NHS staff can refuse to return to work even if they are given an exemption from self-isolation requirements, it has emerged.

On Monday, the Health Secretary announced that NHS frontline staff who are pinged by the NHS Covid app, or contacted by NHS Test and Trace, would be able to continue to work when needed.

Sajid Javid said allowing fully vaccinated frontline NHS workers “to continue to work when needed” would ensure they could keep providing the best possible care for patients.

Under the changes, if it is deemed essential for staff to return to work, they can instead be offered daily tests.

NHS managers welcomed the exemption, saying it would help trusts to deliver vital services.

However, a letter sent from NHS chiefs to all hospitals says that even if staff are identified as essential to the safe running of services, and offered the exemption, they do not have to take it.

The letter from Prof Stephen Powis, national medical director of NHS England, sent to NHS trusts on Monday says the new Public Health England guidance “sets out that if there is a risk that staff absence would lead to potential patient harm then staff who are fully vaccinated… may be brought back to work ahead of the self-isolation period following the completion of a local risk assessment”.

But it stressed: “These guidelines give employers the ‘right to allow’ not to ‘compel’ staff to return to work.”

Over half a million 'pinged' at start of July

And it said that exemptions should not apply to any NHS or social care workers sharing a household with a positive case.

Staff who care for the most vulnerable patients, such as those who are immunocompromised, could be redeployed to other areas, it stated. 

The exemption for NHS and social care frontline workers applies only if they have a negative PCR test and take daily negative lateral flow tests for a minimum of seven days.

Announcing the changes on Monday, health officials said the changes were being made “to alleviate pressure on NHS and social care services”.

On Wednesday, NHS executives said hospitals may now be entering the “most difficult period” of the pandemic since the first wave.

A letter from NHS England’s Midlands region sent on Wednesday said hospitals are expected to open extra critical care beds, which may have an impact on routine surgery.

The letter, signed by Jeff Worrall, NHS England Midlands director of performance and improvement, as well as by the region’s medical director and its chief nurse, said pressures from Covid-19 are being compounded by the impact of the virus on staff absences.

Why the NHS app pings some phones but not others

It also warned of “unprecedented pressure on urgent and emergency care while trying to maintain the momentum created to tackle the long waiting elective patients”.

“We are entering, potentially, what will be the most difficult period since wave one of the pandemic,” states the letter, reported by Health Service Journal.

It also said that in areas with high numbers of hospitalisations, the trend is “closely linked to the lower levels of Covid-19 vaccination”.

Trusts are told to “surge capacity” to cope with rising Covid cases, with health officials saying this will impact on routine surgery.

A spokesman for NHS England and Improvement in the Midlands said: “The NHS has tried and tested plans for managing extra demand, including by flexing critical care as needed. People should continue to come forward for the care they need, including by using NHS 111 or contacting their GP and of course, it remains vital that everyone gets their vaccination to protect themselves and their communities against the virus.”