COVID-19: doctors isolating and those in vulnerable groups

Read our frequently asked questions for doctors who are isolating, have underlying health conditions or live with someone who is in a high risk group.

Location: UK
Audience: All doctors
Updated: Wednesday 29 July 2020
Changes to government advice from 1 August 2020

Please be aware that from 1 August government advice on shielding is due to change. We will be updating this guidance to reflect these changes.

When should I self isolate?

  • If you show symptoms of the virus you should stay at home and not meet up with other people for seven days.
  • If you feel better after that period you can start your usual routine again.

If you share your home with someone who has symptoms

  • You should stay at home and not meet up with other people for 14 days.
  • If you develop symptoms during that time then you must stay home for seven days from when you became ill.

The above advice is following guidance from Public Health England.

 

Will I be paid if I self isolate?

NHS staff receive full pay whilst in self-isolation. 

In the event that you are asked to self-isolate, you should do so as quickly as possible.

You should discuss with your clinical manager whether there are any duties which you can perform from home whilst you are self isolating, if you are not ill.

‘Full pay’ is paying what the staff member would have otherwise earned if they were not in isolation, inclusive of any enhancements.

 

Should I self-isolate if I have a health condition or am over 70?

Governments are advising that those who are at increased risk should be particularly stringent in following social distancing measures.

This includes:

While this stops short of recommending self-isolation, it does recommend measures which would be hard to reconcile with delivery of some frontline services.

NHS employers are being advised to engage with staff who are categorised as being at ‘increased risk’ and jointly consider whether adjustments to work or redeployment might be appropriate. This could include working remotely or in lower risk areas.

 

What does shielding mean?

Shielding is a measure to protect people who are clinically extremely vulnerable by minimising all interaction between those who are extremely vulnerable and others.

People with the following serious underlying health conditions:

People with specific cancers
  • People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer.
  • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment.
  • People having immunotherapy or other continuing antibody treatments for cancer.
  • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
  • People who have had bone marrow or stem cell transplants in the last six months, or who are still taking immunosuppression drugs.
  • solid organ transplant recipients
  • people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD
  • people with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)
  • people on immunosuppression therapies sufficient to significantly increase risk of infection
  • Women who are pregnant with significant heart disease, congenital or acquired.

The NHS in England has contacted people with these conditions to provide further advice.

If you think you fall into one of the categories of extremely vulnerable people listed above and you did not receive a letter by Sunday 29 March 2020 or have not been contacted by your GP, you should discuss your concerns with your GP or hospital clinician.

 

What is the effect of shielding?

You are strongly advised to stay at home at all times and avoid any face-to-face contact for a period of at least 12 weeks from the day you receive your letter. Please note that this period of time could change.

Visits from people who provide essential support to you such as healthcare, personal support with your daily needs or social care should continue, but carers and care workers must stay away if they have any of the symptoms of coronavirus.

You may find guidance from GOV.UK on home care provision useful.

All people coming to your home should wash their hands with soap and water for at least 20 seconds on arrival to your house and often while they are there.

You should have an alternative list of people who can help you with your care if your main carer becomes unwell. You can also contact your local council for advice on how to access care.

If you think you have developed symptoms of COVID-19 such as a new, continuous cough or fever, seek clinical advice using the NHS 111 online coronavirus service or call NHS 111. Do this as soon as you get symptoms.

Further information on shielding is available at GOV.UK

 

Will I receive pay if I am shielding?

Whilst there is nothing specific in the Public Health England guidance we believe you should still receive payment if you need to shield yourself from the workplace. 

Ideally you should take advice from occupational health, however, we are aware that this may be difficult in the current environment. 

You should therefore discuss with your line manager in the first instance if there is work that you can carry out from home and, if not, you should seek confirmation that your pay will be protected. 

If you have any concerns you should contact us.

Further advice is available from the Faculty of Occupational Medicine.

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I live with someone who is shielding, what should I do?

If you live with someone who is shielding, you are not required to do the same.

However, you should do what you can to support them in shielding and the government advice is that you should stringently follow guidance on social distancing and reduce your contact outside the home.

If you care for but don’t actually live with someone who is extremely vulnerable, you should also stringently follow Government guidance on social distancing.

We recognise that working in a hospital environment may make stringent social distancing impractical. You should discuss your concerns with your line manager in the first instance to see what other arrangements can be agreed.

Some doctors have agreed to temporarily live separately from a family member who is shielding, however, this is voluntary and arrangements need to be agreed.

