Government plan for 'smarter shielding' will relax advice for some at-risk patients

Patients currently included on shielding lists could be advised that they can 'take more risk' under government plans to overhaul the system for identifying people most at risk from COVID-19.

Prime minister Boris Johnson (Photo: Chris J Ratcliffe/Getty Images)
Prime minister Boris Johnson (Photo: Chris J Ratcliffe/Getty Images)

Plans to adopt a 'more nuanced' risk assessment mechanism for patients at increased risk were set out in a 50-page COVID-19 recovery plan published on 11 May by the government.

The document reveals more detail on how lockdown measures could be eased over the coming days and weeks after prime minister Boris Johnson announced the change in approach on Sunday.

The decision to ease lockdown restrictions has been sharply criticised by the BMA as 'too fast, too confusing and too risky', with doctors' leaders warning it threatens to trigger a deadly second wave of coronavirus infection.

Vulnerable patients

GPs have faced significant workload in identifying and verifying patients who should be shielding during the pandemic. A senior NHS England official apologised last month and admitted that the process had been 'really frustrating' after problems including patients being missed out or incorrectly identified for shielding, and changes to guidance on who should be included.

The recovery plan document suggests that in the second phase of the NHS response to the pandemic, shielding will change again as the government takes a 'more differentiated approach to risk'.

The document says: 'As the UK moves into phase two, the government will continue to recognise that not everybody's or every group's risk is the same; the level of threat posed by the virus varies across the population, in ways the government currently only partly understands.

'As the government learns more about the disease and the risk factors involved, it expects to steadily make the risk assessment more nuanced, giving confidence to some previously advised to shield that they may be able to take more risk; and identifying those who may wish to be more cautious.'

Care homes

Protections for 'other vulnerable locations' such as care homes and prisons are also likely to be modified as understanding of the risks presented by coronavirus increases, the document says. Despite this, it makes clear that 'the clinically extremely vulnerable cohort will continue to be advised to shield themselves for some time yet' - and the government has promised to roll out additional support to mitigate the impact of this.

While changes to lockdown measures unveiled yesterday apply across England, the government suggested that in future measures could be more targeted - with rules relaxed or tightened in specific parts of the country depending on levels of risk.

Meanwhile, the government has promised to increase daily testing capacity to 200,000 by the end of May - and says that as it 'increases the availability and speed of swab testing it will be able to confirm more quickly whether suspected cases showing symptoms have COVID-19', shortening the period of self-isolation required for many people.

BMA GP committee chair Dr Richard Vautrey told GPonline last week that a one-size-fits-all approach to shielding patients was inappropriate.

Shielding

'This is a diverse group of people, ranging from those who are extremely healthy otherwise but are taking medications that make them vulnerable, to patients who are very frail. They can't be treated as one group.'

He said work was underway to look at how councils and the NHS could support different groups. The Leeds GP said it had been difficult for GP practices 'in contacting, working with and identifying at risk patients'. He added: 'Going forward we need to bear in mind these people will continue to be anxious and need to be mindful of the longer-term impact.'

The government document confirmed plans to press ahead with 'accelerating the introduction of a new service of enhanced health support in care homes from GPs and community health services, including making sure every care home has a named clinician to support the clinical needs of their residents by 15 May'.

It also confirmed that the government intends to stick to its manifesto promise to increase the number of GP appointments delivered annually by 50m by 2024/25.

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