance and exposed patients guidance.

Question 4

Unique organisation number

Accepted Answer

To use all testing services, organisations are assigned an 8-digit unique organisation number (UON).

Each setting has been assigned their own UON so that test kit orders, courier bookings and test kit registrations can all be tracked back to an individual setting.

Through the use of UONs, our IT systems can uniquely identify each setting.

Better data helps us to better understand the risk posed by the virus. All testing we do supports an array of scientific research, which needs up-to-date and robust data. This is why it is important to register all results.

How to find out your UON

Once onboarded, an email will be sent to an organisation informing them of their new UON number. The email will come from organisation.coronavirus.testing@notifications.service.gov.uk

The email will have the subject title: COVID-19: Your new unique organisation number (UON).

Eligible settings will only receive a UON once your local authority has approved your request.

If your setting is eligible and has been onboarded, but you have not received your UON, call 119.

Question 5

Ordering test kits

Accepted Answer

The testing coordinator is the person responsible for ordering and distributing test kits for all staff, including both housing staff and care staff, in the setting. If applicable, they should also order tests for all residents, including those without care packages.

To place an order, you’ll need the following information:

your UON
the total number of staff (including agency staff) and residents to be tested
contact details

Once you have placed an order, you’ll receive a confirmatory email from organisation.coronavirus.testing@notifications.service.gov.uk

Question 6

Preparing your setting

Accepted Answer

Once you have placed your order for test kits, you should prepare for testing if it is being carried out on site.

Make sure your facility is fully prepared

Communicate with your staff and residents: ensure all staff and residents are aware of your testing plans and what the tests are for.

Obtain consent: before testing you must obtain consent from all staff and residents to be tested in line with your normal policies and procedures.

Delivery and storage

Once you have placed your order for test kits, you should prepare for delivery and storage.

You must:

follow guidance in the delivery confirmation email and printed instructions with your test kits
store test kits as detailed within the instruction leaflet

You must not:

store test kits in the fridge
mix test kits with test kits from your local HPT, as this may lead to complications with the registration
share test kits, as this may lead to issues with test kit registration, courier collection and also contact tracing
allow staff to come into work if they are symptomatic (they can get a test for people with symptoms)

Question 7

PCR testing in high risk settings

Accepted Answer

You must have a courier booked if you plan to test 9 or more people.

Your PCR test kit

The test kit contains the following items (one of each) when delivered:

Rapisac bag (that the individual test kit arrives packaged in)
swab, inside a sealed wrapper
plastic vial, containing a small amount of clear or coloured liquid
absorbent pad
biohazard bag with a silver seal
return box
security seal
pre-paid Royal Mail return label (pre-attached to the return box)

Note that test kits will arrive in boxes of 40 along with printed guidance booklets.

Taking the test

You will conduct a combined throat and nose self-swab for the test.

Follow the instructional video on how to do a throat and nasal swab.

Where a combined nose and throat swab is not possible, a nose swab from both nostrils should be taken if this is feasible. The swab does not need to be pushed far into the nostril. Extra care is needed when interpreting the results from a nasal swab compared with a full throat and nose swab. If the result is negative but the resident has persistent symptoms, a clinical assessment should be made to determine whether a repeat test is required. Staying at home or isolation from others should continue until symptoms reside.

The link to your test kit guidance document will be in your delivery confirmation email.

You will also receive printed instructions with your test kits.

You must register each test kit after completing the test using the link given to you in your delivery confirmation email.

Register a single kit online

Make sure you register your test each week after you have completed your test.

1. Go to the registration site to begin your registration.

2. Enter the UON of your ECSL setting, which you will have received in an email. You will get a confirmatory email from organisation.coronavirus.testing@notifications.service.gov.uk.

3. Enter or scan test kit barcode – enter carefully and do not copy and paste.

4. Enter personal details:

name
whether they are a service user or staff member
whether they have symptoms or not
gender
date of birth
email address (for results)
phone number (for results)
home postcode
NHS number (optional – note that this is important to update the subject’s NHS records)

5. Check your answers.

6. You’ll get confirmation of registration via email.

If there are any problems with registering a test kit, call 119.

Making multiple registrations online

You can also use the record-keeping multiple registration spreadsheet to register up to 100 tests.

Ensure you only use the most recent version of the multiple upload spreadsheet to register COVID-19 tests for your organisation.

Organisations can still upload their testing data using the self-registration route. This is an additional option and does not replace the self-reporting routes.

You will need to read the guidance and download the multiple registration spreadsheet to record the details of people you have tested for coronavirus on that day.

