National Guidance

Main Symptoms

The main symptoms of coronavirus are:

  • high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
  • new, continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal

Most people with coronavirus have at least one of these symptoms.

If you or a family member is experiencing these symptoms, use the 111 online coronavirus service to find out what to do next

Isolation Notes & Letters

Isolation notes and letters for Covid-19 related absence from the workplace

If you have concerns and/or anxiety about your return to work, you should discuss this with your employer in the first instance as we cannot provide you with a sick note (MED3) for this reason.

If you are self-isolating because you are symptomatic, have a symptomatic household contact or have been told to self-isolate by a test and trace service, you should obtain a self-isolation certificate through the NHS 111 isolation note tool which can be accessed here. If you do not have an email address, you can opt for your note to be sent to a trusted family member or friend or directly to your employer. You can also use the service to request an isolation note on behalf of someone else. You do not need to speak to a GP unless your symptoms are worsening and you need clinical advice

If you are in the stringent social distancing group (vulnerable but not shielded) your employer may ask for medical evidence as you will not be eligible for a sick note (MED3) to exempt you from work. We have put together a letter that you can download and print off which is located at the bottom of this text to pass on to your employer.

If you are in the shielded group (deemed extremely clinically vulnerable). You should have received a letter (either centrally or from your GP/specialist) confirming you are in the shielded category which can be used for the purposes of certification off work.

Isolation notes and letters for Covid-19 related absence from school

There have been reports that as schools re-open, they are requesting medical certificates on fitness to return. Please note, we are unable to make judgements on individual children’s suitability to return to school. We have produced a template letter to provide to parents which summarises the Royal College of Paediatrics and Children’s Health RCPCH guidance on guiding principles for children returning to school which you can download and print at the bottom of this text

The rules regarding isolation for children who are symptomatic or who have a symptomatic household member apply as above and parents can get an isolation note from the 111 service.

Changes to Shielding Guidance

Sheilding Information

People classed as clinically extremely vulnerable are advised to take additional action to prevent themselves from coming into contact with the virus. If you’re clinically extremely vulnerable, you’re strongly advised to stay at home as much as possible and keep visits outside to a minimum (for instance once per day).

This is called ‘shielding’ and the advice is now updated:

  1. If you wish to spend time outdoors (though not in other buildings, households, or enclosed spaces) you should take extra care to minimise contact with others by keeping 2 metres apart.
  2. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household (ideally the same person each time).
  3. You should stay alert when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size.
  4. You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services.
  5. You should strictly avoid contact with anyone who is displaying symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in, your sense of taste or smell).

The Government is currently advising people to shield until 30 June 2020 and is regularly monitoring this position.

Sheilding FAQs

The government has updated its guidance for people who are shielding taking into account that COVID-19 disease levels are substantially lower now than when shielding was first introduced.

People who are shielding remain vulnerable and should continue to take precautions but can now leave their home if they wish, as long as they are able to maintain strict social distancing. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household. Ideally, this should be the same person each time. If you do go out, you should take extra care to minimise contact with others by keeping 2 metres apart. This guidance will be kept under regular review.

 

Q: I have received a letter telling me that I am at the highest clinical risk during the COVID-19 pandemic. Why have I received this letter?

A: You have received this letter because you have been identified as having a condition(s), or are taking medication, or receiving treatment, that puts you at the highest risk of severe illness if you catch COVID-19. The list of highest risk diseases was agreed by the United Kingdom’s Chief Medical Officers and includes:

  1. Solid organ transplant recipients

  2. People with specific cancers:

    • people with cancer and are having chemotherapy

    • people with lung cancer and are having radical radiotherapy

    • 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 6 months,

      or who are still taking immunosuppression drugs

  3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and

    severe COPD

  4. People with rare diseases and inborn errors of metabolism that significantly increase the

    risk of infections (such as SCID, homozygous sickle cell)

  5. People on immunosuppression therapies sufficient to significantly increase risk of

    infection

  6. Women who are pregnant with significant heart disease, congenital or acquired

 

Q: I am in one of the highest clinical risk groups, so what do I do now?

