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COVID-19 FAQs

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COVID-19 MDS Guidance

COVID-19 FAQs

Updated on 25 June 2020

Q1: What should I do if I have been exposed to a colleague who has started to show symptoms of COVID-19?

A1. You will not necessarily need to go home or work from home unless you yourself develop symptoms. If you develop symptoms then you should follow the government’s stay at home guidance for households with possible coronavirus infection. This guidance provides that if you have possible or confirmed COVID-19 then you should stay at home for at least 7 days from when your symptoms started. You should follow the government’s home isolation advice sheet where possible, which can be accessed here.

If your colleague is confirmed to have coronavirus, then you should be contacted by the NHS Test and Trace service to say that you have been in contact with a person who has coronavirus. If you have been contacted by the NHS Test and Trace service then you should stay at home and self-isolate for 14 days from the day that you were last in contact with your colleague. You should follow the NHS Test and Trace advice sheet which can be accessed here

Considering the above, we would advise you to contact your employer and explain what your situation is to them as soon as possible. You should take advice from your employer as to what they believe are the most appropriate steps in the circumstances, with reference to the requisite guidance. We note that testing is now available, and so if you get any symptoms of coronavirus then you should arrange to have a test done as soon as possible. If you test negative then you can return to work if you are well enough to do so.

Q2: What type of leave will my absence be recorded as, if I am self-isolating?

A2: If a staff member has been told to self-isolate, then they should do so as quickly as possible. Where the member of staff is unable to work from home, then their self-isolation must be recorded as COVID-19 special leave with full pay. That is, the pay that the staff member would have normally received including any pay enhancements. It does not matter whether the staff member has already self-isolated before because COVID-19 special leave will apply to each and every episode of self-isolation.

The Electronic Staff Record (ESR) has issued a user notice (UN2864) describing the steps that employers should follow to record any COVID-19 related absences where staff are self-isolating.

Q3: How will my self-isolation be recorded if I am working from home?

A3: If a staff member is working from home while self-isolating, then no further recording action will be required. If the situation changes and the staff member becomes ill so that they are no longer able to work from home, then the subsequent period of the staff member’s absence should be recorded as COVID-19 related sick leave.

Q4: What if I have not been advised to self-isolate, but have concerns about returning to work?

A4: Under employment terms, the employee does not have the right to work from home or stay at home because they are worried about coronavirus. However, you may be concerned about this in case it puts you and your family at risk. We would advise you to discuss your concerns with your employer who may be able to let you work from home or in some other capacity. We note that some employers have arranged hotel accommodation for employees who have families that may be at an enhanced risk or are self-isolating.

If your employer is unable to accommodate your concerns, then they may be able to arrange for you to take the time off as holiday or unpaid leave. Please note that your employer is under no obligation to agree to this.

If there is no reasonable reason for you to stay at home, then a refusal to work could lead to disciplinary procedures.

Q5: If I follow Occupational Health’s advice to work in low risk areas/work from home etc. then can my employer create any problems later for me?

A5: Your employer has a duty to act reasonably, and so if Occupational Health has made recommendations for you to work in low risk areas/work from home then they will have an obligation to consider whether they can act upon those recommendations.

However, you will not be able to act on the advice of Occupational Health alone. Your employer and you must agree to an altered working pattern based on Occupational Health’s recommendations. If you disagree with your employer’s proposal and believe that it is wrong or unreasonable, then please contact us for further advice.

Q6: What should I do if I have a condition that puts me at an increased risk of severe illness from coronavirus?

A6: Public Health England’s guidance on staying alert and safe has acknowledged those conditions which place people at an increased risk of severe illness from coronavirus. The guidance can be accessed here

This guidance applies to everyone in England who is fit and well, however if your area is experiencing a local COVID-19 outbreak then you should consider your local lockdown restrictions as well. We also note that there is different guidance in Scotland, Wales, and Northern Ireland.

The staying alert and safe guidance states that if you are a clinically vulnerable person then you should ‘be especially careful and be diligent about social distancing and hand hygiene’. You may be able to work from home, but that is only where possible.

