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Review of children and young people
GPs and hospital paediatricians are being asked to review the risk status for those children and young people in their care who are currently flagged as 'high risk' through summer 2020.
You should review the RCPCH guidance and where you consider children in your care are no longer at 'high risk' of complications from Covid-19, you should amend their shielding flag to 'moderate' or 'low' as per the guidance below.
Shielded patients list records added to practice
Missing shielding letter
If the patient is missing a shielding letter, please check that they are clinically extremely vulnerable and then issue a letter using the template. We are unable to reissue patient letters nationally.
The shielded patients 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.
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
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.
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 avoiding areas identified as being in a local lockdown.
An updated Word template of the letter was made available to GPs via GP systems In September 2020. Download the letter template.
You do not need to write to your patients if they are identified nationally or by hospitals. Correspondence should be provided nationally and the Trust adding the patient to the Shielded Patient List respectively.
How to flag patients as low or moderate risk
If you decide the patient should not be on the Shielded Patient List, you can flag them at moderate or low risk to keep a record of your decision.
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.
An updated Word template of the letter was made available to GPs via GP systems in September 2020. Download a letter template for patients assessed as not being at high risk.
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
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.
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
Public Health England have provided guidance for the public on the mental health and wellbeing aspects of coronavirus (COVID-19).
Local councils are working with voluntary sector organisations and local communities to support residents in the response to coronavirus (COVID-19).
Government advice on employment and financial support
The government has provided advice on employment and financial support.
All practices should now have completed the assessment of 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: firstname.lastname@example.org and this will be investigated.
Shielded patients list records added to practice
During week commencing 4 May, flags were added to patients identified on the national shielded patients list. This comprised three weeks of additions by the national algorithm and hospitals, completing the initial population of the list. There should now be incremental updates to the list, with GP systems populating weekly.
The lists can be found in TPP by searching for:
- "LOT 3 High Risk COVID-19 code added 05/05/20"
- "LOT 3 High Risk COVID-19 code added 05/05/20, without a more recent Low Risk or Moderate Risk code"
EMIS users can search as follows:
- Select your practice name, then open the 'EMIS Health: COVID-19 searches' folder
- Use the 'Shielding patients identified centrally, added 6 May 2020' folder - these are the patients identified within this latest addition to the Shielded Patients List (SPL5)
The free text of each shielded patients list flag will describe why it is added and who by.
For further information on why hospitals have added a flag, please contact the Trust.