We believe any additional accommodation costs in these circumstances should be met by the employer and you should ensure that the arrangement can be brought to an end if it is not suitable.

 

Will I be paid if I stay at home with a family member who is shielding?

There is currently no national agreement on this issue therefore we are talking with NHS Employers and the Department of health and Social Care in an effort to secure one. 

You should initially discuss your circumstances with your line manager to see whether there is work you can do from home or if you need to take leave what payments can be made. We believe that suitable arrangements should be made to protect your pay in the current exceptional situation. 

If you are unhappy with the proposal from your employer then please contact us.

 

What support can I expect from my employer?

It is vital that staff who are shielding are supported by their employers to be able to continue contributing to work and that employers engage with staff to identify tasks which are suitable for home working. This way staff can continue to feel productive while remaining safe.

Employers have a duty of care to employees working from home and must ensure appropriate health and safety arrangements are implemented, and equipment provided.

This includes:

When can I stop shielding?

Shielding in England will be paused from 1 August, unless there is a significant rise in COVID-19 cases. In Scotland, people are advised to keep shielding until at least 31 July. In Wales, shielding will continue until 16 August.

See the below links for up-to-date information in each nation:

 

Do I have to return to my workplace on 1 August?

If you have been identified as clinically extremely vulnerable and live in England, the government advice is that from 1 August you no longer need to shield and you can go to work. This is if you cannot work from home and your workplace is ‘COVID-secure’.

However, you can carry on working from home if you can. This is government advice and is kept under regular review.

 

What duty does my employer have to make my place of work ‘COVID-secure’?

Your employer cannot force you to return to the workplace if it is unsafe. It is the duty of the employer to make the workplace safe in light of COVID-19.

It is an employer's duty to protect the health, safety and welfare of their employees and they must do whatever is reasonably practicable to achieve this.

Employers have duties under health and safety law to assess risks in the workplace.

Employers must give you information about the risks in your workplace and how you are protected. They must also instruct and train you on how to deal with the risks.

Employers must consult employees on health and safety issues.

 

What should happen before I return to work?

Before your return to the workplace, your employers should undertake an individual risk assessment and implement any necessary adjustments based on individual circumstances.

This could include that you carry on working remotely.

1. Your individual risk assessment

  • Depending on where you work the approach to risk assessments will vary. Generally, it is your line manager who will carry out a risk assessment with input from the occupational health service. You can find further information in our risk assessment guidance.
  • Your risk assessment should cover the reasons for shielding properly (including if you are living with someone else who is considered clinically extremely vulnerable).
  • If you feel your questions weren’t addressed sufficiently or if there are outstanding issues, ensure there is a follow up discussion.
  • After the assessment, you and your line manager should come to an agreed decision regarding your risks and appropriate mitigating actions.
  • Also read your employer’s workplace policies around COVID-19, health and safety, and workplace attendance.

2. Return-to-work conversation with your employer

  • You should have a meeting with your employer to agree a plan for return and discuss any support you may need to have a smooth return to work.
  • Discuss factors outside of work which may affect your return, including childcare or caring responsibilities.
  • Your employer should update you about any relevant changes to the team or organisations.
  • Don’t feel pressured to take on too much too soon. If you are concerned about returning having not worked in your usual role for a few months and need further support, your employer should offer support including an induction, training, clinical supervision, mentoring and/or buddying. See our guidance on agreeing a plan for return and assessing your readiness to take up full responsibilities.
  • If you are a trainee you can access support through your HEE office, including the SuppoRTT (Supported Return To Training) programme to provide targeted assistance to help you get back up to speed.

3. Your return to the workplace

  • Your employer should keep their working arrangements under constant review, based on the latest government advice.
  • You should let your employer know if you have any concerns, have identified new potential risks, or have suggestions for further adaptations.
  • Your risk assessment should be repeated if there is a change in your medical condition.

 

I have a difference in view with my employer about the outcome of my risk assessment, what should I do?

If you and your manager assess individual risk differently then an independent assessment of the risks should be carried out through input from a medical professional, for example, an accredited specialist in occupational medicine.

If you need any further advice then please contact the BMA on 0300 123 1233 and [email protected] 

 

How should my employer support me working remotely, following my risk assessment?

Following your risk assessment, if you and your line manager have agreed that you continue working remotely, read our briefing on supporting staff who are shielding to return to work. This briefing outlines how your employer should support you and what types of tasks you could undertake.

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