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Individuals who have been fully vaccinated and have been in contact with someone who has tested positive for COVID-19 or someone in their household who has COVID-19 symptoms are required to follow the steps outlined in this guidance.

This guidance has now been amended to include:

  • removal of the need for follow up PCR for a positive LFT result announced 5 January 2022
  • changes to the self-isolation regulations for positive cases announced 30 December 2021
  • changes to the self-isolation guidance for contacts announced 21 December 2021 which includes the introduction of daily testing for all contacts and removal of Omicron specific isolation
  • changes to the regular asymptomatic testing guidance for public-facing health and social care workers announced 17 December 2021 to test using LFTs before every shift
  • asymptomatic staff who live in the same household as the person who has COVID-19 symptoms or has tested positive for COVID-19 to return to work

This guidance is designed to provide additional safeguards and protections for people who may be more vulnerable to COVID-19. It outlines a process of risk assessment and mitigation for patient/service user facing staff working in specific settings.

The majority of health and social care staff will be able to continue with their usual duties. Those deemed to be working in close contact with those more vulnerable to adverse consequences of COVID-19, are likely to be those health and social care workers who are currently eligible for regular asymptomatic testing.

We will keep this guidance under review to ensure additional measures:

  • remain justified
  • are proportionate to the current risk

When a health or social care worker has tested positive for COVID-19

Staff who are positive should:

  • Notify their manager and follow the advice on self-isolation and isolate for 7 days
    • Staff should start taking lateral flow tests on day 6 of the self-isolation period. When a staff member has two consecutive negative lateral flow tests 24 hours apart they can return to work the day after the second negative result i.e. no earlier than day 8. 
    • The likelihood of a positive LFT in the absence of symptoms after 10 days is very low. However If the staff member’s LFT result is positive on the 10th day, they should resume the testing regime of testing before attending work/ going on shift from day 11. Staff should not return to work until a single negative LFT result is received.
    • Staff who report positive LFTs after day 8 will result in a new case on the contact tracing system and will therefore need to inform the contact tracing team the LFT positive is due to testing associated with an existing case.
  • All staff should resume the testing regime of testing before attending work/ going on shift again as soon as self-isolation ends. 
    • Social care workers who usually perform weekly PCR tests should wait for 90 days from infection before restarting PCR tests.

When a patient/service user facing health and social care worker has been identified as a close contact or a member of a household has tested positive or is symptomatic

Before the worker attends the workplace the employer should ensure:

  • The staff member is asymptomatic – symptomatic individuals must self-isolate in line with general guidance.
  • The staff member who has been identified as a contact, books a PCR test as soon as possible and receives a negative result before returning to work.
  • The staff member has not received a positive COVID-19 PCR test result within the previous 90 days. 
  • The staff member is fully vaccinated. This means they received their second vaccination (MHRA, EMA or FDA approved) at least 14 days before the point of exposure. Vaccination status should be verified via the Welsh Immunisation System (WIS) but local judgements may be made as to use of staff evidence of vaccination where necessary – unvaccinated staff must self-isolate in line with general guidance.
  • The staff member agrees to the testing scheme as set out below.
  • If the staff member does not agree to the scheme of testing, they should either be redeployed to a non-patient/service user facing role or instructed not to attend work.

The employee:

  • Should notify their employer as soon as they are aware that they are a confirmed contact or a household member has symptoms/tested positive.
  • Should book a PCR test as soon as possible.
  • Once a PCR result is known, follow the testing scheme.

This guidance applies to staff working with the following two groups of patient/service users:

1. Workers in close contact with patients/service users

Where the staff member is providing care, support or treatment which means they are unable to maintain a social distance. This may include:

  • the administration of medical treatment
  • provision of personal care
  • supporting the individual to promote their independence
  • other interventions bringing staff into close contact with the patient/service user.

Staff must agree to the specified testing process to continue to work with patients/service users.

If they do not agree they should be redeployed or not attend work.

2. Workers in close contact with patients/service users who are known to be immunosuppressed and/or clinically extremely vulnerable 

For example patients in oncology or transplant services. Staff should not continue to work with these patients/service users. Staff should be redeployed to work with patients/service users who are known to not be  immunosuppressed and/or clinically extremely vulnerable. They will be asked to take the necessary tests or asked not to attend work.

If neither of the scenarios above apply, there are no specific requirements arising from this guidance on these workers however general self-isolation guidance for the general public would apply and DCT would be advised for 7 days.

Testing scheme requirements

To provide an additional level of safety to vulnerable patients and service users, the staff member must agree to take specific tests in place of the usual tests that person takes for their job role.