A: You are strongly encouraged to follow the guidance issued by Public Health England, as set out in the letter you have received – stay at home and avoid all face-to face contact for the next 12 weeks. This approach is called ‘shielding’.

If you have any concerns/ queries about the content of the letter you have received; your condition, or ‘shielding’, and what this might mean for you, please get in touch with your GP or hospital clinician in the first instance. All people who have received the letter should register with the Government’s web https://www.gov.uk/coronavirus-extremely-vulnerable. This will help you to access support wih activities such as obtaining food packages or medications. Even if you do not need any support with daily tasks, please do register with this website to let Government know.

Please note that patients are being added to the central data base all the time and there may be a slight delay between you being added to that database and being recognized by the website/ support phone line as someone who is eligible for support.

 

Q: I think I should be considered as highest clinical risk, but I haven’t received a letter. What should I do?

A: Most people that are within the highest clinical risk group have already received a letter through the post. However, we are aware that central records do not capture everybody in this group. The process for identifying additional people who meet the clinical criteria but have not been identified through the initial central process is continuing. People identified through this process will receive a letter shortly. This list is also being reviewed by GPs and hospital clinicians.

In the meantime, please continue to follow the social distancing guidance, as published on 23 March 2020.

 

Q:I have been told that I am not considered to be at highest clinical risk, but I still want to be in the shielding group. What should I do?

A: If you are not considered by healthcare professionals to be at the highest risk but nevertheless wish to follow ‘shielding’ advice then this is a personal decision that you are, of course, free to make and to follow as far as possible.

However, we suggest that people who are not included in the shielding group but who are on the broader list of conditions (below) follow strict social distancing measures instead.

This is because shielding is a severe intervention which may be difficult to ad here to for such a long period of time, and the additional benefit gained from this extra measure needs to be weighed against any impact on your mental and physical wellbeing from a significant loss of social contact and needing to stay in the home for a long period of time. We do not wish to advise anybody to follow these measures unless absolutely necessary. We also cannot provide a dedicated food and medicine delivery service to those outside the shielding programme.

People who are considered in a wider vulnerable group (sometimes referred to as the ‘flu group’) but are not in the highest clinical risk registry are:

• aged 70 or older (regardless of medical conditions)

• under 70 with an underlying health condition listed below(i.e. for adults this usually anyone instructed to get a flu jab as an adult each year on medical grounds)

A: If you have any queries/ concerns about the letter you have re ceived or think that you may have received it in error, please contact your GP or hospital clinician, as soon as possible, to discuss how you can stay safe during this time. In the meantime, we strongly advise that you follow the Public Health England guidance on shielding unless advised otherwise by a healthcare professional.

 

Q: I have had a telephone call from somebody claiming to be from the National Shielding Helpline. How do I know this is not a scam?

A: While you are at home ‘shielding’ a government support service may contact you by letter, email or telephone. This team is calling to understand your food and wellbeing support needs and will always identify themselves with their name and as a representative of the National Shielding Helpline.

To give you confidence, the number they’re calling from will register on your phone as 0333 3050466. It’s not a live telephone line, however if you call it you will get the following recorded message: “You were called today by the Shielding Helpline, sorry that we missed you, there is no need to call us back as we will try again soon. Thank you goodbye”.

Additionally, for extra peace of mind early on in the call agents from this service will ask you to confirm some details, for example your name and NHS number, to make sure they are speaking to the person identified by the NHS as extremely clinically vulnerable / highest clinical risk of COVID- 19. They will never ask you for information like your National Insurance number or bank details. Your local council may also be in touch.

 

Q: What support is being offered to people who are advised to shield?

A: It is expected that many people who have been identified as highest clinical risk and are now ‘shielding’, i.e. staying at home and avoiding all face-to-face contact, will have family members, or carers/friends/neighbours, who can help them out during the period in which they are required to stay at home, picking up essential food shopping/ medicines etc.

