Amendments from previous version

Amendments as follows: 

• switch from one-off GPFLU to weekly GPSPL extract
• update of 6 month date range for PCPM data

Amendments as follows:

• SNOMED-CT: 716872004 anti-neoplastic chemotherapy regimen moved from category 4 (People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections) to category 2b (People with cancers of the blood or bone marrow)
• additions (general practice and NHS Trust) and subtractions (general practice only) logic applied

Amendments as follows:

• update of 6 month date range for PCPM data

No amendments made.

Amendments as follows:

• subtractions (NHS Trust) logic applied

No amendments made.

• Introduction of the Detained Person’s SPL.
• Removal of the following codes due to clinical assessment that these should be classed as speciality guidance. Note that all of the below codes have been included in the SPL since the introduction of GPFLU data in version 2 and subsequent use of GP SPL data.

Amendments as follows:

• Implementation of RCPCH guidance

Amendments as follows:

• Introduction of Down Syndrome in category 4: People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (see Table 1 above), treated under a new CMO Rule 'Learning Disabilities'

For Down Syndrome the following clinical codes are included:

Any of the above codes recorded with no time parameters applied

HES ICD10 Code

Q90 Down syndrome (all 4 character codes under this) and all sub-types, counting people with a hospital episode since 2006

• Introduction of Chronic Kidney Disease Stage 5 in category 4: People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (see Table 1 above), treated under a new CMO Rule ‘Chronic Kidney Disease’

For Chronic Kidney Disease Stage 5 the following codes are included:

HES ICD10 Code

N18.5 Chronic kidney disease, stage 5, without a newer CKD1-4 episode (N18.1-4) with a hospital episode since 01 April 2012

Business logic has been applied to manage conflict between GPES/ HES. If either dataset identifies a CKD5 patient, but the other dataset has the patient coded with CKD1-4, the patient should be treated as Clinically Extremely Vulnerable and added to the Shielded Patient List (an inclusive approach).    

Transplant and dialysis were excluded from CKD5 at the request of the CMO for England, noting that transplant and dialysis are risk groups in their own right.

Amendments as follows:

• Processing of new additions for Down Syndrome was suspended from version 37.0. NHS Digital undertook a review of coding anomalies and this has been published as a known issue, with associated action plan

Amendments as follows:

• Cohorts identified by the University of Oxford Q-COVID algorithm were introduced into the Shielded Patient List. The added 1.53M patients to the Shielded Patient List
• In version 44 this represented the cohort aged 19 – 69 identified by the COVID19 Population Risk Assessment
• In version 46 this represented the cohort aged 70 and over identified by the COVID19 Population Rick Assessment

See the link for further details about which datasets have been used by the algorithm to identify Clinically Extremely Vulnerable cohorts:  COVID-19 Population Risk Assessment

Amendments as follows:

• Change to rule 2a used to identify adult patients at very high risk of hospitalisation from COVID-19

Patient communication preferences applied to the SPL weekly process. This amendment means that communications preferences (braille or large print) captured in the Person Demographic Service data for any patient will be applied when issuing printed letters.

• Patient exits from the NHS in England applied. This additional routine enables removal of a volume of patients on the SPL who have “exited” the NHS in England since last March, as well as the routine prevention of SPL processing of patients who leave in future
• The exit reason (also referred to as REMOVAL_TYPE, REASON_FOR_REMOVAL or RFR) describes the reason for removal from NHAIS registration
• The exit process will identify any patient with the following reason code: 
  • Embarkation (EMB)
  • Transferred to Scotland (SCT)
  • Transferred to Northern Ireland (NIT)
  • Temporary resident not returned (TRA) will be processed
• SPL outputs will carry a category description of “Subtracted by NHS Digital - NHAIS Exit
• Where a patient returns to the NHS in England, the exit reason is removed and the previous SPL category will be applied

The high risk category flag has been removed from approximately 12.5K patients records. This follows identification that the SNOMED-CT code of 1300561000000107 had been deleted from their clinical (General Practice) record. This action brings the national SPL back in line with local systems.

The SPL service ceased to process children and young people (CYP), including dissemination to those organisations that receive SPL data across the health and care system. Printed letters were issued to 55k CYP to inform them that they were no longer considered clinically extremely vulnerable. CYP still persist in the SPL, but the routines that process their data have been suppressed.

• Version 75 was the final release of the SPL in its current form, at which point the list was closed to new patient additions as well as revisions to the risk status of existing high risk patients
• Following version 75 release, the SPL will no longer be distributed to those organisations who had previously consumed data files each week
• Feedback has been sought from SPL health and care consumers through October and November 2021 to review ongoing purposes for processing the final versions of the distributed data, and to support and inform the deduction of any remaining high risk flags from the national list and local care systems based on an assessment of residual risk
• The service will remain in “warm-standby” until such time as appropriate national deductions processing is ready to be completed
• The weekly SPL operational run continues to refresh the closed list, updating for deceased patients, demographic changes and NHS “exits” processing, to ensure the underlying data source remains accurate to enable ongoing support for health and care enquiries about the previously CEV cohort