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Shielded patients list guidance for hospital trusts

You should identify patients who are at the highest risk from coronavirus (COVID-19), and make sure they are put on the shielded patients list (SPL).

We are asking hospitals to identify patients who are at the highest risk from coronavirus (COVID-19), and submit their details to us, so that they can be added to the shielded patients list (SPL).

Shielding is a measure to protect people who are extremely clinically vulnerable by minimising all interaction between them and others.

What you need to do

All NHS Medical Directors and all NHS Nursing Directors have received letters to inform them about the SPL, to ask them to:

  • review patient lists sent by NHS Digital
  • add patients they deem clinically at highest risk as appropriate. You should also write to the patient confirming this. 

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

We have provided hospital trusts with a list of the patients under their care who the national algorithm has identified as needing shielding.

This has been produced using admitted patient care data to the end of February 2020 and will remain one to two months in arrears.

If you have not received a list this is because we have not identified any patients under your care.

Hospital trusts should now identify any additional patients considered to be in the highest risk category, but who have not been identified centrally, and return information about these patients to us directly. You should consider:

 

    • patients whose episode of care started from 1 March 2020 onwards
    • patients receiving treatment through outpatient services

How to submit data

The submission window will be open daily between 8:00am and 5:00pm.

We can only accept one submission from each trust per day.

The data must be submitted by a named contact in the trust.

If you want to nominate another contact, it must be someone who is already registered to submit for one of the COVID-19 related data collections.

All error messages will be flagged in column N of the collection tool. You will not be able to submit the file until all errors are resolved.

image showing the SPL trust templateThis image shows the template in the SDCS. It includes the following fields:

  • addition/subtraction
  • consultant code
  • NHS number
  • date of birth
  • postcode
  • disease group:
    • 1 - transplant
    • 2a - cancer undergoing active chemo
    • 2b - haematological cancers
    • 3 - respiratory
    • 4 - rare genetic, metabolic and autoimmune
    • 5 - women who are pregnant with significant heart disease, congenital or acquired
    • 6 - Academy of Medical Royal Colleges (AoMRC) categories – patients identified by Medical Royal College guidance that does not fit into 1 – 5
  • supporting summary (max 255 char) including supporting ICD-10/OPCS codes

Mapping between the CMO criteria and the submission spreadsheet

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

CMO criteria

Hospital spreadsheet disease group field

People who have had an organ transplant who remain on long term immune suppression therapy

 

1. Transplant

People with specific cancers - people:

  • with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
  • with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • having immunotherapy or other continuing antibody treatments for cancer
  • having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs

 

2a. Cancer undergoing active chemo

2b. Haematological cancers

People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. Severe asthmatics are those who are frequently prescribed high dose steroid tablets.

3. Respiratory

People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell)

4. Rare, genetic, metabolic and autoimmune

People on immunosuppression therapies sufficient to significantly increase risk of infection

4. Rare, genetic, metabolic and autoimmune

People who are pregnant with significant congenital heart disease

5. Congenital Heart
Any other AoMRC grouping State NO to all categories

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

Deductions

If you decide the patient should not be 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 or moderate risk. We will calculate their risk as moderate or low nationally and update the GP record. They will also be deducted from the government’s extremely vulnerable patient service.

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.

Download a letter template for patients assessed as not being at high risk.

Background

Public Health England has published guidance for people, including children, who are at very high risk of severe illness from coronavirus (COVID-19)  because of an underlying health condition, and for their family, friends and carers. This guidance was published on 21 March 2020, and from 23 March 2020 the NHS wrote to the patients identified using the national algorithm to inform them that they should stay at home at all times and avoid all face-to-face contact for a period of at least 12 weeks.

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

More information

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

Last edited: 3 June 2020 8:43 am