If you are at highest clinical risk, and have received a letter from the NHS, advising you to stay at home, you should register for support from the Government. Support is initially focused on provision of food packages and ensuring medication delivery where you have no other means to doso. Everybody who has a letter and is on the highest clinical risk list should go to https://www.gov.uk/coronavirus-extremely-vulnerable. Even if you do not require support at this time, please register with the site so that we know that you have received your letter.

We know that not everybody will have people around to support them. Local councils are working with the voluntary sector and other partners to support people at highest clinical risk during this time. Please look at your local council’s website where you will find information and advice about support available in your area.

 

Q: If I am ‘shielding’ and must stay at home, can I go outside?

A: If you wish to spend time outdoors (though not in other buildings, households, or enclosed spaces) you should take extra care to minimise contact with others by keeping 2 metres apart. If you choose to spend time outdoors, this can be with members of your own household. If you live alone, you can spend time outdoors with one person from another household (ideally the same person each time). You should stay alert when leaving home: washing your hands regularly, maintaining social distance and avoiding gatherings of any size. You should not attend any gatherings, including gatherings of friends and families in private spaces, for example, parties, weddings and religious services. You should strictly avoid contact with anyone who is displaying symptoms of COVID-19 (a new continuous cough, a high temperature, or a loss of, or change in sense of taste or smell).

 

Q: I think I am in the highest clinical risk group but I am not currently registered with a GP, and am not currently being cared for by a hospital specialist. How will I be contacted?

A: The NHS is making every effort to identify all individuals who we think should be on the highest clinical risk list. However, it is difficult for us to get in touch with individuals who are not registered with a GP or with a hospital service.

We are working with the voluntary sector to see if there is more we can do to identify people who are known to charities/ local community groups, so that we can get support to those who might be eligible.

 

Q: I am in the highest clinical risk group but do not want to follow the ‘shielding’ restrictions. What do I do now?

A: We understand that the restrictions imposed by ‘shielding’ are difficult, both for you and for your family members and/or carers. Public Health England has issued ‘shielding’ guidance, strongly advising you to stay at home and avoid face-to-face contact for 12weeks. This is the safest thing to do to protect you from illness/ complications of COVID-19.

However, this is guidance and whether you follow the guidance or not is a personal decision for you to make.

You may decide, having weighed up the risks and the implications of ‘shielding’, that you do not want to follow the guidance. Before deciding, we would ask you to discuss the matter with your GP or hospital specialist and those that may provide care for you. This may be particularly relevant for patients who are receiving end of life care. Please do talk to somebody before you decide what to do.

If, having discussed the matter with your GP or hospital specialist, you decide not to follow the ‘shielding’ guidance, we would ask you to follow the same social distancing and hygiene measures as everybody else, i.e.

  • Stay at home

  • Only leave home to buy food, for health reasons, or to go to work (if you cannot work from home)

  • Stay 2 metres (6ft) away from other people

  • Wash your hands as soon as you get home.

Q: I live with a person who is ‘shielding’, but I am unable to socially distance from others because of my work (i.e. NHS, social care worker, education or other key worker), or the size/ layout of my home doesn’t allow me to live separately from the vulnerable person who is shielding. What do I do?

A:  If you live with someone who has been identified as being at highest clinical risk, you should read and familiarize yourself with the ‘shielding’ guidance below, and strictly follow social distancing guidance. The rest of the household should support the person shielding to stay safe and stringently follow guidance on social distancing, reducing their contact outside the home. In your home, you should:

  • minimise the time spent in shared spaces (kitchen, bathroom and sitting areas) and keep shared spaces well ventilated;

  • aim to keep 2 metres (3 steps) away from others and encourage them to sleep in a different bed where possible;

  • use separate towels from other people in the house and, if possible, use a separate bathroom from the rest of the household, or clean the bathroom after every use;

  • avoid using the kitchen when others are present, take your meals back to your room to eat where possible, and ensure all kitchenware is cleaned thoroughly.

    If the rest of your household are able to follow this guidance, there is no need for them to take the full protective measures to keep you safe.