If you are a clinically vulnerable person and are likely to come into contact with someone who is displaying symptoms of COVID-19 during the course of your employment, then we would advise you to write to your line manager and speak to Occupational Health about this as soon as possible. We note that, in consideration of PHE and NHS guidance, most Trusts have been drawing up their own local policies to help deal with vulnerable members of staff.

Q7: What should I do if I fall within the high-risk category for coronavirus?

A7: The government has issued some guidance on shielding for people who are clinically extremely vulnerable from coronavirus. The guidance can be accessed here.

The guidance applies to everyone who is clinically extremely vulnerable, and strongly advises for those people—that is, people with certain health conditions—to ‘stay at home as much as possible and keep interactions outside to a minimum’. The government is currently advising people to shield until 31 July and this position is being regularly monitored.

That being said, this guidance is only advisory, and so you do not necessarily have a right to stay at home and self-isolate just because you are a clinically extremely vulnerable person. We would advise you to speak to and make arrangements with your employer about this as it may be appropriate for you to work from home, take up an alternative role or adjust your working patterns temporarily. If your area is experiencing a local COVID-19 outbreak, then you and your employer should also consider your local lockdown restrictions and public health measures. We note that your employer is under a duty to act reasonably, and so will likely adhere to the government’s guidance if it is within their capacity to do so.

Q8: What should I do if I am living with an extremely vulnerable person?

A8: The government’s guidance on shielding advises that if you are living with an extremely vulnerable person then you are not required to adopt any of the protective shielding measures for yourself. However, you should do what you can to support the vulnerable person in their shielding and should continue to follow the government’s guidance on social distancing outside of the household, by staying alert and safe. You should socially distance yourself from the extremely vulnerable person as well if you are unwell.

Considering the above, we would advise you to speak to your line manager directly. Your employer may be able to make some reasonable adjustments for you in order to accommodate your concerns if it is within their capacity to do so. If your employer is unable to do this, then you may be able to stay in NHS-reimbursed hotel accommodation while you continue to work.

NHS England and NHS Improvement have established a single process for NHS staff to secure accommodation at hotels within their immediate area if they have been affected by COVID-19 in some way. You should consider discussing this with your line manager and can access more details about this here.

Q9: What should I do if I am pregnant?

A9: The Royal College of Obstetrics and Gynaecology has issued some guidance on coronavirus for pregnant healthcare workers. The guidance can be accessed here.

The guidance advises that every pregnant worker should have a risk assessment with their manager, in accordance with the Management of Health and Safety at Work Regulations 1999. Pregnant women under 28 weeks’ gestation should only be supported to continue working if their risk assessment concludes that it is still safe for them to do so. Your employer should try to support you as much as possible for example by removing any workplace risks or offering suitable alternative work, as employers have a legal obligation to protect the health and safety of pregnant employees and their unborn children.

Pregnant women in their third trimester, and pregnant women with certain underlying health conditions, are advised to take a more precautionary approach and stay at home. In any event, they must not be deployed in any public-facing or patient-facing roles. If you are in your third trimester and your employer is unable to arrange for you to work from or be appropriately redeployed, then you must stop working. In these instances, you will still receive full pay.

We would advise you to discuss the RCOG’s recommendations with your employer and more specifically with your line manager as soon as possible so that you can arrange for a risk assessment to be taken. We would also encourage you to speak to Occupational Health about your pregnancy as soon as possible and in conjunction with the above.

Q10: Can I start maternity leave early if I am pregnant?

A10: You cannot start your maternity leave until at least 11 weeks before your due date. You may be able to take annual leave that leads into your maternity leave. Again, we would advise you to speak to your line manager about this. However, this would be immaterial as the advice in point 9 would be of more relevance.

Q11: What are my rights as a doctor in relation to PPE?

A11: The GMC has stated that ‘[employers] and contracting bodies should take all necessary steps to make sure that staff are suitably equipped for their clinical setting’, in line with the government’s guidance on PPE for coronavirus.

However, the GMC also acknowledges that if suitable equipment is not immediately available then ‘difficult decisions may need to be made quickly about the safest and best course of action, taking account of the clinical situation’.

This is in line with the statutory duty for employers to ensure the health, safety and welfare of their employees and non-employees in the workplace under the Health and Safety at Work etc. Act 1974. Employers are under a legal obligation to protect their employees and non-employees at work; however, this duty is only insofar as is reasonably practicable, and so in this context will depend upon, for example, national PPE supplies.

