GPonline reported on 16 February that 1.7m additional patients had been identified as being at increased risk from COVID-19 based on a combination of factors including age, ethnicity, BMI and medical conditions or treatments.
The overhaul - based on data analysis by the QCovid risk assessment tool developed at the University of Oxford - will almost double the number of patients on shielding lists from the previous 2.2m total.
Meanwhile, the government has confirmed that patients currently asked to shield will be asked to continue to do so until the end of March 2021.
NHS England has said shielding lists will be updated automatically to reflect the change - although patients may be informed before updates appear in practice IT systems because the changes may take up to five working days to come through to practices.
GP practices have previously been deluged with calls during the pandemic as policy changes sparked confusion among patients.
The shielding overhaul will add around 250 patients to the group considered at high risk per average practice - and practices will now need to contact many of these patients to arrange COVID-19 vaccination.
Around 820,000 of the 1.7m total added to the shielding list are outside the over-70 age group already offered a first dose of COVID-19 vaccine by the NHS and will now be prioritised for a jab. NHS England has confirmed in a letter to GPs that patients in this group 'should be prioritised ahead of others in cohort 6, once the new high-risk flags are visible on your system'.
GP practices may also need to revise additions to the shielding list where patients have been added inappropriately. A letter from NHS England makes clear that a 'precautionary approach' was taken that may have inflated the number added to shielding lists.
It says: 'If certain information is missing from a patient’s record, then default values have been used as a substitute to calculate risk assessment results. A precautionary approach has been taken, to allow patients identified as at high risk to access vaccination, support and advice including to shield.
'Clinicians can use the COVID-19 Clinical Risk Assessment Tool to review a patient’s risk assessment results (more information is available on the NHS Digital website), and can add or remove patients from the SPL as per the usual process.'
Responding to the changes, BMA chair Dr Chaand Nagpaul said: 'The BMA has long highlighted the fact that people from an ethnic minority background, especially with underlying conditions, are at high risk of death from COVID-19 and that those from poorer areas are also twice as likely to die from this terrible disease. Both of these groups are now included in this new QCovid risk tool.
'Many of these patients fall outside of the current JCVI priority groups for the COVID-19 vaccine and so it is now vitally important that these patients are prioritised for vaccination and urgently protected.
'Additionally, adding a large swathe of the population to the shielding list at short notice is a process that needs to be very carefully managed. Understandably, this will be concerning for those who will now have to shield and may be questioning why, at this stage, they are being asked to do so - as well as having to manage fears over the implications for their lives going forward.'
GPs responding on Twitter backed the changes - with one saying it was the right thing to do despite the extra work it could generate for general practice. Others said the addition of patients in risk groups previously not prioritised for vaccination would 'save lives' - but said the changes should have come sooner.