COVID-19: toolkit for GPs and GP practices

COVID-19 patient vaccination exemptions

Location: England Wales Scotland
Audience: GPs Practice managers
Last reviewed: 25 January 2022
Topics: COVID 19, GP practices

The government has introduced an exemption process for those who are unable to be vaccinated and/or tested for COVID-19 for medical reasons.

This guidance applies to England only.


The application process

  1. Practices should direct all patients directly to 119 to request an NHS COVID Pass medical exemptions application form.
  2. 119 will then send an application form to those deemed eligible.
  3. 119 should inform and explain to any caller if they do not meet the pre-screening assessment criteria.
  4. 119 will send a largely pre-populated application form to those meeting the criteria. The applicants can complete it before sending it to the clinician identified during the 119 pre-assessment. This may be the GP, but could also be a specialist clinician familiar with the patient’s care and reasons for seeking medical exemption.
    NHS Digital has published guidance setting out what the clinician will need to do on receipt of a completed application form.
  5. The applicant will consequently receive an automated letter confirming the decision. This is not the responsibility of the practice and there is no right of appeal for the applicant.


Clinical guidance

DHSC have advised that clinical guidance has been sent to practices. It can be found in the 'online help' section of the summary care record application - from the new ‘COVID-19 exemptions’ tab, you can either click 'help' on the menu at the top of the screen or on the 'clinical guidance' link. 

The possible criteria for exemptions are limited. Examples that might be reasons for a medical exemption are:

  • patients receiving end of life care where vaccination is not in the person’s best interests
  • patients with learning disabilities, autism or a combination of impairments which mean that vaccination and testing result in distress and who cannot be vaccinated through reasonable adjustments such as an accessible environment
  • a patient with severe allergies to all currently available vaccines - information on vaccines and their cautions can be found in the Chapter 14a of the Green Book
  • those who have had an adverse reaction to the first dose (for example, myocarditis).

These are only examples and other conditions may, in the judgement of the clinician, be given as reason to exempt a patient from vaccination and/or testing.


Temporary exemptions

Time-limited exemptions for those with short-term conditions, such as receiving hospital care or medication that may interact with the vaccination, and for pregnant women may be considered.

While COVID vaccination for pregnant women is considered safe, the guidance does allow for temporary exemption following consultation with a clinician.

SCRa (summary care record application) provides an option to record an expiry date for exemption for relevant patients.

DHSC recommends that any temporary exemptions should be limited to the time needed for individuals to receive two doses of the vaccine, plus two weeks.


Care home workers

From 11 November 2021, staff will need to be fully vaccinated to enter a care home, unless medically exempt under the regulations.

However, there is a process available to this group to self-declare their exemption until 24 December 2021.

Any care home workers approaching practices seeking exempt status, outside of the exemption certification process, should be directed to their employer to agree to this temporary self-declared exemption.


Service provision payment

A payment of £44 will be triggered by the input of each medical exemption review onto the SCRa by the practice.

SCRa will generate a report detailing the number of assessments per month and will send a payment for them at the end of the month.