NHS Medical Directors and NHS Nursing Directors were asked from April 2020 to:

• review patient lists sent by NHS Digital
• add patients they deem clinically at highest risk, as appropriate, and write to those patients confirming this

Clinicians may have received additional communications from their Royal Colleges or Specialist Societies articulating the same process.

We have continued to provide hospital trusts with a weekly list of the patients under their care who appear on the shielded patient list (SPL). These lists are provided to hospital COVID-19 leads who have been nominated by each hospital. Two lists are provided, one for adults and one for children and young people. The lists can change each week so it's important to review these files and consider the impact on individual patients in your care.

The SPL is used to provide current information, advice, guidance and to offer support across health and care to those who are at the highest risk.

As such, it is important that those involved in the identification and review of patients at high risk within the trust and trust data teams understand the responsibilities outlined below. Ensuring specialists know who their COVID-19 data lead(s) are and how to receive the latest information from them and submit updated information to them, is critical to assuring the currency and accuracy of those patients identified as clinically extremely vulnerable on the national SPL.

If you have not received a list for a given week, this is because we have not identified any patients on the SPL under your care for that period.

If the task to review children and young people in your care has not yet been completed in your trust, please continue to review and if appropriate, remove patients from the SPL, by submitting a deduction to NHS Digital and discussing the change with each patient as per the guidance below. An updated feed is now being provided to trusts to support with decision making in this context.

Trust renal units have already been asked to identify on an ongoing basis, those of their patients receiving dialysis as at high risk, to notify such patients and to submit these patients as high risk to NHS Digital for inclusion on the SPL. 

As outlined above, patients with Stage 5 CKD are now also to be included as at high risk of complications from COVID-19.

Trusts should work with their renal units to:

1. Identify adults (18+) with CKD 5 (or G5 A1-3) not on renal replacement therapy (dialysis and renal transplantation), defined as:

• a reduction in kidney function or structural damage (or both) present for more than three months (NICE CG 182)
• a Glomerular Filtration Rate (GFR) less than 15 ml/min
• It excludes individuals who transiently drop below 15 ml/min (e.g. acute kidney injury, acute on chronic kidney disease)

2.       Send a list of these patients to your trust’s named COVID-19 data lead(s), asking them to add them to the SPL. When sending a list of these patients to your trust’s named COVID-19 data lead(s), please ensure that you have included each patient’s NHS number, date of birth, postcode and consultant, with a request to add these patients to the SPL.

3.       Send adult patients affected an Updated high risk patient additions letter, informing them that they have been identified as clinically extremely vulnerable.

4.       Ensure trust data leads add your patients to the SPL. When submitting patients with Stage 5 CKD, the trust data lead should submit patients under disease category 6 “Academy of Medical Royal Colleges (AoMRC) categories”, along with supporting information to identify the qualifying condition – See section on “Mapping” below.

5.       Ensure this process is ongoing, with patients added and removed from the list in accordance with the definition above. Wherever you no longer think a patient should be considered clinically extremely vulnerable, please have a conversation with them about their personal situation and, if they agree, they should be removed from the list. Please follow the process described above to request removals.

You should write to your patients if you identify them as being at high risk of complications from 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 for patient additions was sent to trusts in April 2021. Download a copy of the updated high risk patient additions letter.

You should notify your nominated COVID-19 trust lead who will follow the process below in 'How to submit data' to request relevant patients are added to the SPL with a high risk flag via a submission to NHS Digital.

If you decide a patient should no longer be included on the Shielded Patient List, you can request that they are deducted. This should only take place after a conversation with the patient and confirmation that there are no conditions that make them high risk. Once deducted, the patient will no longer be included on the NHS Shielded Patient List.

You should also write to patients who have previously been on the Shielded Patient List and now are assessed as being at moderate or low risk. We will calculate their risk as moderate or low nationally and update the GP record.

Updated Word templates of the letter and a new Easy Read version of the letter was sent to trusts in early December. Download a letter template for patients assessed as not being at high risk, and the new Easy Read letter template for patients assessed as not being at high risk. This Easy Read template should be used in addition to the former where it is appropriate to do so.

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.

Your nominated COVID-19 trust lead should follow the process below in “How to submit data” to request patients are removed from the SPL via a submission to NHS Digital. You will need to provide your COVID-19 lead with:

1. The patient's NHS number, date of birth, postcode and consultant
2. A request to remove the patient from the SPL

The list of conditions that define patients as needing shielding was signed off by the Chief Medical Officers (CMO) of the four nations of the UK and should be mapped to the disease group fields on the spreadsheet as follows.

For the new condition “Adult patients with kidney impairment (Stage 5 Chronic Kidney Disease (CKD))”, patients should be mapped to category 6 “Any other category” at this time, along with appropriate supporting summary information and codes to identify them as CKD stage 5:

View full details of the methodology used to identify patients who should be shielded including a list of relevant ICD-10 codes.

In addition to trust submissions, NHS Digital distribute a weekly list of shielding patients who are receiving care in your trust. The lists are distributed via our Secure Electronic File Transfer (SEFT) system.

This weekly list includes patients where their risk of complications from COVID-19 has changed either as a result of being added to the list because they meet one or more of the CMO criteria, or because a GP has added or removed a patient from the list following an assessment of their health.

There are two lists available each week, and you will receive both where you have both adults and children and young people in your care who have been flagged as at high risk from COVID-19.

The data feeds we provide for both adults and children have been enhanced to support patient reviews and to inform decision making about their clinically extremely vulnerable status.

For both SPL feeds your data team receive each week (where there are both adults and children in your care on the national list), the feeds will include core information including the source of the addition, patient details, practice details, CCG details and trust consultant codes. The lists now also provide the following additional information:

• for patients identified by the national CMO ruleset, we include the disease group and disease code that resulted in the patient’s addition to the SPL
• for patients identified by the COVID-19 Population Risk Assessment, in addition to the triggering condition of “high risk” they will also have an initial source of “Added by COVID-19 Population Risk Assessment”
• information to identify the organisation and consultant where a patient had an inpatient stay and diagnosis that resulted in their addition to the SPL
• information on organisations that added a patient to the SPL directly
• information on recent (within 2020-2021) outpatient appointments that a patient has attended

For children and young people, an additional field has also been included to indicate whether the patient has an oncology and/or immunodeficiency condition by which they continue to be considered at the highest risk by the RCPCH; this will help you identify children and young people on your list who do not meet these conditions and therefore need their “high risk” status reviewed.

Both the adults’ and children’s data feeds include information on all other direct care interactions that each patient has had with other NHS organisations, providing a complete picture of a patient’s direct care journey.

This should enable more informed decisions where a patient has had multiple points of contact with the NHS, and as appropriate, contact can be made with other organisations prior to a decision on the patient’s ongoing COVID-19 risk status.

View the full set of data items and supporting information for the adults feed.

View the full set of data items and supporting information for the children and young people feed.

Public Health England has published guidance on shielding and protecting people who are clinically extremely vulnerable from Covid-19 . 

Updated guidance has also been provided by the Royal College of Paediatrics and Child Health on identifying children who are extremely clinically vulnerable.

See the list of conditions that mean people fall into this extremely vulnerable highest risk clinical group.

Royal College of Paediatrics and Child Health (RCPCH)

COVID-19 shielding guidance for children and young people

If you have any other questions about the shielded patients list, identifying high risk patients or submitting data, contact us at splquery@nhs.net.