    All people who have a letter and have been identified at highest clinical risk should register for government support at https://www.gov.uk/coronavirus-extremely-vulnerable. Even if you do not require support at this time, please register with the site. Please note that government support is only available to the individual who is at the highest clinical risk and has received a letter confirming this.

 

Q: I have received chemotherapy in the last three months - am I at highest clinical risk and should i be adopting shielding measures?

A: People’s immunity remains compromised for some time after finishing chemotherapy and clinical teams will be aware of this when considering their highest clinical risk patient lists.

If you have completed chemotherapy in the last 3 months, please contact your care team to discuss your specific circumstances.

In the mean time, you should follow the Public Health England guidance on ‘shielding’- in summary, stay at home and avoid face-to-face contact for a period of 12 weeks.

 

Q: Are people who are currently on targeted therapies for lung cancer classed as highest clinical risk to the same level as immunotherapy patients?

A: Both groups of people are considered to be at highest clinical risk from COVID-19.

People in these groups should follow the Public Health England guidance on ‘shielding’ – in summary, stay at home and avoid face-to-face contact for a period of 12 weeks.

 

Q: Are people with metastatic cancer in the lungs who are not currently being treated at highest clinical risk?

A: People with metastatic cancer in the lungs could be more vulnerable and therefore at highest clinical risk from Covid-19. Vulnerability will depend on the type of cancer and treatments that you have had. If you have not received a letter, please contact your care team to discuss your specific circumstances.

In the meantime, you should follow the Public Health England guidance on ‘shielding’ – in summary, stay at home and avoid face-to-face contact for a period of 12 weeks.

 

Q: Are people being shielded entitled to statutory sick pay for the whole time they are advised not to leave the house?

A15: The government has established a package of measures to support individuals who are not able to work during this pandemic – go to https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19/covid-19-guidance-for-employees for more information.

 

Q: I have received a letter for a family member or loved one who is deceased. Why have I received this letter?

A: We are aware that a very small proportion of letters sent by the NHS, notifying people that they are at highest clinical risk from COVID-19, have been sent to people who are sadly deceased. We apologise for any distress caused.For more information please go to: https://digital.nhs.uk/news-and-events/latest-news/coronavirus-letters-sent-in-error. You can also read the apology statement about letters sent in error to a cohort of patients: https://digital.nhs.uk/news-and-events/latest-news/coronavirus-letters-sent-in-error-message-to- family-members

 

Q: I have received a letter to say that I am at highest clinical risk, does this mean I will be de-prioritised for ventilation if I contract COVID-19 and require hospital care?

A: You were sent this letter to inform you that your condition, or the treatment/ medication you are receiving, means that you are at the highest clinical risk from COVID-19. The purpose of the letter is to draw your attention to the guidance issued by Public Health England regarding ‘shielding’ in order to keep you safe during this COVID-19 outbreak.If you fall ill from COVID-19, or any other condition, and require treatment in hospital, you will still be treated as normal and will not be denied any medical intervention because you are in the ‘shielding’ group.

 

Q: Where can I find an electronic copy of the letter sent to people considered to be at highest clinical risk?

A: A copy of the letter can be accessed through the NHS England website: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/at-risk-patient- letter-march-2020.pdf

 

Q: Is the letter available in other languages or accessible formats?

A: An easy read version of the letter is available here: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/2020325_Easy-Read_At-Risk-Patient-Letter.pdf

The letter is also available in alternative languages and are available here: https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk- patients/

The Public Health England guidance, which the letter is based on, is online and available in different languages and accessible formats here: https://www.gov.uk/government/publications/guidance-on-shielding-and-protecting-extremely-vulnerable-persons-from-covid-19

 

Q: I have received a text message telling me that I am at highest clinical risk. How do I know if this text is real or a scam?

A: NHS Business Services Authority have sent out a number of text messages from the ‘NHS coronavirusservice’. Daily text messages were sent from 23 to 29 March from the same number - 07307 810357. If your text does not come from this number, please ignore it.

