A letter setting out the support the NHS should provide to shielded patients, sent to GP practices and NHS trusts on Thursday, said that care for this group should still be provided at home wherever possible, ideally virtually or online.
However if this was not feasible, for example if a patient needed invasive treatments or diagnostic tests, NHS England said that care could be provided in a clinical setting providing infection control processes were in place.
The guidance says that in such cases, practices should 'identify a safe location and ensure the patient has safe "door-to-door" transport.'
Until now, the standard operating procedure for general practice, which was updated at the end of last week, has stipulated that shielded patients should receive all care at home, recommending that GPs set up a separate home visiting service for this group of patients across PCN areas.
NHS England's letter also reiterated guidance from the latest standard operating procedure for general practice that all shielded patients should have a care coordinator or team 'to help support patient-led follow up or provide regular check ins, where these are required'. The care coordinator could be based in primary or secondary care, but the guidance added that 'for most patients this will be someone from their GP practice'.
The letter advised that this person should provide a 'single point of contact to help support patient-led follow up or provide regular check ins, where these are required.'
As in previous advice, practices have been asked to proactively contact shielded patients to ensure they know how to access care, review and adjust personalised care pans as appropriate and support patients to self manage their health and wellbeing.
Review of shielding guidance
The letter also said that the government plans to further review its guidance for shielded patients during the week commencing 15 June. After this it will write to patients explaining the next steps and the support that will be available to them. GPs have been asked to ensure that they contact any patients they have added or removed from the list before that date if they have not already done so.
NHS England added that, other than the change in advice announced at the weekend that allows shielded patients to spend time outside, the current recommendation remained that these patients should continue to shield at home until the end of June.
In a primary care webinar on Thursday, deputy chief medical office Dr Jenny Harries said that managing people in the extremely clinically vulnerable group at home would remain 'really important' because many patients remained very frightened to go outside.
However, she said that as the lockdown eased further and advice for shielded patients was updated managing people at home, alongside a 'halfway house' in surgeries was 'probably the way to go'.
'Obviously a GP surgery is the one place in their community they're more likely to meet [COVID-19] and so I think sensible precautions about side rooms is good,' Dr Harries added.
During the webinar Dr Harries revealed that the DHSC was developing a new risk algorithm for shielded patients to help healthcare staff and patients themselves understand the risks particular groups or individuals faced.