All Year Virology and Serology Surveillance

Eligibility

Participating practices will provide virology swabs from consenting patients who are showing acute (within 10 days of onset):

• Symptoms of influenza (ILI), COVID-19, lower respiratory tract infection (LRTI), or
• Acute bronchitis/bronchiolitis (if under 5 years of age)

Practices can also swab from anyone who has had a recent drive through/NHS test centre COVID-19 test and is still symptomatic.

Swabbing

This can be done by either of the two pathways outlined below:

1. An in-practice kit can be administered by a healthcare professional during a face-to-face appointment, if appropriate. Please always follow PHE guidance. Practices will need to order these kits ahead of time. Kits can also be given to patients to self-swab at home, OR
2. New! A self-swabbing kit can be delivered directly to the patient for the patient to self-swab at home. Practices will need to be set up to receive weekly voucher codes, which they can then pass on to patients to order kits online at TakeATestUK.

Virology samples are sent to the PHE Colindale lab in London, tested for respiratory viruses, and then stored.

Results

Practices will receive results for flu, RSV, HMPV and COVID-19 from the lab via eLab, and will need to notify patients. Patients will only receive an automatic notification of COVID-19 test result if they have used a TakeATestUK kit.

Coding

Coding into the patient's computerised medical record (CMR) is vitally important to the quality of data the Oxford-RCGP RSC can extract, and for practice payments. We encourage practices to code wherever possible, including during a consultation, when a swab has been taken, and when results have been received. Please see below for further details.

Documents

• Lab Form for General Virology Surveillance (ERCGP20, December 2020 onwards)
• Patient Information Sheet (PIS) for General Virology Surveillance

Please view this flowchart (version 3) for a detailed explanation of the process.

In-Practice Virology Kits

In-practice kits can be ordered to practices using the Material Requests portal. Practices can either order batches of 25 or 50 kits.

Each kit consists of UN3373 transport box containing:

• A nose and a throat swab
• Swab tube for completed swabs
• Secondary transport tube with absorbent
• Instructions for swabbing and posting
• Lab Form for General Virology Surveillance (ERCGP20, December 2020 onwards with COVID-19 vaccine details)
• Patient Information Sheet (PIS) for General Virology Surveillance
• Pre-paid envelope (addressed to PHE Colindale lab in London)

Please be sure to thoroughly check the entire contents of the kit before emailing about potentially missing items.

Instructions for HCAs and phlebotomists

1. Consent: Please ask if patient is willing to provide a swab for research  
   • Patient can be provided with Patient Information Sheet (PIS) for General Virology Surveillance
2. Swab: Please take a nose, and throat swab. See instructions on how to take a swab, or visit the RCGP RSC YouTube page
3. Label the swab tube: Please make sure the tube is correctly labelled, or use printed patient label
4. Lab form: Please ensure that every field is completed on the lab form and especially that the NHS number is correct
5. Post using pre-paid envelope, please make sure lab form is included with the swab tube in the box for posting
6. Code into patient medical record (CMR): For swabs taken in practice, please code:
   • 'Swab for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) taken by healthcare professional' (SNOMED CT ID: 1321051000000103)

Please post samples on the same day

Self-Swabbing Virology Kits

Practices can provide patients with a unique TakeATestUK voucher code which they can use to order self-swabbing kits online from the TakeATestUK website. Patients will be asked to complete a short questionnaire, which requires their NHS number. Patients will receive their COVID-19 results via text message.

New voucher codes will be emailed to a designated practice email from TakeATestUK every Monday. To be set up to receive weekly voucher codes, please email practiceenquiries@phc.ox.ac.uk.

Instructions for HCAs and phlebotomists

1. Consent: Please ask patient if they are willing to provide a swab for research
   • Patients can be provided with: Patient Information Sheet (PIS) for General Virology Surveillance (this is also available on the TakeATestUK website, see below)  
2. Provide patient with the following information (this may be texted):
   • Unique TakeATestUK voucher code
   • Patient's NHS number
   • TakeATestUK webpage https://takeatestuk.com/ 
   • Guidance: For more information on how to order and use a self-swabbing kit, including the Patient Information Sheet, please visit: https://takeatestuk.com/phe-home/
3. Practices must make a note of who received which unique voucher. (This is so the Practice Liaison Team can contact a practice if TakeATestUK is unable to deliver a result to a patient. This usually happens when a mobile phone number has been incorrectly entered on the TakeATestUK website)
4. Code into patient's clinical medical record (CMR): For self-swabs ordered via the voucher code system and taken by the patient at home:
   • 'Self-taken swab for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) offered' (SNOMED CT ID: 1321041000000101), OR
   • 'Self-taken swab for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) completed' (SNOMED CT ID: 1321031000000105)

Results

Practices must be set up with eLab in order to receive virology results. Please contact practiceenquiries@phc.ox.ac.uk to be set up on eLab.

Practices will receive results for flu, RSV, HMPV and COVID-19 via eLab.

1. For results from in-practice kits: Practices will need to inform the patient of their results
2. For results from self-swabbing kits (TakeATestUK kits): Patients COVID-19 result only via text. Practices will need to inform patients of their results for other viruses e.g. flu, RSV, HMPV)

Results Coding

Please make sure to code results into the patient's clinical medical record (CMR).