 

Q: The text I have received does not name me as being the person at highest clinical risk. How do I know the text has gone to the right person?

A: We cannot include people’s names or other personal identifiable information in the text messages in case the mobile device or the number associated with it belongs t o someone else.This is in line with recent guidance published by NHSX in agreement with the Information Commissioners Office.If you are concerned that you may have received a text message in error, and/or have not received a printed letter, please review the guidance issued by Public Health England and/ or contact your GP or hospital specialist to discuss whether the advice provided applies to you.

NHS Immunisations FAQs

Q: Why aren’t you stopping routine immunisations?

A:Whilst preventing the spread of COVID-19 and caring for those infected is a public health priority, it is very important to maintain good coverage of immunisations, particularly in the childhood programme. In addition to protecting the individual, this will avoid outbreaks of vaccine-preventable diseases that could increase further the numbers of patients requiring health services. 

 

Q: Should people/babies really still go and be immunised at their GP surgery even though there is a risk that by doing this they may be infected with COVID-19?

A: Your GP surgery or health clinic will take all possible precautions to protect you and your baby from COVID-19. People should still attend for routine vaccinations unless they are unwell (check with your GP whether you should still attend) or self-isolating because they have been in contact with someone with COVID-19. In these circumstances please rearrange your appointment.  Vaccines are the most effective way to prevent against other infectious diseases.  Babies and toddlers in particular need vaccinations to protect them from measles, mumps, rubella (MMR), rotavirus, diphtheria, whooping cough, meningitis, polio, tetanus, hepatitis B, TB and more.

 

Q:What are “routine” childhood immunisations?

A: The national immunisation programme is highly successful in reducing the incidence of serious and sometimes life-threatening diseases such as pneumococcal and meningococcal infections, whooping cough, diphtheria and measles. It remains important to maintain the best possible vaccine uptake to prevent a resurgence of these infections.

Practices will be prioritising the following:

  1. Routine childhood immunisations, from 8 weeks up to and including vaccines due at one year of age including first MMR and hepatitis B for at risk infants;
  2. Pertussis vaccination in pregnancy;
  3. Pneumococcal vaccination for those in risk groups from 2 to 64 years of age and those aged 65 years and over (subject to supplies of PPV23 and clinical prioritisation).

Neonatal BCG and all  doses of targeted hepatitis B vaccines should also be offered in a timely manner.

 

Q: If you are not doing school age immunisations, isn’t there a risk that we will see big increases in the diseases those children are normally vaccinated against?

A: School aged immunisations will be rescheduled. UK government has provided clear public health advice on specific measures to take to prevent further Coronavirus cases which includes social distancing. On this basis, community clinics are not recommended given that this is likely to increase the risk of exposure to the virus.

 

Q:Do GP surgeries really still have the time to do immunisations? 

A: Practices will be busy responding to the COVID-19 pandemic and the routine childhood immunisation programme will continue to play an important role in preventing ill-health through causes other than coronavirus infection.

 

Q:How important is it that you get your immunisation at the time you are called?  Is there a risk in delaying for a few months and if there isn’t then why don’t we stop and reduce the risk of contracting COVID-19 through a visit to the general practice?

A:Parents should be informed that despite the COVID-19 pandemic, it is important that routine childhood immunisations are started and completed on time. This will help protect the infant or child from a range of serious and sometimes life-threatening infections. Whilst infections such as invasive pneumococcal and meningococcal disease are now much reduced in incidence, this has only come about because of high levels of vaccination. To prevent resurgence, infants still need protecting through vaccination. Pertussis continues to circulate at elevated levels and it remains important that pregnant women are offered the pertussis vaccine, and that their babies start receiving protection against this, and other infections, from 8 weeks of age. 

 

Q: There is a shortage of liquid infant paracetamol which is often used by parents to help manage a baby’s reaction to their routine immunisations so won’t parents stop bringing their babies because of this?

A: Vaccination to protect from serious conditions should not be delayed. Whilst parents should continue to try to obtain and administer infant paracetamol if possible, infant vaccines can and should still be given even if it is not possible to give prophylactic paracetamol.

