Covid vaccines will be made mandatory for all frontline NHS staff in England, the government announced today.
Health Secretary Sajid Javid confirmed the jab will be a "condition of deployment" for more than a million health workers, like it will become on Thursday for care home staff.
The NHS change is expected to take force from April 1, pending parliamentary approval.
Patient-facing NHS staff without a medical exemption will need to have had both doses - or face being reassigned to back office jobs or losing their jobs completely.
The move has sparked fears of a staff exodus as around 103,000 of England's NHS staff have not had a single jab.
Mr Javid said "the scales clearly tip to one side" in favour of mandatory jabs - given "our imperative to protect the NHS and those services upon which we all rely."
But his own government's documents estimated 126,000 health and care workers - including 73,000 NHS staff (nearly 1 in 20) and 35,000 care workers - could have to be reassigned or leave their jobs due to the policy.
An impact statement warned: "This suggest the impact on workforce levels and health and care services could be significant.
"If a proportion of staff decides to leave the NHS, this would put pressure on NHS services.
"This is likely to be more acute in clinical staff groups where there are existing staff shortages and lags in labour supply caused by education and training requirements, but all services are likely to be impacted."
The Health Secretary said: “No-one should scapegoat or single out anyone in the NHS or social care that has for whatever reason… at this point chosen not to get vaccinated.
"This is all about working with them positively, making sure they have the information they need.”
But Shadow Health Secretary Jon Ashworth warned ministers to “proceed with caution”, adding: "We simply cannot afford to lose thousands of NHS staff overnight."
Some 1.35million out of 1.45million NHS workers in England have had their first dose as of October 31.
Mandatory jabs will include some private contractors in NHS hospitals, workers in private healthcare, unpaid volunteers, agency staff, and trainees.
The government confirmed it will cover all patient-facing staff in health and social care settings regulated by the Care Quality Commission.
Doctors, nurses, dentists and domiciliary care workers are included, as well as non-care staff who have face-to-face contact with patients - such as cleaners, porters, ward clerks and receptionists.
However, it will not currently apply to CQC-regulated activities in residential or inpatient settings, like drug rehab centre, hospices and supported living services.
Staff will have to prove their vaccination status using the NHS app, a website or a letter.
Staff who can show a medical exemption - such as anaphylaxis - will not have to get the vaccine but may have to take steps to "mitigate the risk" to patients.
Staff will not be allowed to declare an exemption due to their religious beliefs.
Government documents admit some NHS staff may still choose not to get vaccinated, putting "additional pressures on the social and healthcare sectors".
The CQC will have the power to take enforcement action against those who continue to employ unvaccinated staff without a medical exemption.
Some MPs sounded caution over the move - but others said it should have happened quicker.
Tory MP Dr Andrew Murrison said: “If this has to be done, then it is better to do it quickly, and by the Spring, clearly we’re going to be past the winter pressures we’re all concerned about.”
There will be a vote by MPs. There will then be a 12-week grace period before the move takes effect.
A consultation on making Covid and flu jabs compulsory for "other health and care settings" in England closed on October 22.
The government will not be introducing any mandatory flu jabs for England's NHS staff but "will keep this under review", Mr Javid confirmed.
It comes as a deadline for care home workers to get their second dose as a condition of deployment looms this Thursday. Some staff can temporarily self-certify that they have an exemption, but care chiefs have pleaded for the deadline to be delayed with more than 100,000 vacancies already.
Mr Javid warned "it cannot be business as usual when it comes to vaccination", adding: "The first duty of everyone working in health and social care is to avoid preventable harm to the people they care for.
“Not only that, they have a responsibility to do all they can to keep each other safe.”
But Rachel Harrison of the GMB union warned: "Bulldozing this vaccine will exacerbate the already crushing staffing crisis we face across the NHS and ambulance services.
"Both are operating under extreme pressures, after a decade of austerity and cuts, with an exhausted and demoralised workforce who are fearful of what is to come as we head through winter.
"Staff are already leaving their employment and this will certainly force many more to go."
Royal College of Nursing General Secretary Pat Cullen added: "The vast majority of NHS nursing staff received the COVID-19 vaccine as soon as it was offered, having led the vaccination roll out across the UK and continuing to do so with the booster programme.
“With the five months until this decision takes effect, the government and employers must continue to engage with the small minority who have chosen not to have the vaccine.
“This is vital to understanding their concerns, supporting them to understand the importance of the vaccine and to make that important choice."
