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GPs go forth

GP practices spending 26 hours a week verifying shielded patient lists

Exclusive GP practices in England have spent an average of 26 hours a week reviewing whether patients should be shielding during the coronavirus pandemic, according to a survey of the profession by Pulse.

After assessing the list of shielded patients provided by NHS England, practices have on average each had to remove 30 patients from the list, while adding in 53 patients who have been missed off, the survey results revealed.

GPs have described the list of patients provided to them by NHS England as ‘poor’ due to the number of misidentified patients and some have said practices would have been better off checking their patient lists without NHS England’s help.

GP leaders said verifying shielded patient lists was a 'complex and timely process' and that it was crucial NHS England accounted for the time it would take GPs so it did not add to their already higher workload.

NHS England said it is 'right' that the most clinically vulnerable patients are 'supported proactively by their GP practice'.

Its director of primary care, Dr Nikita Kanani, has previously apologised for the delay in NHS England providing lists of shielded patients to practices for them to review, and for the tight deadlines it set GPs to complete the checks by.

GP practices were asked to assess NHS England’s list of patients requiring quarantine for 12 weeks and then decide whether more should be added because they are at the highest clinical risk from Covid-19 - or if some should be removed because they are not in the highest risk category.

NHS England said from the outset the national data it was using to draw up the list was not sophisticated enough and so it would require help from GPs and hospital consultants to ensure patients were contacted about having to shield.

But delays in NHS England compiling its list and sending out shielding letters to patients meant GPs were forced to wait until Easter before they could review those patients. This resulted in a last-minute rush for practices to complete their assessments and GPs say it led to them working under ‘ridiculous pressure’.

Meanwhile, practices are expected to be still working their way through assessments of patients who have self declared as requiring shielding, due to be completed by 28 April.

In Pulse’s survey of 588 GPs in England, which took place between 17 and 21 April, it was revealed that practices have spent on average 26 hours a week reviewing shielded patients.

Meanwhile, out of around 365 GPs in England responding to a question about shielded patient assessments, the survey results showed practices are on average finding NHS England has wrongly identified 28 of their patients as requiring shielding – while having missed 52 patients who do need to shield.

Dr Julie Kitlowski, a GP based in Sheffield, said this work had created a ‘ridiculous pressure at such a busy time’.

She said: ‘When the Government sent the letters out to patients this immediately cranked up our workload as patients were ringing the practice with questions about why they had or had not had the letter.

‘This put particular pressures on our skeleton reception staff as well as clinicians.’

She added: ‘Then last week we were tasked with ringing all the patients on the very vulnerable lists, which generated a huge number of phone calls and all sorts of long conversations whilst trying to triage all the normal day-to-day enquires.’

Another GP taking part in the survey, Essex-based Dr Sally Dowler, maintains practices could have searched their own patient data more effectively than NHS England.

She said: ‘GPs could have done it much better ourselves if allowed.’

Dr Dowler, who works at a practice with a patient list size of 14,500, added: ‘We had to go through 3,300 patients records over Easter weekend. So that was Saturday and Sunday - as we were working Friday and Monday.

‘That’s about 500 patient records each and it took hours. And now of course they are all phoning to query why as there is no explanation in the letter about complex co-morbidity.’

Dr Kevin Hollier, a GP partner in Worcestershire, described the shielded patient list provided by NHS England to practices as ‘poor’.

He said his practice was refusing to downgrade all patients incorrectly identified by NHS England as requiring shielding, because they would still be at some elevated risk from Covid-19.

Dr Hollier said: ‘We have found that 20-30% of the patients on the list don't meet the criteria but in many cases we feel reluctant to remove and downgrade them. Many of the patients are still vulnerable even if they don't need to shield.

‘Once told by the Government to shield there is some feeling of risk in downgrading them because some will inevitably develop severe Covid-19 over time.’

He added: ‘We have only been downgrading some of the patients who are clearly at the lower end of the risk spectrum but haven't downgraded many of the more vulnerable at the moment.

