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Known issues

We are aware of the following issues. If you wish us to investigate cases where the rule set may have an issue please contact splquery@nhs.net.

Open issues

Issue

Description Category
Flu reference data out of date For patients who are no longer high risk, flu vaccination reference data used by NHS Digital to determine whether patients should be marked as “moderate” or “low” risk in their GP record, is out of date. This reference data has been updated to the most recent available flu reference data from June 2021. As such the currency of a moderate or low risk flag on a patient record should not be relied upon without clinical review.

Shielded Patient List

Vitamin D requests A number of patients who were high risk and made an application for Vitamin D between December 2020 and 21st February 2021 were excluded from distribution of supplements where they hadn’t provided a valid email address with their application. The patients who were excluded have been identified and Vitamin D will be issued to those previously excluded as a consequence of the above, where they provided a valid postal address in their application. Shielded Patient List

Closed issues

Issue

Description Category
Deductions from the SPL arising from the CMO rule set

23,000 patients records have been removed from the NHS Shielded Patient List as they no longer meet the requirements of the national methodology, but were not removed at the request of a clinician. During September 2020 we wrote to the patients to inform them that they have been removed from the list. A small number of patients have been reinstated on the list by GPs following their removal.

Shielded Patient List
Hospital Deductions of Patients A small number of requests by hospital trusts to remove patients from the NHS SPL were not correctly processed. These were passed to general practice during August for review using a technical method known as an intra-systems task to ensure that the latest clinical information is used in the decision making. Following GP review, patients were removed from the NHS SPL by them adding a "low" or "moderate" risk code to a patient's record. Shielded Patient List
Missing Risk Status in GP Records In mid-August 2020 we became aware of circa 65,000 patient records in general practice where the patient was on the NHS Shielded Patient List but there was not a similar entry on their GP record, for example if added by the national methodology. The patients had been advised they were high risk and other organisations, including the Government service, were aware. This information was added to the affected GP records by the end of September 2020. Shielded Patient List
Stable HIV

Patients with stable HIV and no other conditions have not been specifically allocated to the shielded patient list.

We are aware that despite this they are being identified as high risk. This is likely because the code of “immunosuppressed” is used on their record and this is being used to add an entry.
National Ruleset
Sickle cell trait The code for sickle cell disease has been used on the patient’s record rather than sickle cell trait. This has meant patients have been over identified. National Ruleset
Peripheral Vascular disease (PVD) We have received reports that PVD is being picked up. PVD is not on any of the inclusion criteria. This cannot be explained without further specific investigation. National Ruleset
Splenectomy

Splenectomy was included in the indications for identifying people who may be clinically extremely vulnerable to COVID-19 as a precautionary measure in England, based on the available evidence and expert advice taken at the time. Given emerging evidence and the improving epidemiology, the Government’s Shielding policy is currently under review.  

While this is underway the Government advice, available on GOV.UK, is that all people who have been added to the Shielded Patient List continue to follow the shielding measures. Anybody who is unsure about whether they should follow this guidance should contact their GP or hospital specialist to discuss their individual circumstances.  Further guidance will be issued by the Government when the shielding policy review is completed. Further information is available.

Shielded Patient List
Antineoplastic Chemotherapy (GP Extract) In the GP flu cluster Antineoplastic Chemotherapy is included in the immunosuppression category which means it is not limited by time, that is, it includes patients who have ever had Antineoplastic Chemotherapy. We intend to limit this by time (24 months in a later release). National Ruleset
Corneal Implant (HES) Following specialist input, corneal implant where patients are on systemic immunosuppression drugs will remain part of the national methodology. National Ruleset
Incorrect category selected by GP A small number of additions made by Trusts are for the category “Women who are pregnant with significant heart disease, congenital or acquired” where this is not possible (e.g. aged over 70). We have contacted the Trusts to make them aware of the issue. GPs should delete the code or mark it in error and add a new high-risk code. Shielded Patient List
Risk of exposure to communicable disease Flag At the start of the NHS Shielded Patient List, GP IT systems used the “Risk of exposure to communicable disease (situation)” flag whilst the correct SNOMED CT codes were being added. Patients who have been flagged with a communicable disease during this period (for example scarlet fever) will also have been added to the NHS Shielded Patient List. National Ruleset
Deceased patients Some shielding patients who have sadly died may receive a letter about the changes to shielding policy guidance. This is because there are a few days delay between the list being generated and the letter being printed, which means that letters may be sent using slightly out of date information. We apologise if this has caused distress to any loved ones. Shielded Patient List
Overlapping communications about shielding Some patients may receive two letters about shielding – one to advise them about the new guidance and another to advise them that because their condition has changed or their doctor has evaluated them as not needing to be on the shielded patient list, they have been removed from the list. This is because we regularly update the list to ensure that people are added or removed from the list by doctors as their clinical circumstances change or evidence changes. We will continue to keep the Shielded Patient List up to date throughout the lifetime of the pandemic, so even though the guidance has changed, patients may still receive a letter to say they have been added to, or removed from, the list. Shielded Patient List
Incorrect tier 4 emails On 21 December 2020, clinically extremely vulnerable patients outside the first set of tier 4 areas incorrectly received emails informing them that they needed to shield. On 22 December 2020, NHS Digital was informed and issued a retraction email to those affected. A small number of clinically extremely vulnerable patients will incorrectly receive letters for the same reason. Shielded Patient List
Patients who leave the NHS in England The Shielded Patient List does not currently identify patients who have moved away from England and de-registered from their English GP. As such, some patients identified nationally may be included in the Shielded Patient List for England despite having moved and registered for primary care outside of England. Shielded Patient List
Patients without a registered GP practice Where a patient is identified nationally as “high risk”, but is not registered with a GP practice, their high risk flag will not have been passed to a GP practice. Where they have since registered with a practice, they will need to raise their high risk status with their new GP who can update the risk flag in their GP patient record. Shielded Patient List
Down's syndrome

We have been notified of a small number of patients who have been incorrectly added to the NHS Shielded Patient List due to their record including a code for Down’s syndrome. This has occurred for patients where a clinical code for Down's Syndrome has been added in the GP system in error, for a person who does not have Down's Syndrome.

Patients can ask to be removed from the list immediately by contacting their GP practice. 

National Ruleset

Population Risk Assessment

Some patients not added to the SPL Approximately 8,000 patients were not added to the SPL despite a high risk code being present on their record. Another circa 6,000 patients were not detected by the SPL. This was due to a technical issue that has now been resolved. Shielded Patient List

Last edited: 7 September 2021 11:29 am