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Shielded Patient List: guidance for General Practice

Guidance to ensure the right patients are identified as at high risk from developing complications from coronavirus (COVID-19).

Missing shielding letter

If a patient is missing a shielding letter, please check that they are clinically extremely vulnerable and then issue a letter using the relevant letter template in the “how to flag patients as high risk” section below. We are unable to reissue patient letters nationally.


The Shielded Patient List

The Shielded Patient List comprises patients identified using national administrative datasets and patients identified by hospitals or general practice and flagged as high risk. Patients identified nationally are selected using a rule set as well as a COVID-19 Population Risk Assessment.

The Shielded Patient List is updated daily with hospital data, address changes and where patients have passed away. It is updated weekly with GP data.


Clinical criteria for a high-risk patient

The clinical criteria have been identified by the UK Chief Medical Officers. We have also provided details of our methodology so that the mapping to individual conditions and medicines can be seen.

GPs and hospitals are no longer required to add Children and young people (CYP) on the Shielded Patient List. GPs should continue to review the risk status of those of their patients who are 18 years and over with these conditions on an ongoing basis using the additional guidance and specific patient letter templates provided in the sections below.


COVID-19 Population Risk Assessment

The Chief Medical Officer for England has instructed NHS Digital to use a coronavirus risk prediction model to generate or estimate risk assessment results for adults in England using data held centrally. Patients who are or who have previously been included in the Shielded Patient List have not been included in this assessment. Those whose results are higher than an agreed threshold have been added to the Shielded Patient List (SPL).

Your GP IT provider will provide a search to help you to identify these patients. Patients identified as high risk through the COVID-19 Population Risk Assessment will have a high risk flag on their record along with one of two free text messages:

  • “Added by COVID-19 Population Risk assessment on <DATE>.”
  • “Added by COVID-19 Population Risk assessment on <DATE>. Calculated using assumed values”

Where one or more data items were missing from a record held by the NHS or were recorded as unknown, then default values were used by the COVID-19 Population Risk Assessment as a substitute. In this case the second message above will appear in the patient record. The date in the free text in both cases reflects the date the assessment was undertaken.

If you determine that a patient identified through the assessment should not be considered high risk, you should revise their risk status flag as per the guidance below, ensuring you use the appropriate patient deduction letter template.

Read more about the COVID-19 Population Risk Assessment and the default values used.


Review of children and young people

The Department of Health and Social Care have written to children and young people patients and their parents to inform them that they are no longer clinically extremely vulnerable (CEV).  

Recent research shows that children and young people, including those originally considered to be clinically extremely vulnerable, are at very low risk of becoming seriously unwell from the virus.  

There will be a very small number of patients advised to isolate or reduce their social contact for short periods of time due to the nature of their medical condition or treatment. These patients will be under a specialist consultant and should continue to follow their advice.  

CYP vaccination eligibility is not affected by the changes to the Shielded Patient List. Vaccination is now available for all 16-17 year olds. Some 12-15 year olds are also eligible for vaccination because of the very specific risks they face and the particular benefits they will receive from the vaccine. However, being eligible for vaccination does not mean CYP are considered to be clinically extremely vulnerable or need to shield. 

Any parent or young person who approaches their GP with questions about this should be directed to their consultant. 

No further action is required of GPs at this time. 


Guidance for coding of Trisomy 21 disorders

An issue was identified relating to patients added to the SPL where a code for Down’s syndrome has previously been added to their record in error (see known issues). Guidance has been developed to support GPs when reviewing the coding of people with Down’s Syndrome and how this differs from coding of screening/diagnostic tests which have indicated that a woman’s unborn child has Down’s Syndrome.


How to flag patients as high risk

You should flag any patients you identify as high risk by adding the SNOMED CT code to their patient record.

SNOMED CT code for high risk category

1300561000000107 - High risk category for developing complication from coronavirus disease caused by severe acute respiratory syndrome coronavirus infection (finding)

You should write to your patients if you have identified them as at high risk of complications from coronavirus (COVID-19). The letter provides advice and guidance on what it means to be at high risk, information relating to the support available, going to work, accessing NHS services and mental health support, as well as guidance on current restrictions.

An updated national additions letter template can be downloaded here:

You do not need to write to your patients if they are identified nationally or by hospitals. Correspondence will be provided either nationally or by the Trust adding the patient to the Shielded Patient List respectively.

We are aware that some GPs have continued to use the SNOMED code

  • 443999008 | Risk of exposure to communicable disease (situation)

This SNOMED code was used early in the COVID-19 pandemic as a temporary “high” risk flag, prior to the introduction of explicit SNOMED codes to identify patients as at high, moderate or low risk as detailed in the section above.


The SNOMED code for “risk of exposure to communicable disease” above should no longer be used to identify patients at high risk from COVID-19.

How to flag patients as low or moderate risk

If you decide the patient should no longer be included in the Shielded Patient List, you should revise their high risk flag to moderate or low risk (do not delete the high risk flag) to remove them from the national list and prevent them from receiving continuing national advice and guidance.

It can take up to two weeks for a patient to be removed from the national list once their high risk flag has been revised.

