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Patient receiving COVID-19 vaccine

COVID-19, mandatory vaccination and vaccination as a condition of employment


Please see the RCN's position on mandatory vaccines

These FAQs form part of the wider COVID-19 and vaccination FAQs which include links to the current advice for pregnant women, support from religious organisation and wider medical exemptions. 

What changes have the Government in England announced?

On the 15 March 2022, legislation that revoked vaccination as a condition of deployment (VCOD) came into force. 

If your employer has served you with notice, then they should contact you to revoke this. You can consult guidance from NHS England and NHS Improvement for more information.

The RCN strongly recommends all members are vaccinated as soon as they can be. It is considered best practice to protect you, your patients and clients, as well as friends and family, and is evidenced in the COVID-19 vaccine surveillance reports.

The RCN consider that vaccination is a key pillar in infection control and disease prevention in health care settings. 

As such best practice is for all members of the nursing team to have any vaccine deemed necessary to help protect themselves, patients, colleagues, family members, and the wider community, and:

  • vaccination is the right thing to do as part of the health care workers duty of care and that where vaccines are recommended these should be taken up
  • we would want staff to have easy access to these as part of occupational health or other provision
  • pre employment assessment and offer of vaccination is recommended and should be encouraged by organisations as per the Control of Substances Hazardous to Health (COSHH) regulations
  • specific vaccination requirements need should to be based be identified from on the risk assessment in the particular workplace and the role staff are undertaking.

The RCN recognise that the best way to achieve high uptake is for vaccines to be easily accessible to staff during the working day and where staff have anxieties or concerns about vaccines, they are given relevant  information to help accept vaccination in a supportive and non-punitive environment.

The RCN do not agree that vaccination should be compulsory or mandated as this will not help achieve high uptake or support staff who have questions to accept vaccination. The RCN has stated  publicly that mandating vaccines as a condition of employment may further marginalise those who remain unvaccinated, rather than support them to access vaccination.

See the RCN position on immunisation and mandatory vaccination

The Nursing and Midwifery Council (NMC) strongly encourage anyone eligible to be fully vaccinated as quickly as possible. The NMC adds that “our Code and our standards have always made clear that professionals have a responsibility to maintain their own level of health, taking all reasonable personal precautions to avoid potential health risks to colleagues and people receiving care.”

However, the NMC has stated that they “do not consider that solely turning down COVID-19 vaccinations is a basis for a Fitness to Practise referral”. Please see the NMC's full position statement for further detail.

Could I be breaching the NMC Code of conduct if I decline to be vaccinated?

Under the NMC code all registered nurses midwives and nursing associates have a professional responsibility to preserve safety and to take all reasonable precautions necessary to avoid any potential health risks to themselves or others. 

Please see the NMC statement on COVID-19 vaccinations

Where staff are not vaccinated, they may potentially need to be redeployed to areas with less vulnerable patients, undertake regular testing and have access to additional PPE. Provided that you co-operate with your employer to avoid exposing others to risk, you should be deemed compliant with the NMC code.

On the 1 November 2021, changes to the health and social care legislation were introduced making it a condition of employment for staff working in or providing services in social care environments to be vaccinated. This legislation was revoked on 15 March 2022, but some staff may have been affected by this. Although there is no automatic right in law to any staff previously dismissed getting their job back, we recognise that members may have been impacted by this legislation. 

If you have been impacted by the legislation, please contact us so that we can explore the options open to you relevant to your individual circumstances.

What vaccines are recommended for health and care staff?

A number of vaccines are recommended for health and care staff. This is to protect individual staff, their families, patients and service users, including vulnerable patients who may not respond well to their own immunisation, and allow for the efficient running of services without disruption.

Immunisation against infectious disease, the ‘Green Book,’ sets out the policy position and guidance for all vaccines and vaccine preventable infectious diseases across the UK and Chapter 12 sets out the requirements and recommendations for the Immunisation of healthcare and laboratory staff

The Control of Substances Hazardous to Health Regulations (COSHH) 2002 and the Control of Substances Hazardous to Health Regulations (Northern Ireland) (COSHH) 2003 legislation, require employers to sufficiently assess the risks to workers from becoming exposed to substances hazardous to health and identify adequate control measures to ensure all staff are protected, so far as is reasonably practicable. This includes exposure to pathogens (also referred to as biological agents in COSHH). Suitable and sufficient personal protective equipment (PPE), where identified by the risk assessment, should be provided by the employer and be readily available.

The green book states that all new employees should undergo a pre-employment health assessment, which should include a review of immunisation needs. This should be based on the COSHH risk assessment and which pathogens staff are likely to be exposed to in their workplace. Staff considered to be at risk should be offered appropriate immunisation. 

Based on this, most health care employers will check immunisation status through pre-employment occupational health screening. 

Specific guidance for blood born viruses (BBV) Integrated guidance on clearance and management of healthcare workers living with bloodborne viruses ( provides information on hepatitis b vaccine. This is used by many organisations to inform their employment policies. All staff involved in exposure prone procedures (EPP) should be offered and encouraged to have the hepatitis b vaccine. See Health clearance for tuberculosis, hepatitis B, hepatitis C and HIV: New healthcare workers guidance from the Department of Health. 

Legally therefore, under COSHH, employers must identify the steps that need to be taken to prevent exposure and the specific vaccination requirements for staff come from this. However, the requirement to be vaccinated is guidance only and it is not actually mandated anywhere.

