Immunisation Requirements and Mandatory Health Screenings The purpose of pre-employment screening is to ensure that you are fit for the position you have applied for and that you don t have any condition that could put you or a patient at risk. Screening is a very short and simple process when you are able to bring all the right documents to your interview. However, it can also cause the greatest delays in getting new staff out to work. Please be sure to read this guide and ensure you have all the evidence you need to prove your health and immunisation status. If you are missing anything you need from your doctor or Occupational Health (OH) provider, especially if your OH provider is your employer we strongly suggest that you act immediately to obtain the information you need. (Some employers are reluctant to provide staff with access to their immunisation, serology and medical records. If this seems to be the case in your instance you can remind them that it is your right under data protection legislation to copies of all information held about you on your personnel file. We can give you a standard request letter to give to the person who holds your health documentation.) It is also essential that you complete our medical questionnaire, attaching additional information where you think your health may affect you, your work or the clients/service users you attend. Healthier Business UK Ltd is PNL s contracted health screening service provider. You can find out about them here: www.healthierbusinessukltd.co.uk. PNL and Healthier Business UK Ltd are committed to promoting and adhering to the principles of equal opportunities; if you have a significant health condition or disability we will consider reasonable adjustments to your job description, as per disability discrimination legislation. Our medical questionnaire complies with the Equality Act 2010. If you have a query about anything in this document please let us know. Immunisations and Blood Tests If your work involves direct patient contact or the handling of clinical specimens you may be at risk of acquiring or transmitting infections. We will assess the information you provide with the immunisations required for the post according to national and local health policies. If you need additional immunisations or blood tests these must be obtained before a certificate of fitness can be issued; PNL can help you find a suitable local OH provider. Please note that: OH stipulations have increased in recent months and years and we may ask you for more information and documentation than you have encountered at previous job interviews. Some of our clients notably NHS trusts ask for more stringent levels of compliance than others before you can work for them. When we need to see serology reports or other documents issued by your GP or occupational health provider, these should be originals and not photocopies or scans. Documents must be signed or stamped by an OH qualified professional and should be on their letterhead paper. In other words, they cannot appear to be home-made! Page 1 of 5 Document (Website Version) Created 03/05/2012
What are the requirements and why are they necessary? Varicella For Work Not Involving Exposure Prone Procedures (EPPs) In accordance with the Green Book (Immunisation Against Infectious Disease, DoH 2006) 1, Healthcare Care Workers applying for employment through nursing/care agencies should be assessed for immunity to varicella, regardless of whether they are employed in the NHS. Whilst past infection often suggests immunity the only true way of ascertaining this is by blood testing. Satisfactory evidence includes: A positive serology report, Proof of two-part immunisation A written declaration, signed by you. However, some employers won t accept selfdeclarations so the first two options are preferred. Tuberculosis In accordance with the Green Book, healthcare workers applying for employment via agencies should be assessed for immunity to TB, regardless of whether they are employed in the NHS. Immunity can no longer be self declared; candidates must provide evidence of immunity in one of the following formats: Confirmation of a BCG or Mantoux scar. This must be completed by someone who is trained and/or competent in the reading of scars. Evidence of a positive Heaf or Mantoux result (skin test): o Heaf Positive Grade 2; or o Mantoux Positive 6mm or greater but less than 15mm. Note: Persons who will be working with patients or clinical specimens and who are Mantoux tuberculin skin test (or interferon-gamma test) negative should have an individual risk assessment for HIV infection before BCG vaccination is given. (See Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers, DoH). Measles, Mumps and Rubella In accordance with the Green Book, healthcare workers applying for employment via agencies should be assessed for immunity to Rubella, Measles and Mumps regardless of whether they are employed in the NHS. Satisfactory evidence of protection would include proof of: Two MMR vaccinations (or two each of the individual M, M & R jabs); or Positive antibody tests for Rubella, Mumps and Measles 1 The Green Book : http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_079917 Page 2 of 5 Document (Website Version) Created 03/05/2012