Where parents have been unable to obtain infant paracetamol, the following advice is for clinical staff in primary care and parents.

  • Fever can be expected after any vaccination but is more common when the MenB vaccine (Bexsero) is given with the other routine vaccines at eight and sixteen weeks of age.
  • In infants who do develop a fever after vaccination, the fever tends to peak around six hours after vaccination and is nearly always gone completely within two days.
  • Ibuprofen can alternatively be used to treat a fever and other post-vaccination reactions. Prophylactic ibuprofen at the time of vaccination is not effective. Ibuprofen is not licensed for infants under the age of 3 months or body-weight under 5 kg. However, the BNF for Children advises that ibuprofen can be used for post-immunisation pyrexia in infants aged 2 to 3 months, on doctor’s advice only, using 50 mg for 1 dose, followed by 50 mg after 6 hours if required. See the BNF for Children for more details https://bnfc.nice.org.uk/drug/ibuprofen.html#indicationsAndDoses
  • There have been concerns about the use of non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, in relation to COVID-19. This is being investigated by the Commission on Human Medicines and NICE. NHS England have advised in the interim for patients who have confirmed COVID-19, or believe they have COVID-19, that they use paracetamol in preference to NSAIDs. If parents cannot obtain their own supply of infant paracetamol and it has not been possible to prescribe it, as their baby will have been assessed as being well before vaccination, providing their baby has fever only and no symptoms consistent with COVID-19 infection, consideration should be given to using ibuprofen as described above. https://www.cas.mhra.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=103001
  • Information about treating a fever in children is available from the NHS UK webpage “Fever in children” at www.nhs.uk/conditions/fever-in-children/
  • If an infant still has a fever 48 hours after vaccination or if parents are concerned about their infant’s health at any time, they should seek advice from their GP or NHS 111.
  • The diseases that the vaccines protect against are very serious and therefore vaccination should not be delayed because of concerns about post-vaccination fever.

 

Q: How will parents know when their babies have a temperature after their regular immunisations whether it is an expected reaction or COVID-19?

A: Parents should be advised that the vaccines given may cause a fever which is usually resolved within 48 hours (or 6 to 11 days following MMR). This is a common expected reaction and isolation is not required, unless COVID-19 is suspected.

When the MenB vaccine (Bexsero) is given with other vaccines at 8 and 16 weeks of age, fever is more common. Where parents are able to obtain liquid infant paracetamol, they should follow existing PHE guidance on the use of prophylactic paracetamol following MenB vaccination available at: https://www.gov.uk/government/publications/menb-vaccine-and-paracetamol

Indications to date suggest that COVID-19 causes mild or asymptomatic illness in infants and children. As has always been recommended, any infant with fever after vaccination should be monitored and if parents are concerned about their infant’s health at any time, they should seek advice from their GP or NHS 111. Post-immunisation fever alone is not a reason to self-isolate.

This advice applies to recently vaccinated people of all ages.

Any infant with fever after vaccination should be monitored and if parents are concerned about their infant’s health at any time, they should seek advice from their GP or NHS 111.

 

Q: Should people aged 70 and over attend the practice for immunisation?

A: It is recommended that PPV23 continues to be offered to eligible groups, including those aged 70 and over who have not previously been vaccinated. If an eligible individual aged 70 years and over attends the practice for other reasons, the opportunity to vaccinate them should be used. This may also present an opportunity to vaccinate them against shingles if they are eligible.

Covid-19 – The compulsory wearing of face coverings on Public Transport, Shops and Supermarkets

Following the introduction of the requirement for people to wear face coverings on public transport from 15th June, the government have now announced that face coverings will be mandatory in shops and supermarkets from 24th July 2020. This change is intended to help prevent the spread of the Covid-19 virus.