  • The staff member will take a PCR test on the first day they are identified as a contact, or the first day someone in their household had COVID-19 symptoms, or as soon as possible thereafter and receive a negative result before they come into work. 
  • If a staff member has had a positive COVID-19 PCR test result within the previous 90 days, a local decision/risk assessment will be needed to determine the management of the staff member in terms of test monitoring or continuing to work.
  • Following a negative PCR test, the staff member must take a LFT every day up to day 7 from initial exposure with the confirmed case and have a negative result. 
  • All results should be logged and reported appropriately: Report a COVID-19 rapid lateral flow test result on GOV.UK  
  • If a LFD test is positive they must self-isolate and follow the self-isolation guidance for health and social staff outlined above.  

Infection prevention and control

To further mitigate the risks workers must continue to adhere to their employer’s guidance on infection prevention and control measures. This includes social distancing in the workplace when not delivering care or treatment and the use of PPE in line with the current Public Health Wales/UK COVID-19 IPC guidance COVID-19: infection prevention and control (IPC (on GOV.UK).

Process governance

  • Within health boards and trusts, the medical and nursing leaders, the Board lead for IPC and/or Director of Public Health will work with each organisation on this risk assessment process and use of the checklist with staff.
  • In primary care the independent contractor should make decisions about this process in line with the criteria but must advise the health board about their approach.  
  • In regulated care services, the Responsible Individual is accountable for decision-making. Private sector employers may wish to liaise with health and social care commissioners.
  • Managers in supported housing will make decisions and liaise with local authority commissioners as appropriate.

Annex A - Fact sheet for patient/service user facing health and social care workers following identification as a COVID 19 contact

In order for patient/service user facing staff to attend work, certain requirements which are summarised below must be met:

  • The staff member is fully vaccinated at least 2 weeks prior to returning to work and are symptom free.
  • Staff member should inform manager as soon as a household member has symptoms or tests positive or when they have been identified as a contact via TTP or the COVID app. 
  • The staff member has a PCR test performed and has a negative result prior to returning to work. 
  • Following negative PCR result, LFD testing should commence on a daily basis up to day 7 from initial exposure, results should be reported on the on-line portal and manager informed. 
  • Consideration is given to the patients/service user with whom the worker has regular contact. Please consult the guidance for further information.

What staff can expect from their employer

  • That the employee checklist is completed in discussion with the staff member prior to staff member attending work. This should record vaccination status, PCR results, identifies that staff have no Covid-19 symptoms and records provision of LFD testing kits.
  • That staff are supported to record LFD results.
  • That consideration is given to the patients/service users the worker is usually in contact with.
  • That if appropriate, suitable redeployment is considered.

What employers should expect from staff

  • That they should have read this fact sheet to familiarise themselves with the policy and  agree to the testing regime
  • That they participate in completion of the employer checklist and discussion with manager prior to attending work.
  • That they book a PCR test through agreed mechanisms and provide result to employer prior to returning to work.
  • That they agree to perform LFD tests, inform employer of and record results for 7 days from initial exposure to the person who has tested positive to COVID-19.
  • That they adhere to IPC procedures ensuring appropriate use of PPE at all times.
  • That they refrain from work, inform manager and book a PCR test if symptoms develop.

Annex B: Checklist for employer to complete with staff member

This assessment to be used if a relevant health or social care worker has been identified as a contact of a positive case of COVID 19. This should be completed before the worker returns to the workplace and so should be discussed via phone or video call.

Checklist: employer with employee
  Check Mitigation

Does the staff member have COVID-19 symptoms?

  • A high temperature
  • A new, continuous cough
  • A loss, or change to sense of taste or smell

Yesshould attend for PCR and self-isolate

No move to Q 2
2 Is the employee fully vaccinated (at least 14 days post 2nd vaccination and evidence provided)?

No – staff member should follow the self-isolation guidance staff and isolate for 10 days.

Yes - move to Q.3

3 Is their PCR status known?

PCR negative 

Are they agreeing to follow the required testing process? 

Yes - move to Q.4 

PCR positive

Follow the self-isolation guidance staff.

Status unknown – Need to book PCR in order to return to work

4 Does the staff member know where to access lateral flow devices and are able to use them appropriately?

Yes – take a LFD test each day up to day 7 from initial  contact with the positive case and receive a negative result before attending work and report result to their line manager and online Report a COVID-19 rapid lateral flow test result - GOV.UK. – move to Q.5

No- Line manager should facilitate access to LFDs prior to return to work.– move to Q.5

5 Is the staff member working with patients/ service users known to be in either of the two groups outlined in the guidance?

No – there are no specific requirements on these workers

Yes – action should be taken as outlined in the guidance.

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