Under regulation 4(1) of the Personal Protective Equipment at Work Regulations 1992, every employer shall ensure that suitable personal protective equipment is provided to his employees who may be exposed to a risk to their health and safety while at work except where and to the extent that such risk has been adequately controlled by other means which are equally or more effective. Essentially, then, your rights will extend as far as to the government’s guidance on the appropriate use of PPE which we note has been rapidly changing. Therefore, please feel free to get in touch with us for some further advice or information in relation to this point.

Q12: What should I do if suitable PPE is not immediately available to me?

A12: The GMC has said that doctors should consider the following factors:

• Whether treatment can be delayed, or provided by another team;
• What course of action is likely to result in the least harm in the circumstances;
• Whether alternative actions or additional steps can be taken to minimise the risk of transmission;
• Whether any doctors or other healthcare professionals are at a higher risk from infection than other colleagues.

At all times, it is important that you think of your patient’s safety but you must not put yourself under any unacceptable risk. The GMC advises that ‘you should take all available steps to minimise the risk before providing treatment or making other suitable alternative arrangements for providing treatment’. Ultimately, it is a question of your professional judgement in the given circumstances, however you should make a record of any decisions that you take with reference to your safety concerns. Please also see the GMC’s guidance in point 11.

Q13: What should I do if I am concerned about the lack of PPE for doctors in my workplace?

A13: We would advise you to talk to your Trust’s management about your concerns either directly, through your clinical lead or through the LNC. They may be able to advise you further, for example, on their current stocks of PPE, their current management and use of PPE and their scheduled deliveries which may be able to reassure you. If this remains unresolved, then you can approach us for advice and assistance.

Q14: What is being done about PPE?

A14: The National Medical Director previously stated that services across the NHS have been urgently receiving PPE to help them manage cases and potential cases of COVID-19 and to keep staff safe. We note that there is now a new PPE Dedicated Supply Channel operating in parallel to the normal NHS Supply chain in order ‘to meet the urgent volume requirements for core PPE items’.

We will continue to support our members in every way possible with regards to PPE.

Q15: What is the appropriate use of PPE?

A15: The government’s guidance should give you an idea of what PPE is required in different situations.

Recommended PPE to be used by healthcare workers delivering or assisting with a single aerosol generating procedure (AGP) on a possible or confirmed case of COVID 19:

• FFP3 respirator (single use)
• Disposable fluid-resistant coverall/gown (single use)
• Disposable gloves (single use)
• Eye/face protection (single use)

Recommended PPE to be used by healthcare workers working in a higher risk acute care area with possible or confirmed cases of COVID-19:

• FFP3 respirator (sessional use)
• Disposable fluid-resistant coverall/gown (sessional use)
• Disposable plastic apron (single use)
• Disposable gloves (single use)
• Eye/face protection (sessional use)

Public Health England’s guidance on PPE for COVID-19 describes the different types of PPE that should be used in different healthcare contexts, including inpatient areas, emergency department and acute admissions, operating theatres and labour wards. The guidance can be accessed here. Likewise, the government has created some short-form tables on the recommended PPE for different clinical contexts and healthcare workers. The tables can be accessed here.

Recommended PPE to be used, subject to local risk assessment, when case status is unknown and SARS-CoV-2 is circulating at high levels:

• Fluid-resistant surgical mask (varied use)
• Disposable plastic apron (single use)
• Disposable gloves (single use)
• Eye/face protection (varied use)

The guidance states that ‘[ultimately], where staff consider there is a risk to themselves or the individuals they are caring for they should [at least] wear a fluid repellant surgical mask with or without eye protection, as determined by the individual staff member’.

We understand that staff members will be worried, and so we note that there are many other preventive measures for COVID-19. We would encourage you to continue engaging in standard infection control and transmission-based precautions at work, in order to mitigate your risk of contracting the disease. Likewise, the government has recommended that all hospital staff should now be wearing a Type I or Type II facemask when they are not otherwise required to use PPE.

Q16: Is CPR classified as an aersosol generating procedure?