For further information about MMR requirements please visit: http://www.dh.gov.uk/en/publicationsandstatistics/lettersandcirculars/ Dearcolleagueletters/DH_085628. Hepatitis B In accordance with the Green Book, healthcare workers applying for employment via agencies should be assessed for immunity to Hep B, regardless of whether they are employed in the NHS. Although levels of 10iu/ml or more are generally accepted as enough to protect against infection the best way of minimising risk is to provide evidence of anti-hb levels of 100 IU/ml or greater. Under the Control of Substances Hazardous to Health (COSHH) Regulations, individual workers have the right to know whether or not they have been protected. It is therefore important that those with anti-hb levels of between 10-99 miu/ml are not placed in locum (temporary) positions unless they are confirmed as being a low- or non-responder. All candidates should have levels of 100 miu/ml or greater. Anyone with antibody levels below 10 IU/ml may be classified as a non-responder to the Hepatitis B vaccine. In cases of non-responders and low responders it is imperative that clinical evidence is supplied in order for us to process a fit-to-work certificate. Satisfactory evidence would include documentation of: A copy of the most recent pathology report showing titre levels of 100 lu/l or above; or If you are a non- or low-responder we need your most recent pathology report along with clinical evidence, i.e. a letter from your OH Department or GP confirming that you are a non- or low-responder. If you are a non-responder we will also require evidence of a negative result for Hepatitis B Surface Antigen. All Hep B reports must be in English and be stamped or signed by a named OH professional with clear details of the laboratory that issued the report. IVS To be valid, all serology reports must be IVS ; in other words, you need to have shown photographic evidence of your identity (NHS trust identity badge, driver s licence, passport or EU identity card) when the blood sample was taken. For Work Involving EPPs In addition to the above, healthcare workers who undertake EPPs (procedures involving open wounds where infection transference is most acute), such as theatre and A&E nurses, must show additional OH documentation. Page 3 of 5 Document (Website Version) Created 03/05/2012
In accordance with DoH guidelines (Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers) you must provide us with evidence of negative results for the following blood-borne viruses prior to undertaking EPPs: Hepatitis B (Surface Antigen) Hepatitis C HIV Satisfactory evidence would include your most recent pathology report confirming negative results. All EPP reports must be be IVS compliant (see above). For further information about EPP requirements please visit: http://www.dh.gov.uk/en/publicationsandstatistics/publications/ PublicationsPolicyAndGuidance/DH_073132. Please note: Due to the nature of the risks involved when moving from one client to another all locums/temporary workers are automatically considered new to the NHS, even where they have been a permanent employee of a NHS trust for years. What happens next? When you have your interview we will take copies of your OH documents and keep them on file throughout the time you are registered for work with us. We will fax copies to Healthier Business UK Ltd so they can carry out the screening process. We may also give them your phone number in the unlikely event they need to talk to you directly about any issue. Screenings can take up to five working days, however most clearance certificates are returned from Healthier Business within one day. There is no cost to applicants for the screening; however, as a temporary or self-employed agency worker, any corrective action such as new blood tests or immunisation boosters, are your responsibility. You can arrange for tests and immunisations through your GP or workplace OH department, or we can provide you with a list of private OH providers in your area. What if I am deemed unfit or non compliant? If our Occupational Health expert or Clinical Nurse Manager feels that you are unfit for the role you are applying for, or your documents are incompliant, we will let you know. We will suggest some steps you can take to quickly become compliant. Then, upon receiving updated evidence, we will re-submit your details for screening. As you may be aware, as an NHS approved agency we are subject to stringent and regular on-site audits of our workers files. Anyone considered to be non-compliant can be removed from placements with immediate effect and sanctions put upon the agency. It is therefore imperative that you, we and Healthier Business UK Ltd work together to ensure that you are fully compliant prior to starting work and that you remain legal thereafter. Page 4 of 5 Document (Website Version) Created 03/05/2012
We ask you to remember that although you may be considered fit for a permanent post within the NHS it does not follow that this will be the case for a locum position as their OH requirements for agency staff vary from those applied to their employees. The five most common reasons for non-compliance Non-compliance Proof of only one MMR vaccination Evidence is not provided as original documents It is not clear who has created/ signed off the evidence No clinical evidence of BCG/ Mantoux scar Medical questionnaire not fully completed Corrective action Obtain evidence of the other shot from your OH provider or arrange to have another inoculation. Please find your original documents or, if lost, contact your OH provider for a new certificate of compliance. As a last resort it may be enough for us to speak to your OH clinician. Ask your OH provider to resupply the documents on headed paper or have them signed and stamped by a suitable OH clinician. If the signature is unreadable their name should be printed clearly next to it. It is no longer possible for agency workers to selfdeclare their TB inoculation. Have your scar verified and signed by someone who is suitably trained. Ensure that you complete all the questions in the health questionnaire that accompanies our application form or (for existing staff) our annual update form. Contacts PNL Ltd. 1 st Floor, 30 Angel Gate, 326 City Road, London EC1V 2PT. Tel. 020 7427 2670. Healthier Business UK Ltd. 272 Bath Street, Glasgow, G2 4JR. Tel: 0871 572 0947. Page 5 of 5 Document (Website Version) Created 03/05/2012