During a webinar on 24 April, NHS England director of primary care Dr Nikki Kanani said: 'I know there's been confusion over splenectomy. Splenectomy is in the shielded patient list, and 45,000 patients who have had a splenectomy have been sent their letters already, and that that will obviously be added to but that's the broad number at the moment.'
The statement appears to reverse previous advice on shielding - updated on 11 April and still available on the NHS England website at the time of writing - which says patients 'who have had your spleen removed' are 'not in the highest clinical risk registry (or shielding group)'.
Guidance on shielding vulnerable patients from COVID-19 on the RCGP website suggests the earlier advice was a 'mistake'.
The RCGP e-learning module says: 'Patients who have had a splenectomy should shield. There were some early communications which mistakenly said that this was not the case, but these have been clarified.' It adds: 'NHS Digital will identify any patients with a splenectomy who have been wrongly taken off the shielding list.'
The change of policy on splenectomy patients comes just days after Dr Kanani apologised over how NHS England has handled identification of patients who need to shield during the COVID-19 pandemic, admitting the process had been 'really frustrating'. In this week's briefing the primary care director said identifying shielded patients had been 'one of the most complicated pieces of work' during the pandemic.
The process has been fraught with confusion - around 900,000 patients were initially identified from hospital data and automatically sent a text or letter advising them to shield at the end of March.
At the time, GPs were also sent guidance about adding further patients to the list, which NHS England later told them to disregard – although only after many practices had already started this work. Instead, NHS England centrally identified a further 400,000 patients using primary care data, and letters started being sent to this group from 7 April.
GP practices only had access to final lists of patients asked to shield just before Easter - and were suddenly instructed to review these to ensure the correct patients had been identified by the end of Easter Monday, a deadline that was eventually extended.
Dr Kanani said GP practices should check on splenectomy patients added to the shielding list to make sure they 'understand what's going on'.
NHS England has also extended a deadline for practices to verify patients who have self identified as at-risk until Tuesday 28 April.
Slides shown to GPs during the Thursday webinar said 'the majority of the work to establish the shielded patient list is near completion and by the end of the month we expect this to have resulted in the identification of about 2m people'.
Patients on the shielding list include those who have had a solid organ transplant such as a kidney or liver transplant, people undergoing some treatments for cancer, those taking immunosuppressant drugs, those with severe respiratory conditions and patients with some rare diseases.
The RCGP learrning module says further patients have been added to the shielding list since advice was first issued. It says 'patients with interstitial lung disease, some with broncheictasis and those with pulmonary hypertension' had been added to the list.