A16: Under Public Health England’s guidance, chest compressions and defibrillation as a part of CPR are no longer considered AGPs. Employers have therefore been given discretion to decide on what PPE should be provided to healthcare professionals in these situations. The government has noted that ‘[healthcare] organisations may choose to advise their clinical staff to wear FFP3 respirators, gowns, eye protection and gloves when performing chest compressions but it is strongly advised that there is no potential delay in delivering this life saving intervention’.

We note that there is a lot of national discord around this matter with a lot of people and bodies believing that CPR and more specifically chest compressions should be treated as a procedure requiring full PPE. We will continue to support our members during these difficult times, and so if you have any concerns about this then we would advise you to get in touch.

Q17: What should I do if I have been asked to work without a properly fit tested mask?

A17: You should not feel like you have to take any unacceptable risks at work, and so we would advise you to refer this issue to your managers/Clinical Lead. The government’s guidance on PPE for COVID-19 states that ‘all staff who are required to wear an FFP3 respirator must be fit tested for the relevant model to ensure an adequate seal or fit’. The guidance can be accessed here.

Likewise, the Health and Safety Executive’s guidance on fit testing facemasks reiterates this and distinguishes between fit tests and pre-use seal checks or fit checks. It states that ‘[a] face fit test should be carried out to ensure the respirator protective equipment (RPE) [(including disposable FFP3 masks)] can protect the wearer…[and that a] fit test should be repeated whenever there is a change to the RPE type, size, model or material or whenever there is a change to the circumstances of the wearer that could alter the fit of the RPE’. The guidance can be accessed here.

More recently, the government’s Acute Shortages Guidance—which can be accessed here —has highlighted that users of respirators need to be assured that the protective equipment is protecting them properly. This is especially important in instances where a higher level of user protection is required. We note that your employer is under a duty to act reasonably, and so should adhere to the government’s guidance if it is within their capacity to do so. If there is enough PPE and Fit Test solution for the Trust to conduct a formal fit test for you then they should try to accommodate your concerns.

In the absence of adequate protection, you should not be working in any high-risk areas, and so your employer should try to deal with these sorts of issues as soon as possible. If the Trust is adamant that they will not be able to properly fit test you, then they should try to source you with a PAPR hood or some other suitable alternative instead that you are still properly protected.

Q18: Is the UK’s policy on PPE in line with international guidelines?

A18: We are currently reviewing the World Health Organization’s guidance on the rational use of PPE for coronavirus to see whether the UK’s most recent reiteration of its policy on PPE is in line with this guidance. The guidance can be accessed here.

Q19: Will I be asked to work outside of my normal field of practice?

A19: Possibly. The GMC has advised that ‘in these exceptional circumstances, doctors at every level may be required to work [outside of their comfort zone]’.

If there is a second wave, then doctors may need to work in unfamiliar circumstances or surroundings, or in clinical areas outside of their usual practice. Therefore, you may well be required to take on work that you are less familiar with depending on your Trust’s service requirements. Where this is necessary, you will be supported adequately, and training and supervision should be given to you. If you are concerned about this or would like some more information about the training and support available to you, then we would advise you to talk to your line manager directly. You should explain your concerns to them and should ask whether other arrangements can be made. If there are no other options available, then you should provide the safest care that you possibly can to the patient in the circumstances, with the overall aim of providing benefit for the patient.

The GMC advises that, when deciding the safest and best course of action in the circumstances, you should:

• Consider what is within your knowledge and skills, and how your existing skills could be used in a different healthcare setting;
• Identify what skills and experience other members of the healthcare team could offer;
• Be willing to seek professional advice and clinical supervision from colleagues;
• Seek additional training and guidance as far you reasonably can in the circumstances; and
• Make sure you know who to go to for support and professional advice.

Q20: Why have I been asked to work outside of my normal field of practice, when my other colleagues have not?

A20: Organisations have been asked to assess the full range of skills available across their workforce and to consider redeploying staff depending upon their relevant skills and the highest level at which they would practice. Therefore, if the situation worsens then your colleagues may also be asked to work differently.

Q21: What could be the medico-legal implications for doctors during COVID-19?

A21: The GMC has issued some guidance explaining how it intends to regulate practitioners during this outbreak. The guidance can be accessed here.

