Just 48 hours after an updated primary care standard operating procedure (SOP) published on 29 May said patients at highest risk from COVID-19 were being asked to 'shield themselves and stay at home', the government confirmed that guidance for shielding patients had been relaxed.
Communities secretary Robert Jenrick said on 31 May: 'We have updated the shielded guidance so that from 1 June people will be advised that they can take initial steps to safely spend time outdoors.
'Those shielding will be able to spend time outdoors with members of their own household or if they live alone with one person from another household. This reflects a lower risk of transmission outdoors as well as the significantly reduced prevalence of COVID-19 in the community. You must still follow social distancing guidelines and remain at a 2m distance from others.'
GP leaders said they had not been consulted ahead of the change in advice - and have yet to receive any further clarification, warning that it was 'imperative' general practice was kept informed on changes in guidance to be able to support patients.
The sudden change is the latest aspect of the shielding process to have caused confusion and concern in general practice - a senior NHS England official apologised in April and admitted 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.
BMA GP committee chair Dr Richard Vautrey told GPonline: 'GP practices have spent a significant amount of time supporting their patients who are at the highest risk from COVID-19 and who have been told to shield.
'Patients are also often contacted by their practice to make sure they understand what shielding means and that they have support if needed - such as deliveries of medication.
'However, to be able to give appropriate advice to patients, GPs need to be kept up-to-date with Government guidance and consulted on any potential changes to it; changes that directly impact the lives of those in their communities.
'Practices received the updated SOP guidance on Saturday 30 May, which contained detailed advice on the management for shielding patients, and yet only a few hours later the guidance appeared to have changed without warning, and practices still have not received any further clarification.
'It's therefore, imperative that practices are informed before public announcements, on any subject matter, so that they are in a position to support their patients as effectively as possible. Covid-19 is potentially very dangerous for those with underlying health conditions, and it is only right that we, as their family doctors, are properly prepared for any changes to guidance around their care.'
Northumberland LMC medical secretary Dr Jane Lothian said a spike in calls to GP practices was likely from patients concerned about what the change in advice meant for them.
She said that the original 12-week period for which patients had been asked to shield was not due to run out until the end of June - adding: 'I was expecting we'd have a massive job on our hands at that stage talking to these people and reviewing them.'
Dr Lothian said the change had come without warning and was likely to cause a 'great deal of confusion among patients'. She said practices had not been given the information they needed to advise patients on how to change their behaviour in light of the updated advice.
Doctors questioned the sudden change on social media, with one asking: 'Why on earth would you announce this without first communicating with primary care teams?'
Why on earth would you announce this without first communicating with primary care teams?— Rachel Clarke (@doctor_oxford) May 31, 2020
You know, the GPs who actually look after these vulnerable patients.
Do headlines mean more than best patient care? https://t.co/8utAUEXRlF
NHS England primary care medical director Dr Nikki Kanani said she had 'understandably' received a number of queries about the changed advice and promised more information 'as soon as I know more'.
?? I have - understandably - had a number of messages about the #shielding announcements made last night and expected today.— Dr Nikita Kanani (@NikkiKF) May 31, 2020
As soon as I know more, I will post on this thread. In the meantime, please continue to follow the guidance set out:
A DHSC spokesperson said the government had consulted 'extensively' with NHS leaders during the pandemic and hit out at reports that shielding guidance had been changed without NHS England's knowledge.
The spokesperson said: 'It is a complete fabrication to suggest that NHS England were not aware of the shielding guidance being updated.
'We have engaged extensively with partners and the healthcare system throughout this process and will continue to do so when more substantive measures are considered.
'We want to make life easier for the most vulnerable and, as the number of COVID-19 cases continues to fall, the evidence shows those shielding can spend time safely outside if they wish, as long as they follow social distancing guidelines.'