Testing of care home residents and staff will have to be rationed because of a lack of capacity, new guidance from Health Protection Scotland suggests.

Deaths in Scotland’s care homes now account for nearly six in ten of the total toll of 3,212, according to figures released earlier this week.

The interim guidance document from Health Protection Scotland published on Thursday sets out approaches in three categories for increased testing for care home residents and staff.

They include testing of all staff and residents in care homes with virus cases, testing in other homes that share staff and finally proactive testing in residences without any confirmed cases.

But the document says there is unlikely to be “adequate physical or laboratory test capacity” to cover all three areas simultaneously, meaning “some local NHS board level prioritisation” will be needed.

Representative body Scottish Care, which has spoken about some guidelines being “confusing and at worst contradictory”, says routine testing of all residents and staff is needed to break the chain of transmission.

Chief executive Dr Donald Macaskill has told healthandcare.scot that tests for care homes should be prioritised “over and above the testing of general citizens.”

Earlier this month epidemiology expert Professor Hugh Pennington, who chaired inquiries into E.coli outbreaks in Scotland and Wales, told the Scottish Parliament screening of everyone going in to care homes was needed to stop the virus “rampaging”.

The Health Protection Scotland publication also states pre-emptive testing in care homes that do not have any confirmed or suspected cases should only be done when there are plans in place to replace staff who might test positive.

Chief Nursing Officer Fiona McQueen earlier today addressed concerns about part of the guidelines that stated a staff member who tested positive could finish their shift if they could not be replaced immediately.

Ms McQueen said this provision would only apply in special circumstances where it would be inappropriate for a key staff member such as the registered nurse to leave their shift.

However they would be expected to isolate and not carry out any direct care.

The Scottish government today published National Clinical and Practice Guidance for Adult Care Homes in Scotland. It  states everyone being admitted to a care home should have a negative test before admission.

Dr Macaskill said: “We have called for some considerable time for the testing of all care home residents and staff, with permission obviously, as one of the major vehicles through which you will stop the spread of the virus.

“That’s happening in other jurisdictions whether been dealing well with the virus, in Europe and in the Irish Republic.”

“If we’ve got a limited testing capacity then we consider that the testing of those care homes has to be a priority over and above anybody else.”

Sign up to our bulletin sent twice a week so you don’t miss out on the latest health and social care news.