Staff must have access to the correct information, encouragement and clear explanation of the benefit and value of the vaccine and an opportunity to explore any reasons why an individual is hesitant. 

Employers must also monitor the impact of staff vaccination policies on staff recruitment and retention and any equality impact for staff in protected groups. Similarly, employers need to monitor the impact to service users in terms of the care they receive.

In their guidance to the COSHH regulations, the Health and Safety Executive (HSE) point out that immunisation should be seen only as a useful supplement to reinforce physical and procedural control measures, not as the sole protective measure.

The HSE advise that some employees may not wish to take up the offer of immunisation, or they may not respond to a vaccine and will, therefore, not be immune. Employers need to still consider the effectiveness of the other controls and consider whether any additional controls should be implemented to allow them to work safely.  In practice this will mean the continued provision of respiratory and other protective equipment, effective ventilation and, where the risk of harm remains high, potentially redeployment. See HSE guidance for workplaces safe on coronavirus (COVID-19).

ACAS guidance on working safely during coronavirus also provides information on occupational health vaccination specifically for COVID-19.

An individual employer may mandate that vaccination is a requirement for its workers as a result of their local risk assessment. This may be included in contracts of employment for new starters working in some roles and sectors. Every effort should be made to support staff to accept vaccination or deploy them to lower risk areas.

A mandate could result in tribunal claims. ACAS encourage consultation and support rather than mandate in their getting the coronavirus for work guidance.

The RCN recognises that for new staff it may be reasonable for an employer to require them to have a vaccine as part of an occupational health screen at the commencement of their employment, particularly for staff applying to work in specific areas as part of the employers risk assessment and the mitigations to be put in place. It would then be for individuals to decide if they want to take up that employment.

There is a minimum service requirement of two years in England and Wales and one year in NI in order to be able to claim ordinary unfair dismissal or constructive dismissal, so this may be a barrier to any claim for employment.

Mandatory vaccination could however, lead to claims of discrimination, if it were felt that vaccination put employees, who share a protected characteristic, at a particular disadvantage and so amount to indirect discrimination.  There is no minimum service requirement to bring a discrimination claim, so this is open to new applicants.  However, indirect discrimination claims can be defended by employers if they can show that their treatment or action is a “proportionate means of achieving a legitimate aim” – often referred to as “objective justification”.  The health and safety of others could amount to objective justification. Also see our medical and religious concerns below. Like all potential employment/industrial tribunal claims, it will depend on the individual circumstances and the RCN's legal team will assess each potential claim on its merits.

If you have any concerns about your employer's proposals, please contact us for advice.

Check your sick pay entitlements as set out in your contract of employment. You should be paid statutory sick pay as a minimum, but your employer may try to argue that any additional element of your sick pay should be withheld. The RCN believes that you should be paid normal pay for absence to prevent cross infection. You should check your employment contract to determine what sick pay is owed to you contractually.

If you are unable to resolve the issue, contact us. A claim for unlawful deduction of wages and/or discrimination may be considered.

This may be a requirement as part of an occupational health assessment. It should not be asked by line managers. Vaccination information is classed as 'special category data' under data protection legislation - all employers must therefore comply with this.

More guidance on this is available from the Information Commissioners Office (ICO). If you have any concerns about how your data is being gathered or used, please contact us for support.

There are very few contraindications to vaccination. The RCN are clear that all members should be vaccinated as soon as possible.

What if I am refusing vaccination because of my religion and belief?

COVID vaccination is recommended by UK religious leaders they have a range of resources with useful information to help dispel some of the myths and provide advice for those who are hesitant.

NHS England guidance on supporting COVID-19 vaccine uptake during Ramadan.

Under the amendments to the legislation in England Health and Social Care Act 2008 (Regulated Activities) (Amendment) (Coronavirus) Regulations 2021, there is no exemption for not being vaccinated for religious or philosophical belief reasons.

What if I am refusing the vaccination because I am pregnant?

Pregnant women are strongly advised to have COVID-19 vaccines as soon as they are able. Vaccination not only helps protect the mother but maternal antibodies to the vaccine will provide immediate protection to new born infants. See the guidance from the RCOG and RCN.

Individuals should discuss any concerns they have in relation to their medical history with their GP.

What if I am refusing the vaccination because of a medical issue? 

The Green book Immunisation against infectious disease Chapter on COVID-19 details the few medical contraindications to receiving the vaccine.

Please also see our section on allergies in our COVID-19 and vaccination FAQs. 

If you are subjected to a detriment as a result of a valid exemption from vaccination, or even dismissed and the reason for your refusal is related your medical condition and vaccination being contraindicated for you, you may have a disability discrimination claim for under the Equality Act 2010, provided your medical condition amounts to a disability. Employers are obliged to make reasonable adjustments for disabled workers if they are placed at a substantial disadvantage in the workplace.

Members who believe vaccination is contraindicated because of an existing medical condition should discuss this with their GP. As with any medical information, your medical reason for refusal should be treated in strictest confidence by your employer, following occupational health guidance.

If you are subject to a formal process because of your decision not to be vaccinated, please contact us for support.

What is the situation for student nurses on placement?

The RCN encourages all nursing students to speak to their university for advice and guidance. The Green book section, Immunisation of healthcare and laboratory staff recognise students on placement should be vaccinated in the same way as any other staff involved in patient care should be vaccinated.

Looking for something else?

Please see our COVID-19 and vaccination FAQs for our most commonly asked questions about accessing and receiving the vaccine.

If you are a vaccinator, our clinical guidance may also be helpful.

Page last updated - 30/05/2022