An NHS England primary care bulletin sent on Sunday 20 December said that the deputy chief medical officer has confirmed that shielding will be reintroduced and advice on the government website was updated later in the day to reflect this.
The government will be writing to all patients on the shielding list in the affected areas, with letters being sent out from today (Monday 21 December). NHS England highlighted to practices that the letters may be delayed due to postal issues over the Christmas period and that they will be emailed to patients where an email address is available.
According to current government advice, patients who are advised to shield should not go to work. NHS England has said that shielding patients in tier 4 areas will be eligible for support including free deliveries of medicine and statutory sick pay where they are unable to work from home.
Clinically extremely vulnerable people can still go outside, but they have been advised to strictly follow social distancing measures, keep contact with people outside their household to a minimum and avoid busy areas.
Shielding patients are also advised to stay at home as much as possible, not to travel unless it's essential and to avoid going to the shops. The letters that are being sent to patients should provide them with advice on how they can access any additional support that they need.
Most children will have been removed from the list following guidance from the Royal College of Paediatrics and Child Health earlier this year, however there may be some children under specialist care that are still classed as clinically extremely vulnerable. These children have been advised not to attend school if they live in a tier 4 area.
The NHS England bulletin said: 'As during the previous period of shielding advice, this will be an inevitably difficult and worrying time for clinically extremely vulnerable people. We anticipate that patients may have questions about the advice they should follow. We are very grateful for your continued efforts in supporting those at highest risk from COVID-19 during the pandemic and will be in touch to provide further updates as necessary.'
Tier 4 restrictions
Prime minister Boris Johnson put the whole of London, Kent, Buckinghmashire, Hertfordshire and large parts of the south east of England into tier 4 at the weekend following a rapid rise in COVID-19 cases. Public Health England scientists have confirmed that the surge in cases is directly linked to a new strain of the coronavirus, which was first highlighted last week.
During a Downing Street briefing on Saturday evening Mr Johnson revealed that the new strain of the virus was up to 70% more transmissable than the original version. People living in tier 4 areas have been advised not to travel outside their immediate area in a bid to stop the new variant from spreading to other parts of the country.
On Sunday, health secretary Matt Hancock told the BBC and Sky that the new variant was 'out of control'. He suggested that the restrictions could be in place for 'the next couple of months' until the vaccine is rolled out more widely.
Welsh health minister Vaughan Gething has also said that the new variant has been found in every part of Wales. The country is also now in lockdown.
On Sunday the UK recorded a record daily rise in COVID-19 cases, with another 35,928 infections.