The vast majority of individuals will be able to wear a face covering to help reduce the risk of transmission of this potentially fatal disease. There are, however, certain groups of people who are exempt from this requirement and they include:

  • children under the age of 11

  • people who cannot put on, wear, or remove a face covering:

    o without severe distress

    o because of any physical or mental illness or impairment, or disability (within the meaning of section 6 of the Equality Act 2010)

  • people travelling with, or providing assistance to, another person who relies on lip reading to communicate

  • people travelling to avoid injury, or to escape a risk of harm, and do not have a face covering with them

    These groups of people, their parents or guardians can indicate the reason, if required, as to why they are not wearing a face covering.

    General practice is under considerable pressure as a direct result of the current challenges they are faced with delivering a service to patients at the same time as coping with the consequences of this virus.

    There is no requirement for general practice to issue letters for patients who are unable to wear face coverings, as the Government have clearly defined the exemptions to this requirement.

    General practice needs to focus all its time and effort managing those who need their help and not be diverted from this by unnecessary tasks.

For more information on face masks/coverings and exemption cards, visit the Government website here.

Wearing a face covering

A cloth face covering should cover your mouth and nose while allowing you to breathe comfortably. It can be as simple as a scarf or bandana that ties behind the head.

Wash your hands or use hand sanitiser before putting it on and after taking it off. Avoid touching your eyes, nose, or mouth at all times and store used face coverings in a plastic bag until you have an opportunity to wash them.

Do not touch the front of the face covering, or the part of the face covering that has been in contact with your mouth and nose. Once removed, make sure you clean any surfaces the face covering has touched.

You should wash a face covering regularly. It can go in with other laundry, using your normal detergent.

When wearing a face covering, take care to tuck away any loose ends.

how a cloth covering should fit

How a cloth covering should fit

Making your own face covering

Using a T-shirt

You will need:

  • an old T-shirt that you do not want anymore (ideally size small or extra small)
  • scissors

Step 1: Cut a straight line across the width of the T-shirt (front and back) approximately 20cm from the bottom of the T-shirt.

Cutting a strip from t-shirt

Step 2: From a point 2cm below the top right-hand corner of the fabric, make a 15cm horizontal cut through both sides of the fabric that is parallel to the top of the rectangle.

Step 3: Cut down towards the bottom of the fabric until you reach approximately 2cm above the bottom edge. From here, make another 15cm cut that runs parallel to the bottom of the fabric to make a rectangle that can be discarded.

Cutting a rectangle and tie strings

Step 4: To make the ties, cut open the edge of the 2 long strips of fabric. Unfold the main piece of fabric and place over the mouth and the nose. The 4 strips act as ties to hold the cloth face covering in place and should be tied behind the head and around the neck.

Tying the strings of a face covering behind the head

A sewn cloth face covering

You will need:

  • two 25cm x 25cm squares of cotton fabric
  • two 20cm pieces of elastic (or string or cloth strips)
  • needle and thread
  • scissors
Items you need for a sewn face covering

Items you need for a sewn cloth face covering

Step 1: Cut out two 25cm x 25cm squares of cotton fabric. Stack the 2 squares on top of each other.

Step 2: Fold over one side by 0.75cm and hem, then repeat on the opposite side. Make 2 channels by folding the double layer of fabric over 1.5cm along each side and stitching this down.

How to fold face covering

Step 3: Run a 20cm length of elastic (or string or cloth strip) through the wider hem on each side of the face covering. These will be the ear loops. Use a large needle to thread it through. Tie the ends tightly.

Threading the ear loops and sewing into place

If you only have string, you can make the ties longer and tie the covering behind your head.

Step 4: Gently pull on the elastic so that the knots are tucked inside the hem. Gather the sides of the covering on the elastic and adjust so the covering fits your face. Then securely stitch the elastic in place to keep it from slipping. These elastic loops fit over the ears.

Completed face covering

Face coverings should not be used by children under the age of 3 or those who may find it difficult to manage them correctly. For example, primary age children unassisted, or those with respiratory conditions.

This information is a guide to making a simple face covering. We do not endorse any particular method and other instructions are widely available online. Always take care to use equipment safely to avoid injury. Children should only follow these instructions under the supervision of adults.