Mandatory Covid-19 vaccination: Exemptions process

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From 11 November 2021, care home workers are required by law to be fully vaccinated against Covid-19. This means that all care home workers must have both their first and second doses of the vaccine by 11 November or they must have a valid medical exemption. 

To apply for a medical exemption through the Covid-19 pass system, staff who are eligible have been asked to phone 119 to ask for an NHS Covid-19 pass medical exemptions application form and to then complete the form and drop it off with their GP or specialist. Care home staff have been advised that they do not need to make an appointment with their GP about this.

Temporary exemptions are available for those with some short-term medical conditions, and as an option for those who are pregnant, although this is not recommended.

Medical exemption from mandatory vaccination: Process for GPs

What does the GP have to do?

If an applicant contacts a clinician before they have received a form, advise them to contact 119. 

The GP will receive the completed form with the applicant’s justification for requesting exemption. They must consider the application, together with the guidance for clinicians on exemptions (see downloads), to either approve or reject the request. They may consult the person’s GP record and the clinical guidance.

The GP then submits their answer to the Summary Care Records application (SCRa) on the portal (see sidebar).

This will enable a letter to be generated to inform the applicant of the outcome.

How long do GPs/clinicians have to complete the request?

A maximum period of three weeks is given to complete this process.

What are the payment arrangements for GPs for this?

The General Medical Services Statement of Financial Entitlements (No.2) Directions 2021 has been updated to allow for a fee to be claimed (see downloads). The relevant information can be found on page 47, reproduced below for ease of reference:


(2) The Board must pay a Contractor an IoS fee of £44.00 in respect of each response to a valid exemption confirmation request (a) that the Contractor makes. 

(3) The Board must make the payment referred to in paragraph (2) by the end of the calendar month following the calendar month in which the Contractor responded to a valid exemption confirmation request. 

Eligibility for payment

(4) A Contractor is eligible for the IoS fee referred to in paragraph (2) if the Contractor responds to the valid exemption confirmation request by recording its response on the SCRa in relation to the relevant patient. 

Please see the other resources on this page for more information.


Clinical guidance on exemption from Covid-19 vaccination or vaccination and testing (DHSC)

Download PDF, 166.79 KB

General Medical Services Statement of Financial Entitlements (No. 2) Directions 2021

Download PDF, 940.08 KB

Londonwide Local Medical Councils guidance on the Covid-19 vaccine and medical exemption certificates

Download PDF, 160.69 KB

Care home staff vaccinations: Vaccination as condition of deployment and exemptions explained (NHS England presentation)

Download PDF, 1.11 MB