Medico-legal advice on shielded patients

Dr Myooran Nathan from the MDDUS offers some advice for GPs on how they should deal with queries from shielded patients as guidance for this group changes.

MDDUS medico-legal adviser Dr Myooran Nathan
MDDUS medico-legal adviser Dr Myooran Nathan

The coronavirus pandemic has had a significant impact on the workload of GPs, partly due to the additional work required to identify and support patients who are considered to be 'clinically extremely vulnerable and who should shield.

This has been far from easy. We have seen changes to the groups who should be advised to shield, and issues with the accuracy of those who have – and have not – been identified as clinically extremely vulnerable. 

GPs have had to make difficult decisions about shielding for individual patients. They have had to take into account the available guidance and the needs of those individuals, some of whom understandably have strong views of their own about whether they should shield.

Change in advice to shielded patients

From 1 June 2020, the advice to shielding patients in England and Wales has changed. While such patients were previously advised to stay at home, they are now told it is safe to leave their homes in limited circumstances. 

This will inevitably lead to difficult decisions for some GPs, who will need to be involved in advising patients about how they may choose to respond to the changes. 

In working with their patients, GPs may wish to consider the following advice:

Understand the changes
In this time-pressured environment it can be tempting to rely on the widespread media reporting of changes, which may not always be accurate. Common misconceptions include that the recommendation to shield has ended early, and that shielded patients can return to work.

It may be helpful to ensure all staff involved in advising shielded patients are aware of relevant authoritative guidance. This could include guidance produced by Public Health England, the devolved governments, and organisations such as the RCGP.  

If your practice has a lead co-ordinator for shielded patients, they should ensure colleagues are kept up-to-date.  Your medical defence organisation is also a source of independent support and advice.

Determine what actions may be required
Some practices may decide proactively to contact all shielded patients to provide signposting to reliable sources of patient information. This information could be provided on a website or on an automated telephone message. These steps may avoid unnecessary contacts from patients and save valuable administrative time.

It may be helpful to review your shielded patient list and consider contacting any particularly vulnerable patients that you consider should remain indoors despite the new advice. 

It is important to understand the individual risks for each shielded patient based on their circumstances and co-morbidity. If you have any concerns you may find it helpful to seek advice from colleagues in secondary care as well as other reliable sources of information.

Effective use of available resources
A number of patients may call to discuss the new shielding advice.  Consider training non-medical staff to deal with simple queries, for example by signposting patients to relevant sources of information. It is important to bear in mind that any such delegation should be in line with the GMC guidance on Delegation and Referral, and should not prevent a patient from speaking with a doctor if that is what is required. 

Know your limits
The new advice about shielding is just advice, as is any recommendation made to patients. Ultimately it is for patients to determine how they wish to respond to the changes and any additional information provided to them. 

Many doctors feel concerned about the risks of advising patients whether or not to shield, particularly when available information can be widely interpreted. 

However, it is important for doctors to be aware of the sources of authoritative advice and support available to them and recognise their role, working collaboratively with their patients, to enable them to make informed decisions.

  • Dr Myooran Nathan is medico-legal adviser at MDDUS

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