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Testing and tracing


The NHS test and trace service has been set up with three primary goals:

  1. To ensure that anyone who develops symptoms of coronavirus can quickly be tested to find out if they have the virus.
  2.  To provide a targeted asymptomatic testing programme for NHS and social care staff and care home residents.
  3. To help trace close recent contacts of anyone who has tested positive for coronavirus (COVID-19).

A diagram illustrating the 4 main elements of the NHS test and trace service. The 4 elements are test, trace, contain and enable.

The NHS test and trace service includes four key elements:

  • Test: rapid testing, at scale, to identify and treat those with the virus.
  • Trace: integrated tracing to identify, alert and support those who need to self-isolate.
  • Contain: identify outbreaks using testing and other data and contain locally and minimise spread.
  • Enable: use knowledge of the virus to inform decisions on social and economic restrictions.

Test

Anyone in England who has symptoms of coronavirus (a high temperature, a new, continuous cough, or a loss or change to your sense of smell or taste) and whatever their age, can access a test by going to the NHS website or by calling 119.

It will be possible to book an appointment at a drive-through or walk-through test site or ask for a home test kit.

There is a different testing route for essential workers who have symptoms of coronavirus or for someone who has symptoms and lives with an essential worker.

Essential workers include, for example:

  • NHS and social care staff
  • police
  • transport workers
  • education and care workers

Tests can be accessed by the individual at GOV.UK or they can be referred by their employer.

In addition to these two routes, there is specific testing for care home residents and staff (whole care home testing) and NHS Trusts can test patients and make use of local capacity to test staff.

Trace

When someone tests positive for coronavirus the NHS test and trace service will trace contacts of the positive case.

A ‘contact’ means a person who has been in close contact with someone who has tested positive for coronavirus and who may or may not live with them.

The critical timeframe is 48 hours before they developed symptoms and the time since they have developed symptoms.

Close contact means:

  • having face-to-face contact with someone (less than 1 metre away)
  • spending more than 15 minutes within 2 metres of someone
  • travelling in a car or other small vehicle with someone (even on a short journey) or close to them on a plane
  • working in – or recently visiting – a setting with other people (for example, a GP surgery, a school or a workplace)

The NHS test and trace service will assess, and if it is necessary, inform the close contact that they must self-isolate at home to help stop the spread of the virus.

There are 3 tiers to the contact tracing operating model with each tier being bridged by a team leader function to ensure information flows and cases are escalated and de-escalated accordingly:

Tier 3: There are approximately 15,000 national contact tracers who are trained to make initial contact and provide advice to those testing positive and their contacts.

Tier 2: There are approximately 3,000 health care professionals employed nationally who are trained to interview cases and identify contacts.

Tier 1: Where tier 3 and tier 2 identify a degree of complexity and a ‘context’ for concern, for example, a school, health setting, care home or workplace, they will escalate to tier 1.

At tier 1 the Local Health Protection Teams from Public Health England (PHE) will work with local partners, including the Local Authority Public Health Team, to follow up cases and agree on actions to contain the outbreak.

The expectation is that the vast majority of people requesting tests and/or being contacted by the NHS test and trace service will not require any local involvement and will be supported through tiers 2 and 3.

However, for more complex outbreaks (tier 1) the knowledge and relationships which local partners have will be invaluable in providing a timely and appropriate response to a local outbreak working in collaboration with PHE.

This will include the ability to swiftly mobilise local testing units, support local intelligence gathering, provide infection control advice and ensure timely communications to the public and their representatives.

The use of mobile phone technology through the use of the NHS COVID-19 app and a new Google/Apple framework is continuing to be developed.

A COVID-19 app will form just one component of the NHS test and trace service and once fully functioning and rolled out, will complement other forms of traditional contact tracing.

Contain

Early identification of an outbreak, which is generally but not always defined as ‘two or more cases connected in time to a specific place’ (not a household), is critical to help contain the outbreak.

For complex outbreaks (tier 1) a local authority will convene an incident management team. The team will consist of key representatives applicable to the setting.

In some circumstances, it will be necessary to create an outbreak control team (OCT). The OCT will usually be chaired by a member of the Local Health Protection Team or by a consultant in public health from the Local Authority Public Health Team.

The membership of the OCT will vary depending on the setting but includes public health expertise, communication leads and the manager or appropriate staff from the outbreak setting.

The main aim of the OCT is to contain the outbreak and minimise any risks.

Enable

The gathering of data and intelligence (covered in Using data) and national and international research is critical to inform national policy and local action.

We will ensure that as and when new research and policy is produced the plan is updated accordingly.


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