Shielding is paused from 1st April 2021. All shielding patients should be in group 4 or above for vaccination and should have received an invitation for vaccination.
- Full guidance on the shielded patient list for General Practice is available from NHS Digital (includes full guidance on how to flag patients as high risk)
- Government guidance for patients who have been advised to shield available on gov.uk
- Details and guidance on the COVID-19 Population Risk Assessment and QCovid.
- Southwark Proactive Care Pathway
UPDATE 15th February 2021: a significant update to the shielded patient list (SPL) has taken place with the introduction of Population Risk Assessment using the QCovid composite score – patients have been identified and contacted centrally resulting in the addition of about 1.8 million people nationally to the SPL. This score combines several factors and includes Body Mass Index (BMI), deprivation and ethnicity. Being added to the SPL in this way also prioritises individuals for vaccination (as these patients are then added to group 4). Full details can be found on the NHS Digital website where clinicians can also access the calculator (available on NHS networks only).
Patients are automatically added to the SPL if they have a 10-fold increased risk of catching coronavirus and dying compared with others of their age and gender, or if their absolute risk is greater than 0.5%.
Londonwide LMCs have created a template letter which might be helpful for practices to use in addressing any patient concerns raised.
QCovid and Gestational Diabetes
Concerns have been raised that some women with previous gestational diabetes have been advised to shield via the QCovid process. This will be appropriate for many as the model performs an individual assessment based on a wide range of risk factors, and also considers an individual’s risk in comparison to others of the same age and sex. In addition, where data (e.g. on ethnicity or body mass index) are incomplete the risk tool may default to a higher level for that category, which may influence the overall results. However, because the risk assessment is based on routinely coded data from multiple systems, some people may have been identified as having diabetes when in fact they had gestational diabetes. RCGP has developed a flow chart for GPs to use when considering risk for patients with a history of gestational diabetes. Further information is available from NHS Digital here.
GPs can re-evaluate a patient’s risk with the most up to date information using the clinical tool and remove them from the Shielded Patient List if necessary.
All CEV patients affected by the shielding advice have been written to by government and shielding is expected to continue until the end of March 2021.
Letters were sent in the week commencing 21 December and published here.
As during the previous period of shielding advice, this will be an inevitably difficult and worrying time for Clinically Extremely Vulnerable people. We anticipate that patients may have questions about the advice they should follow.
Guidance on shielding and protecting people who are clinically extremely vulnerable from COVID-19 (Updated: 20th December 2020)
Letter to GP Practices with updated guidance for clinically extremely vulnerable individuals and actions for GPs (New: 2nd November 2020) in particular note the requirement to immediately review any children and young people remaining on the SPL, and urgently identify, contact and flag adults with Down’s syndrome
NHS England have developed a flow diagram to support GPs in completing this process, which can be found on the on the FutureNHS platform (New: 20th November 2020). This resource aims to help to address any questions related to the prompt completion of this task.
Home delivery of medicines and appliances during new national lockdown
Please find a link to the 5 January letter from NHS England with vital new information
about the Home Medicines Delivery Service in the context of latest national lockdown.
Free supply of vitamin D for clinically extremely vulnerable people
The Government has written to people on the Shielded Patient List (SPL) advising them of the latest advice on how they can stay as safe as possible. Updated ‘additions’ letters for sending to patients newly added to the SPL will shortly be available on the NHS Digital website and in GP IT systems.
The Department of Health and Social Care (DHSC) has announced that a free four-month supply of daily vitamin D supplements will be offered to those that are Clinically Extremely Vulnerable (CEV) and care home residents to support general health, in particular bone and muscle health. All care homes will automatically receive a provision for their residents, while individuals on the CEV list will receive a letter inviting them to opt in for a supply to be delivered directly to their homes from January 2021.
DHSC has published guidance on how to take these supplements safely, which all CEV patients should read before deciding whether to opt in. This includes advice that people who already take a prescription or a supplement containing vitamin D should not opt in to receive the supplement. It also advises that people with certain medical conditions or treatments should not opt in and should speak to their GP or healthcare professional at their next appointment.
The announcement also highlighted current UK government advice for everyone to take a daily 10 microgram vitamin D supplement over Autumn and Winter encouraging everyone to purchase products from retailers.
Archive of advice prior to November 5th 2020
As Government guidance for shielding patients has recently changed, here is a reminder of the latest information for patients.
Shielding information for specific conditions are also available in some of the pathway specific sections. Please use the covid-19 search function to locate these