New conditions added to shielded patient list ahead of England-wide lockdown

Adults with Down's syndrome and those with stage 5 chronic kidney disease should be added to the shielded patient list, NHS England has told practices, ahead of the nationwide lockdown this week.

Updated guidance on shielding is imminent (Photo:Justin Paget/Getty Images)
Updated guidance on shielding is imminent (Photo:Justin Paget/Getty Images)

GPs should also urgently review and remove all children who are no longer deemed to be clinically extremely vulnerable from the list, NHS England said.

A letter to practices from NHS England primary care medical director Dr Nikki Kanani on 2 November said that government advice on shielding will be updated 'imminently', which will provide detail of the 'support available for people who are clinically extremely vulnerable'.

During a press conference announcing the lockdown at the weekend, prime minister Boris Johnson said that the government would 'not ask people to shield again in the same way' during the coming month.

'However we are asking those who are clinically extremely vulnerable to minimise their contact with others, and not to go to work if they are unable to work from home,' he said. Government advice on the  lockdown, which comes into force on Thursday, says that patients on the shielded list should stay at home as much as possible, 'but are encouraged to go outside for exercise'.

NHS England's letter said that the government would be writing to everyone on the shielded patient list setting out the new guidance this week. Patients will be able to use this letter as evidence to claim statutory sick pay if needed.

Children and shielding

The letters that are sent to parents and guardians of children on the shielded patient list will tell them that their child should have been reviewed by a clinician and will ask parents to contact their GP or specialist if they have not heard the outcome of this.

Dr Kanani said that practices should 'plan to urgently respond to calls from parents and guardians of children on the shielded patient list seeking a review'. She added that 'the vast majority of children and young people who have been reviewed to date using the Royal College of Paediatrics and Child Health guidance have been found to be no longer considered clinically extremely vulnerable'.

Practices should also 'urgently identify, contact and flag adults with Down’s syndrome', Dr Kanani said, adding that they could use this as an opportunity to schedule an annual health check and ensure that they receive a flu vaccine.

A new patient letter will be available shortly for practices to send to this cohort, which will also be available in an easy read format. Practices are advised to send both the full letter and the easy read version to patients.

The letter added that practices should continue to maintain the shielding list 'by adding a high risk flag for patients you identify as being clinically extremely vulnerable, and notifying the patient of their status and the advice they should follow'.

Predictive risk tool

The letter also revealed that work is still ongoing to develop a COVID-19 predictive risk model and decision support tool, which the government had suggested would be available to GPs before a second wave of the pandemic earlier this year.

The model, which is being developed by the University of Oxford, takes into account 'age, sex, pre-existing conditions, ethnicity and BMI to predict weighted and cumulative risk of serious illness at an individual level,' the letter said. 

It is emerging data from the model which has led to the recommendation that adults with stage 5 chronic kidney disease and those with Down's syndrome be added to the shielded list. The Oxford model does not cover children and the CMO has advised that children and young people with Down's syndrome should not automatically be included on the list.

The new guidance from the government on shielded patients will be published here when it is available.

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