September 15, 2021

DHSC releases guidance on temporary vaccine exemptions

Vaccination exemptions

Medical exemption – self-certification

The DHSC has confirmed that staff asserting a medical exemption can self-certify that they meet the medical exemption criteria and has provided template forms for staff to use.

Follow the below links to view/download the forms:

Self-certification form for people vaccinated abroad

Self-certification for medical exemptions

This is a temporary process while the NHS Covid Pass system is launched. When that goes live, care workers will need to apply for a formal medical exemption through that system and their asserted medical exemption will be subject to clinical review.

Self-certification will expire 12 weeks after the NHS Covid Pass system is launched. It doesn't say when that will be.

Who is exempt?

The DHSC has stated the following:

Medical exemptions

"While this list is not exhaustive, examples of medical exemptions from Covid-19 vaccination could include individuals:

  • Receiving end of life care where vaccination is not in the individual's interests.
  • With learning disabilities or autistic individuals, or with a combination of impairments which result in the same distress, who find vaccination and testing distressing because of their condition and cannot be achieved through reasonable adjustments such as provision of an accessible environment.
  • With medical contraindications to the vaccines such as severe allergy to all Covid-19 vaccines or their constituents.
  • Who have had adverse reactions to the first dose (e.g. myocarditis).

Time-limited exemptions will also be available for those with short-term medical conditions (e.g. people receiving hospital care or receiving medication which may interact with the vaccination).

Exemptions for conditions listed in section 4.4 (special warnings and precautions for use) in the Summary of Product Characteristics for each of the approved Covid-19 vaccines (Pfizer, AstraZeneca and Moderna) may also be considered."

Given that the list of medical exemptions is deemed to be non-exhaustive there is potentially broad discretion for care workers to self-certify themselves as exempt.


A time-limited exemption is also available for pregnant women. The DHSC had previously advised that pregnancy would not be grounds for an exemption so you will need to re-engage with any pregnant employees to confirm that the guidance has changed.
Vaccinations received outside the UK

The DHSC has also provided a temporary exemption for care workers who have been vaccinated outside the UK, on grounds that they cannot be vaccinated again in the UK at this stage. A template form has been provided for self-certification.

It is not clear whether this exemption is intended to cover both care workers who have been vaccinated outside the UK with a UK approved vaccine and those who have been vaccinated with a non-UK authorised vaccine.

Our view

The new guidance is vague and looks like it has been drafted in a hurry. Essentially, it just kicks the issue of exemptions down the road by an unspecified period of time, as we have no information about when the Covid Pass system (for clinical assessment of exemptions) will be operational. This isn't particularly helpful but it is probably a relief that you have a bit more time to deal with exemptions and are no longer tied to the 11 November cut off.

It is concerning that the DHSC has changed its position on pregnant employees, to the extent that you may have already told those staff that they are not exempt. However, it will be welcome news that they are now exempt, albeit only temporarily.

Further clarity is needed on the exemption for those vaccinated outside the UK but some comfort can be taken from the fact that you will have more time to deal with this issue.

The DHSC has limited the temporary exemptions to 12 weeks from when the Covid Pass system is operational. Assuming it takes a number of weeks, if not months, for workers to be clinically assessed, if they are found not to be medically exempt and don't want to have the vaccine, there may be insufficient time for them to work their notice period before the 12 week period expires, thereby exposing you to payment in lieu of notice costs.

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