Patients who are shielding are advised that they can choose to be part of a Christmas bubble, which will see restrictions relaxed for groups of up to three households between 23 and 27 December, but warned that 'it does involve greater risks for you'.
The guidance advises shielded patients to maintain social distance from anyone they don't live with at all times over the festive period and ensure everyone in the bubble washes their hands regularly and that spaces are kept well ventilated and cleaned frequently.
Patients should also 'think about who you sit next to, including during meals, and also consider wearing a face covering indoors where social distancing may be difficult as well as encouraging others to do the same'.
The guidance says: 'You will continue to minimise your risk of infection if you limit social contact with people that you do not live with, even at Christmas. It is important that you and the other people in your Christmas bubble consider these risks carefully before agreeing to form a bubble. Forming a Christmas bubble is a personal choice and should be balanced against the increased risk of infection.'
The updated guidance also sets out advice for clinically extremely vulnerable patients in each of the three tiers of local restrictions which come into effect on 2 December. While everyone is advised to work from home where possible, shielded patients who are unable to do so have been told that they can go to work in all three tiers.
Patients are also advised that they can go outside for exercise in all three tiers and can meet friends and those in their support bubbles in line with the rules for their tier.
However, those in tier 3 are being advised to stay at home as much as possible and maintain social distance within their household if it is practical. Those in tier 2 are advised to keep the number of different people they meet with 'consistently low'.
During an NHS England webinar on Thursday 26 November, NHS England deputy primary care medical director Dr Raj Patel said that patients on the shielded list should receive letters explaining the updated guidance starting from this weekend.
At the start of November, GP practices were advised that adults with Down's syndrome and those with stage 5 chronic kidney disease should be added to the shielded patient list. A full list of those covered by the advice for clinically extremely vulnerable people is here.