SNOMED-CT codes for low and moderate risk

1300591000000101 - Low risk category for developing complication from coronavirus disease caused by severe acute respiratory syndrome coronavirus infection (finding)

1300571000000100 - Moderate risk category for developing complication from coronavirus disease caused by severe acute respiratory syndrome coronavirus infection (finding)

You should also write to patients who you have previously been on the Shielded Patient List and now are assessed as being at low or moderate risk.

When removing a patient who was previously added to the Shielded Patient List nationally as a result of the COVID-19 Population Risk Assessment (see above) a specific letter template is provided. Download a letter template for patients identified by the COVID-19 Population Risk Assessment who are no longer at high risk.

An updated Word template of the standard patient deduction letter was made available to GPs via GP systems in July 2021. Download a letter template for patients assessed as not being at high risk

In addition to this, an Easy Read version of the letter was also made available in December 2020.  Download an Easy Read letter template for patients assessed as not being at high risk. The Easy Read template should be used in addition to the former where it is appropriate to do so.

Hospital trusts can also deduct patients by submitting a request to the NHS Shielded Patient List. These patients are identified by a low or moderate risk flag in your GP system.


Support for patients at moderate risk

Government service to find support for those affected by coronavirus (COVID-19)

Find out what patients can do if they're struggling because of coronavirus (COVID-19)

Patients can use the service for themselves or for someone else.

NHS volunteer responders

You can submit a live referral for an individual that needs support, or an NHS service that requires volunteers providing they meet the referring criteria, to NHS Volunteer Responders. 

Online referral

Complete an online patient referral form

Telephone referral

If you are an approved referrer and would like to make a referral over the telephone, please call the NHS Volunteer Responders Support Team: 0808 196 3382.

Volunteers can provide:

  • check in and chat support – short-term telephone support to individuals who are at risk of loneliness because of self-isolation (note, this is not mental health advice)
  • community support – collection of shopping, medication, or other essential supplies for someone who is self-isolating, and delivering these supplies to their home
  • patient transport – transport to take patients home who are medically fit for discharge
  • NHS transport – who will deliver medicines on behalf of the community pharmacy or dispensing doctor

Health at home

Health at home provides patients with an overview of NHS services that are available, such as how to order repeat prescriptions online and get them delivered.

Public Health England guidance

Local councils

Local councils are working with voluntary sector organisations and local communities to support residents in the response to coronavirus (COVID-19). 

You can signpost patients to GOV.UK to find their local council website to get more information.

Government advice on employment and financial support

The government has provided advice on employment and financial support.


Self-referring patients

All practices should now have completed the assessment of self-referring patients. 

View guidance on reviewing self-referring patients.


How the information is used

The information flows to Cabinet Office to allow them to run the shielded patient service which will provide further support for local and regional lockdowns. It is matched with the registrations made by patients and then used to co-ordinate support, for example priority with online shopping.

The information also flows to Local Authorities to allow them to provide targeted support to high risk patients within their authority boundaries, before, during and after a lockdown, offering help, social care and support as part of the local COVID-19 response.

The information also flows back to general practice, hospital Trusts and prison health, by marking the record with a high risk of complications flag.


How often updates are made

Data is extracted from GP systems and passed to the Cabinet Office and Local Authorities on a weekly basis.

Updates from the shielded patient list to GP systems also occur weekly.


Why someone may be flagged as high risk but does not appear to fit the criteria

The national rule set uses clinical codes to identify patients, as described in the methodology, including those provided in national datasets such as the Hospital Episode Statistics (HES) dataset and GP flu extract data. The rule set has been designed to be as inclusive as possible to ensure that all patients are informed.

Patients can be removed from the list by adding a “low” or “moderate” risk of complications from COVID-19 flag.


Why a patient may have been missed by the rule set

Hospital Episode Statistics (HES) data uses clinical classifications which are broader than clinical terminologies, for example, READ or SNOMED CT. The data is also captured monthly and so, less timely. It does not capture patients who receive care in a different country or are treated by a private hospital. The medicines data collected centrally similarly runs several months behind and only collects medicines dispensed in community pharmacies, not any issued form hospitals.

GP data uses terminologies which are more specific (READ or SNOMED CT) but it is reliant upon the application and interpretation of the clinical codes used.


How to report an issue with the rule set

If you are aware of a systematic issue regarding the rule set please email: splquery@nhs.net and this will be investigated.


Shielded Patient List records added to practice

During week commencing 4 May 2020, risk flags were added to those patient records identified on the national Shielded Patient List. This comprised three weeks of additions by the national algorithm and hospitals, completing the initial population of the list.

Since this first set of additions, updates have been applied to the list via weekly feeds to GP systems suppliers, representing changes to the risk status provided from the previous week’s GP amendments (“high”, “moderate” or “low” risk flags), changes requested by hospital trusts to add or remove patients in their care on the SPL, and ongoing identification of those who meet the CMO criteria via the national ruleset.


Further information

NHS Digital

Shielded patients list

Royal College of General Practitioners (RCGP)

Resources available from the RCGP

Royal College of Paediatrics and Child Health (RCPCH)

Covid-19 shielding guidance for children and young people

Email

splquery@nhs.net

Last edited: 25 August 2021 9:49 am