Doctors are required to respond responsibly and reasonably to the circumstances that they face. The GMC recognises that these circumstances are challenging, and so has made it clear that it will be considerate of this in its regulation of the profession. It will consider:

• The specific facts of the case, taking into account the factors relevant to the environment in which the professional is working;
• The pressure doctors are working under, the resources available, and the scale of the challenges in delivering safe care; and
• Any other relevant information about guidelines or protocols in place at the time.

Additionally, a joint statement was issued by the chief executives of the statutory regulators of health and care professionals. The full statement can be accessed here. Therefore, we are reassured that the medico-legal implications of this outbreak are most definitely being considered and dealt with, so that doctors can continue to practice confidently during this crisis. The GMC’s regulatory standards are now being applied quite flexibly in order to accommodate for these difficult times. Likewise, we would like you to know that our team of medico-legal advisers are here to support you through this outbreak and will continue to support our members through their professional dilemmas.

Q22: Can my employer cancel my annual leave?

A22: NHS Employers has issued some interim guidance on annual leave in light of the coronavirus crisis. The guidance can be accessed here.

The guidance reiterates that ‘there will be instances where pre-booked leave may need to be delayed in order to provide continuity of services for patients and support for other members of staff’.

Employers are expected to be both sensitive and reasonable when deciding upon these matters. However, the guidance does recognise that ‘employers will need to consider carefully whether to ask staff to cancel pre-booked annual leave, and/or advise staff that annual leave cannot be booked during certain periods’. Therefore, your employer is entitled to cancel your leave as long as it is following the requirements in the Working Time Regulations 1998. These requirements relate to notice periods and to the consideration of compensation.

Most study leave or training leave during this episode can be cancelled as it is discretionary in nature.

Q23: Can my annual leave be carried forward?

A23: The Working Time Regulations 1998 have been amended to allow for the carry-over of leave untaken due to COVID-19. You are entitled to carry forward any untaken leave into the 2 leave years immediately following the leave year in respect of which it was due, as per The Working Time (Coronavirus) (Amendment) Regulations 2020 SI 2020/365. Employers should consider revising their local policies in order to account for this amendment.

Q24: Will I be paid if I am stuck abroad due to a travel ban?

A24: Trusts have been advised to consider the individual circumstances of their employees, and so it is ultimately up to them what they would like to do in these instances. We would advise you to talk to your Trust’s management or HR about this as soon as possible in order for you to inform them of your situation and to clarify their position.

That being said, NHS Employers has advised for Trusts to treat these absences as COVID-19 special leave where they are satisfied that an employee is stuck abroad due to COVID-19 and there is no reasonable prospect of them being able to return to work. In these circumstances, the employee would receive full pay for the period of their absence, including any pay enhancements. The guidance can be accessed here. Therefore, it is important that you try to demonstrate and, where possible, evidence in writing that you are making every effort to return back to the UK as soon as possible.

Q25: How can I show my employer that I am making every effort to come back to the UK?

A25: It depends on where you are in the world. If possible, then you should try to get a commercial flight back home or, alternatively, should try to register for some of the UK government’s repatriation flights. You can also write to your local MP here in the UK to lobby for your return and your Trust can also write to the Foreign Office for you. These sorts of actions will give you more standing in the matter and will help to prove that you are genuinely stuck abroad with no reasonable prospect of being able to return to work. You should keep a written record of your efforts to return so that you can refer to them when you discuss the matter with your employer.

Q26: Am I entitled to a risk assessment?

A26: By a letter dated 24 June 2020, Prerana Issar, Dr Nikki Kanani MBE, and Amanda Pritchard confirmed that all Trusts and employers are now required to risk assess their at-risk staff (including BAME staff) before 22 July 2020. The letter can be accessed here.

Therefore, if you are an at-risk member of staff, then you will be entitled to a risk assessment, and so you should raise this with your line manager as soon as possible if you are yet to have a risk assessment completed.

Please note that the guidelines are constantly changing, and we are keeping them and our advice under regular review.

If you need any specific advice, you should contact us as below:

For COVID related enquiries, email: priyani@mdsuk.org

MDS 24 hours helpline: 0300 30 32 442

Membership enquiries: membership@mdsuk.org

Advisory services: casemanager@mdsuk.org

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