Intended for healthcare professionals


Covid-19: Who will be eligible for free testing from 1 April?

BMJ 2022; 376 doi: (Published 25 March 2022) Cite this as: BMJ 2022;376:o807
  1. Gareth Iacobucci
  1. The BMJ

With free covid testing ending in England for most of the public on 1 April, Gareth Iacobucci looks at what this means for staff and at-risk patients

What’s changing in England from 1 April?

The government’s Living with Covid document,1 published in February, set out plans to end all covid-19 restrictions in England and move to a strategy where vaccines and treatments are the “first line of defence.” A key plank of this strategy is that, from 1 April, the government will no longer provide free universal symptomatic and asymptomatic covid testing for the general public. Its justifications are the higher levels of immunity in the population and the need to rein in the “very significant cost to the taxpayer” of providing universal free testing.

Ministers have said that “individuals who are most at risk from the virus” will still be able to access free symptomatic testing, but they have yet to set out further details.

Which groups are likely to be eligible?

During the pandemic around 3.7 million people in England were advised to shield, as they were considered clinically extremely vulnerable or severely immunosuppressed. The list included people who had or might recently have had a blood cancer, a weakened immune system from treatment such as steroid medicine, biological therapy, chemotherapy, or radiotherapy, or an organ or bone marrow transplant.

More recently the UK Health Security Agency sent priority PCR tests to 1.3 million people who were deemed to have the highest risk of developing severe covid-19 and who could also be suitable for antiviral treatment if they test positive. But it is still not clear exactly who will be eligible for free testing from 1 April.

On 24 March a spokesperson for the Department of Health and Social Care told The BMJ, “We recognise the importance of ensuring people who continue to be at higher risk from covid receive the right advice and interventions. We will set out more details shortly.”

What about health and care staff?

The government has said that it will continue to fund free symptomatic testing for social care staff, but there is less clarity for NHS staff. England’s health secretary, Sajid Javid, said on 22 February that “if NHS staff need tests, they will be provided with free tests.” But he said that this “will be a decision for the NHS,” which suggests that the service or individual staff may need to foot the bill.

The BMA and the NHS Confederation have criticised this stance, warning that if the existing twice weekly testing requirement for NHS staff continues after 1 April, staff may have to pay around £50 a month out of their own pockets. Both organisations want free staff testing to continue, particularly for patient facing roles.

David Wrigley, BMA council deputy chair, said, “Under no circumstances must NHS staff be asked to pay for testing to go to work. People visit hospitals and surgeries to get better, not to be exposed to highly infectious viruses, and the continuation of routine testing for healthcare workers is one of the most important tools we have in protecting both staff, patients, and the ability of the NHS to care for patients.”

What’s happening in the rest of the UK?

In Scotland free lateral flow tests will no longer be available for the general population from 18 April, and free PCR testing for symptomatic people (apart from some at-risk groups) will end on 30 April.2

Wales is stopping free PCR tests except for at-risk groups from 28 March, but it will retain free lateral flow tests for symptomatic people until the end of June.3

Northern Ireland plans to stop free PCR testing for most people including those with symptoms from 22 April, but it will keep free lateral flow tests available for symptomatic people—possibly until the end of June—“depending on disease trajectory.”4

How have medical and patient groups responded to the changes?

The BMA and charities representing patients are opposed to removing free testing. Chaand Nagpaul, BMA council chair, said that providing free tests only to clinically vulnerable people once they develop symptoms, and not providing any free tests to their friends and family, was “completely illogical, as the priority should be protecting them from infection in the first place.”

Abi Howse, health information manager at Blood Cancer UK, told The BMJ, “Families and carers of the vulnerable will run the risk of exposing them to the virus unless they can pay for tests. We’re calling on the UK government to continue free testing, not just for people at the highest risk but for their households and those closest to them too, because protection from covid should be a right, not a privilege.”

A spokesperson for the charity Kidney Research UK said that regular asymptomatic testing “is the only way to make sure the most vulnerable have the best opportunity to swiftly access alternative treatments” if infected with covid, adding that the government “must reconsider.”

Rachel Power, chief executive of the Patients Association, said that charging patients for lateral flow tests “creates a barrier” that would exacerbate health inequalities for those who may not be able to afford them. “Charging for tests will contribute to covid-19’s continuing spread,” she warned.

How do we know which patients are clinically extremely vulnerable?

In England the national shielded patient list,5 overseen by NHS Digital, was created in 2020 using data from a variety of sources including GP and hospital records.

Speaking at the recent launch of a report from the All-Party Parliamentary Group on Vulnerable Groups to Pandemics that he contributed to,6 Richard Vautrey, former chair of the BMA’s General Practitioners Committee, said that creating the list was initially challenging because it was not clear which patients were most at risk from covid. As an example, he said that someone who might be considered vulnerable to flu would not necessarily be considered vulnerable to covid.

He added, “It wasn’t as simple as, ‘One condition means that you’re on the list and one condition means that you’re not,’ because, as we know, with many conditions there’s a huge spectrum of severity.”

How will the government determine who is eligible for free testing?

After the government announced the end of shielding in England on 15 September 2021 it said that the national shielded patient list would no longer be updated, although it is currently still available as a resource.7 The various primary and secondary care databases that were used in creating the national list8—including the hospital episode statistics and primary care prescribed medicines lists—will continue to be updated, and they will be available to help determine who is eligible for free testing.

Are these databases accurate?

The All-Party Parliamentary Group’s report9 highlighted discrepancies between primary and secondary care databases that have seen some people’s conditions miscategorised or missed entirely. Susan Walsh, chief executive of the charity Immunodeficiency UK, said, “I do have serious, serious concerns about the repercussions for people not being on the high risk list [who should be] in the Living with Covid plan. We really do need to tackle this issue.”

To ensure that data are accurate, consistent, and easily accessible, the parliamentary group’s report advised NHS England to “compile and maintain accurate and up-to-date registers of CEV [clinically extremely vulnerable] people that includes information about their current treatments, the severity of their condition, and their location.”

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