PCR tests dropped for elective patients

In a letter outlining changes to covid-19 testing from 1 April, NHSE confirmed NHS staff and some patients – such as those requested by a GP – would continue to receive free LFDs.

It also revealed that planned elective admissions should be tested using LFDs in advance of admission rather than the more reliable polymerase chain reaction (PCR) tests, which have been required until now.

Patients having surgery with covid have a higher risk of poor outcomes and harm, as well as potentially spreading the virus. However, infection control measures such as testing are one factor slowing elective care recovery. 

The new letter said: “Patients should be directed to the gov.uk website to order their tests, where they will be asked to confirm that they have a planned upcoming admission. Patients should inform their treating trust if they test positive and should be asked to provide proof of testing (text or email from gov.uk) on admission.”

Free universal testing will be scrapped for the general public and asymptomatic non-patient-facing NHS staff in England from 1 April – prompting concerns that infection could spread undetected.

The letter, signed by NHSE’s national medical director Stephen Powis, chief nursing officer Ruth May, primary care medical director Nikki Kanani and chief people officer Em Wilkinson-Brice, confirms free testing will continue for frontline NHS staff and some patients, including PCR tests for:

• All patients in a hospital setting requiring a test by a clinician
• Severely immunocompromised patients who move beds within a hospital setting
• All patients on discharge to other care settings, including to care homes or hospices
• Outbreak testing following local public health advice
• All asymptomatic patients requiring emergency or unplanned admission via emergency departments or any other route (such as GP direct admission)
• Women admitted to a labour ward or setting, but not their birth partners

LFDs will be free for:

• All NHS staff working in patient-facing roles. Staff should continue to test twice weekly when asymptomatic, NHSE said
• Symptomatic NHS staff
• Asymptomatic hospital inpatients on day three and days five to seven of their stay. This has changed from PCR tests previously
• Asymptomatic patients requiring emergency admission to a mental health unit, and NHS patients in mental health and learning disability settings returning from a period of planned leave
• Planned elective admissions
• All NHS patients in a community or primary care setting requiring a test by a clinician during their care and treatment pathway
• High-risk members of the public who are eligible for community covid-19 treatments

The Department of Health and Social Care said free universal testing has “come at a significant cost” to the taxpayer – with testing, tracing and isolation costing more than £15bn in 2021-22 – and that the cost of the incoming changes “will be met within existing funding arrangements”.

Throughout the pandemic, covid testing costs have been funded by the DHSC and UK Health Security Agency. DHSC has not yet clarified if this will continue, or if some or all covid testing will have to come from NHS/NHSE budgets. This has been part of a dispute over funding for 2022-23 between NHSE and government in recent weeks.

NHSE also said it is working with UKHSA to “determine how routine asymptomatic testing should be stepped down in line with any decrease in prevalence rates”.