Currently recommended SNOMED Clinical Terms for Virology Lab Results, please record as:

Eligibility

Patients of all ages and regions attending a prescheduled blood test.

However, we particularly welcome more practices from North East, London, East and West Midlands.

Sampling

Participating practices will collect an additional blood sample from patients attending a prescheduled blood test, using a serology kit at the practice.

Serology samples are sent to the PHE Vaccine Evaluation Unit in Manchester, and used to look at the background immunity of the population to COVID-19.

Results

Please note, serology results will not be sent back to the practice or patient. Understanding of antibody response to COVID-19 is still in its early stages and there is not enough evidence to link interpretation of antibody result to protective immunity for COVID-19.

Coding

Coding into the patient's computerised medical record (CMR) is vitally important to the quality of data the Oxford-RCGP RSC can extract, and for practice payments. We encourage practices to code wherever possible, including during a consultation, when a swab has been taken, and when results have been received. Please see below for further details.

Documents

• Lab form for General Serology Surveillance
• Patient Information Sheet (PIS) for General Serology Surveillance
• Child Certificate for General Serology Surveillance

Serology kits

Serology kits can be ordered using the Material Requests portal. Practices can either order batches of 25 or 50 kits.

Each kit consists of a small UN3373 transport box containing:

1. Blood bottle (BD Vacutainer)
2. Transport tube with absorbent
3. Patient Information Sheet (PIS) for General Serology Surveillance
4. Lab form for General Serology Surveillance
5. Prepaid envelopes (addressed to Vaccine Evaluation Unit in Manchester)

Please be sure to thoroughly check the entire contents of the kit before emailing about potentially missing items.

Instructions for HCAs and phlebotomists

1. Consent: Please ask patient if they are willing to provide an additional blood sample for research
   • Patients can be provided with: Patient Information Sheet (PIS) for General Serology Surveillance
2. Please take approximately 10ml of blood using the enclosed serum bottle
3. Write the patient name, date of birth, NHS number on the serum bottle or use patient label
4. Place the serum bottle inside the green topped hard plastic secondary tube (stopper end outwards)
5. Place the tube in the cardboard box with completed lab form
6. Please post the box using the prepaid plastic envelope on the same day of collection
7. Please code in patient’s clinical medical record (CMR):
   • Save sample for serum serology (SNOMED CT ID: 509571000000108), or if not available:
   • SNOMED CT (EMIS) Sample serology (procedure)
   • (EMIS) Test request: sample serology (with Description ID 1864331000006113)
   • CTv3 (TPP) 43L. Sample serology
   • Read 2 (Others) 43L. Sample serology

Please post samples on the same day

Surveillance swabbing vs Pillar II testing

Turnaround times for surveillance swabbing may be longer than Pillar II tests and patients may wish to get both tests. A second swab for surveillance is never a waste, as the swab also gets tested for other respiratory viruses, as well as COVID-19. Patients may appreciate knowing this.

If a patient does have two tests they may be concerned that any required isolation period will be longer if the second test is positive, and may be notified by Test and Trace. You can reassure them that the isolation period is dated from the first positive test: https://www.legislation.gov.uk/uksi/2020/1045/regulation/2#commentary-key-55a052d7ba0704d04c204465171f7e3b

TakeATestUK troubleshooting

Patients who have ordered a self-swabbing kit via TakeATestUK should expect to receive their kit within 2 working days. If they have not received their kits within 2 working days they should contact TakeATestUK as soon as possible using the Saving Lives helpline on 07838214191. If a patient has returned a kit but not yet received a result this may be because a) Their kit has not been received at the lab, or b) It has not been possible to send them their results (usually this is because they gave an incorrect phone number), in which case the practice will be contacted to give the patient their result directly.

BD Vacutainers vs Sarstedt-Monovette for serology sampling

Both systems for serology sampling will be accepted at the Manchester lab for testing. However, we can currently only supply BD Vacutainers through the Material Request portal.

Up-to-date kits and forms

Please make sure you are using kits from the latest season (October 2020 onwards), as well as the most up-to-date serology and virology lab forms.

Consent

Only verbal consent is required from the patient, parent or guardian for surveillance. The legal basis is The Health Service (Control of Patient Information) Regulations 2002 - Regulation 3.

Payments

• For virology, practices will be paid £7.50 for each matched swab from an eligible patient.
• For serology, practices will be paid for each matched sample based on age of the patient:
  • £5.50 for >18 years of age
  • £11 for 8-17 years of age
  • £30 for <8 years of age

A matched swab is one that can be linked back to the Oxford-RCGP RSC database via information provided on the lab forms, which are completed by practices when they send samples. Practices are therefore encouraged to make sure the information on the lab forms is as correct as possible. Otherwise, it may not be possible to reimburse.

Joining surveillance

If you have read the above information and would like to register your interest, please visit: https://orchid.phc.ox.ac.uk/index.php/oxford-rcgp-rsc-members-study-expression-of-interest/ or email practiceenquiries@phc.ox.ac.uk.

Whilst practices can choose to contribute towards either virology or serology surveillance, we encourage practices to participate in both collections.