To make multiple registrations:

see guidance on how to make multiple registrations and to use our multiple upload portal – you can also download the new multiple registration spreadsheet
the excel document should not be altered: barcode, date and time of the swabs should be entered after the spreadsheet is uploaded (should not be digitally entered into the excel spreadsheet)
the excel document cannot be scanned into the computer – it must be a digital copy
grey cells and columns A and B should not be filled in (unless printing a copy and manually filling in for your own records) – cells should only be grey if you do not have to fill in that particular cell
if the bulk upload feature is still not working, register the test kits individually
you can register PCR tests taken for residents and report LFT results on the same sheet

Return box tracking

In order to return tests by courier, you must package test kits inside the larger outer return boxes provided by NHS Test and Trace. You can order these separately on the online portal. You should place an order for outer return boxes before booking a courier collection.

By using return boxes NHS Test and Trace can track your samples from when they are collected and leave your premises – it also means:

NHS Test and Trace can better manage test kit volumes across the network of laboratories
less cardboard waste
fewer missing tests

Key changes:

new outer return boxes with attached barcode, for packing up to 50 individual test kits
no need to use individual test kit boxes – test kits can go directly into outer boxes
registration portal single journey update, linking test kit box to outer return box

Returning your kits via courier

If you have 9 or more test kits to be collected, you can book a courier.

If you no longer require a booked courier, cancel by ringing 119.

To book you will need:

your UON
your postcode

Make sure you have finished testing an hour before the time your slot is booked for.

Try to register the kits the same day they are being collected if possible.

It is important to only book a courier when you plan to test – you can book up until 7pm the night before and there will always be enough slots available.

You are now able to book one of 3 courier collection slots throughout the day:

9am to 1pm
2pm to 6pm
4pm to 9pm

Returning your kits via priority post box

If you have 8 or fewer PCR kits to return, follow the instructions:

Each test kit contains a pink pre-paid return label. Attach this to the outside of the delivery packaging next to the security seal. If there is no label in the kit check in the box that the kits were delivered in. If you need additional support, call 119.

The test kit should be returned via a Royal Mail priority box. Check your nearest priority post box and collection times.

Only use a Royal Mail priority post box – it will be labelled with the priority box sign and one of the regional NHS logos. Do not enter any Post Office with the kit.

PCR test results

Any staff member who tests positive for COVID-19 with a PCR test should follow the management of staff and exposed residents guidance.

You should also consider whether individuals may be eligible for COVID-19 treatments including antivirals or monoclonal antibodies (through the PANORAMIC national study or through direct access for those at highest risk of becoming seriously ill from COVID-19).

A symptomatic individual who tests negative for COVID-19 may have another infectious illness like flu. Therefore, action may still be needed to limit transmission including using appropriate PPE when working with symptomatic people receiving care and those who are unwell keep away from others.

If you believe two or more symptomatic cases may be linked and that you may have an outbreak within your service, you should contact your local HPT, who will advise whether any further action or additional testing (including flu testing) is needed.

Question 8

Rapid LFT process

Accepted Answer

Rapid LFT technology

The rapid LFT detects a COVID-19 antigen that is produced when a person is infectious with COVID-19. If this antigen is present, then a coloured strip on the LFT will appear to show a positive result within 15 to 30 minutes, however, please read the leaflet enclosed with the testing pack to confirm how to undertake the test.

There are several rapid LFT products available, and all help reduce the risk on top of the other IPC measures, as part of an overall approach to managing the spread of transmission.

Tests can be used for self-test at home or on site

Extra care and supported living (ECSL) staff and visitors are able to self-test at home prior to entry to the setting.

Staff should collect a month’s worth of boxes of LFT kits to keep at home for testing.

In ECSL settings, it is the testing coordinator’s responsibility to maintain records of the kits that are distributed, including the LOT number, which can be located on the box of rapid LFT tests.

For visitors, see the guidance for supported living.

How to do a (COVID-19) rapid LFT

Visit guidance on how to do a COVID-19 rapid LFT.

Registering a rapid lateral flow test result

Once staff have completed their tests, the LFT device will show a result within 30 minutes.

It is important that they register their result. To register an LFT test result, staff will need the ID number on the test strip and the agency UON.

Navigate to this online form to register a result. The online form links the Rapid lateral flow ID number and test result to the individual and your organisation.
The form will ask for UON, personal details, ID number of the rapid lateral flow test cartridge, and whether the result was positive, negative, or void.
When using the online form, there is the option to create a user account. When creating a user account, an individual’s email address is linked to their personal details.

Whether a user account is created or not when ordering tests, notifications of results will be sent to via SMS or e-mail.

As an agency manager you may ask to see SMS or e-mail results as part of your tracking system.

Providers do not need to retain records of proof of registrations.

Any individual who tests positive for COVID-19 with a PCR test should follow the management of staff and exposed residents guidance.

Once they have completed their test and registered their result, they can dispose of the LFT device as detailed in the instruction leaflet contained with the kit.

Digital Reader

You can now use the Digital Reader for reading LFT results via the self-report journey. For detailed information, visit this link to the Digital Reader guidebook.

Read guidance on how to do a COVID-19 rapid lateral flow test.