The NHS test and trace service has been set up with three primary goals:
- To ensure that anyone who develops symptoms of coronavirus can quickly be tested to find out if they have the virus.
- To provide a targeted asymptomatic testing programme for NHS and social care staff and care home residents.
- To help trace close recent contacts of anyone who has tested positive for coronavirus.
The NHS test and trace service (as shown in figure 1) includes four key elements:
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) can be tested, whatever their age.
There is a different route which essential workers, for example, NHS and social care staff, police or transport workers should use to apply for a test.
In addition to these two routes there is specific testing for care home residents and staff (whole care home testing) and NHS Trusts test patients and make use of local capacity to test staff.
When someone tests positive for coronavirus the NHS test and trace service is notified. There are three tiers to contact tracing:
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: In more complex situations, such as an outbreak in a community setting, additional risk assessment and support will be provided by trained health care professionals. The 3,000+ health care professionals will be employed nationally.
Tier 1: Where an outbreak is identified within complex setting, for example, a school or care home, the expectation is that Local Health Protection Teams from Public Health England (PHE) will work with local partners to contain the outbreak and undertake contact tracing.
While 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 (tiers 2 and 3), 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 quickly mobilise local testing units, to support local intelligence gathering, provide infection control advice and ensure timely communications to the public and their representatives.
The NHS COVID-19 app forms just one component of their test and trace service and once fully functioning and rolled out this will complement other forms of traditional contact tracing.
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 3) 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 the risk of spread.
The gathering of data and intelligence (covered in ‘Using data’) and national and international research is critical to inform national policy and local decisions to contain the virus.
We will ensure that as and when new research and policy is produced the plan is updated accordingly.