BMA GP Committee chair Dr Richard Vautrey said: 'Ensuring the list of shielding individuals is accurate is extremely important to ensure the most vulnerable in society are protected. It is a complex and timely process that does requires the input of GPs, patients and NHS England and Improvement, including clinical and non-clinical systems to ensure it is accurate and maintained.

'It is vital that NHSEI factors in the time needed for GPs to make adequate patient assessments so as to not add to the additional workload burden being placed on GPs at this time.'

An NHS England spokesperson said: 'Given that in order to protect particularly clinically vulnerable patients they are being asked to stay at home and stay safe, it is right that they are supported proactively by their GP practice.'

It comes as NHS Digital has now got 1.85 million patients on the shielding lists, as GPs are going through a final smaller cohort of patients who have self-identified as vulnerable. These may or may not get added to the list.

Initially, NHS England had said it expected some 1.5m patients to require shielding.

Readers' comments (7)

  • I thought PCNs would represent the largest burden on GP’s, but patients asking for Shielding letter for a splinter in their finger has taken the biscuit!!

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  • David Banner

    After the heartbreaking loss of CQC and appraisal, thank God they found an alternative useless, pointless, time devouring task for us to waste on hours of our lives that we will never get back.
    You clap for NHSE now.

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  • I really would not mind if I thought it was at all effective.

    Those that think they are at risk will already be isolating properly - regardless of their underlying risk.
    Those who don't think they are at risk will not have their mind changed by this system.

    Most people only want to be on the shielded list because it is easier to get supermarket delivery. When those same people are told they need to continue isolating despite the rest of the country being allowed to relax isolation they will just ignore the advice.

    And just to top the whole hing off - the system for choosing patients is ridiculous. Why does a 22 year old asthmatic with a few courses of prednisolone being dispensed by a quick to prescribe GP need shielding, but a 75 year old with ischemic heart disease and moderately poorly controlled diabetes not need shielding?

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  • Patients are autonomous adults. They will (and indeed should) make their own decisions about this. There is enough advice out there about risk factors. In any case so much depends on an individual's approach to 'risk'.

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  • The whole 'extremely-vulnerable' list idea was simple, and wrong, based on the experience and evidence above.

    Announcing policy before understanding the problem was step one.

    Then NHS Dig believing it has access to the right data steptwo.

    NHS Digital persisting in its delusion, despite multiple sources explaining why it was unable to do the job step three.

    Each step could have been done differently, and in itself could have been fixed.

    I think most GPs would have willingly stepped up to deliver the weekend after the initial announcement, even without being given criteria. We would have grumbled, some wouldn't have managed, but we would have had a more comprehensive list with much less overall work.

    The same issues have dogged the whole response. There has been a massive concentration of 'power' or 'activity' centred around a small group of individuals.

    They have persistently failed to recognise that they are not able to do everything centrally, even when clearly demonstrated by being incapacitated.

    A lack of delegation to the mechanisms in place to deal with the different aspects of response has been a significant and repeated theme.

    It is true that with delegation comes a need to trust that those mechanisms/ organisations are up to the job, and not all are. Where there is delegation there is the potential for parallel and cross cover which solves the problem. Without delegation this doesn't happen.

    'Chain of command', and 'command and control' have been used as excuses for the centre to demand certain activities. Instead of being used to pass decision making to the appropriate level in a well organised system.

    It is also the mechanism for the responsibility to passed back up the 'chain' to stop with the 'decision-maker'!

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  • Much of the problem here though is incorrect belief about risk being created in the public by the government, and an inability for GPs to separate their belief of who is vulnerable to COVID (based on long held views on frailty) and an inability to consider that the categories as described in the NHS digital information prescribe who is defined as at highest/shielding risk. The group was deliberately created to be very limited and we were told not to run searches looking for alternative patients - but to add those we know who fit the criteria.

    There are huge grey areas, especially co-morbidity and how much individual disease risk and age add up but as already said those who feel at risk will shield and all the letter does is help then access minimal support services.

    Anyone having to go through 3330 out of 14500 records misunderstood the process.

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  • Three words:
    -incompetence
    -pointless
    -bonkers

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