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Covid-19 Primary Care Resources


Shielding



The shielded patients list is currently being centrally updated using the QCovid Risk Assessment Tool

This information is sourced from PHE, the Royal College of Physicians (RCP), the British Thoracic Society (BTS), NHSE, NHS Digital and RCGP learning:

Key updates for GPs for the current 2021 Lockdown:

  • This is the current clinically extremely vulnerable (CEV) list on the NHS Digital website (adults with Downs syndrome and people with CKD 5 were added in November 2020)
  • Current shielding advice has now been extended until 31st March
  • From 15th February the QCovid Risk Assessment Tool is being applied remotely to primary and secondary care data to centrally identify additional patients at high risk from Covid-19 (therefore GPs may not get the same results if they run the tool themselves)
  • Newly identified patients who should be shielding will be sent new letters from NHSE
  • Patients who are CEV should not go to work, should stay home as much as possible and only go out for exercise
  • If they cannot go to work the may be furloughed or would be eligible for Statutory Sick Pay
  • Decisions on which children are in the CEV list should be made by paediatricians
  • GPs should liaise with paediatricians if unsure whether a child is CEV or signpost parents with queries to their paediatrician
  • Women with a history of gestational diabetes may or may not be classified as CEV depending on their overall QCovid score

PHE advise that people who are CEV should shield even if they have had both doses of the vaccine

Guidelines for primary care on providing care to patients who are CEV:

  • Ensure the patient has a high risk flag in their care record which is visible to all teams involved in the patient s care
  • Ensure a named lead co-ordinator is in place, either in primary or secondary care
  • Review and update personalised care and support plans and undertake any essential follow-up
  • Provide care at home wherever possible; if this is not possible, provide safe care in infection-controlled clinical settings
  • People who are CEV may be anxious about accessing health services: GP practices should support them by explaining the infection prevention and control measures
  • Household contacts of those on the NHS Shielded Patient List are included on the expanded influenza immunisation programme

The decision to shield is a matter of individual choice:

  • Shielding is a severe intervention
  • The additional benefit gained from this extra measure needs to be weighed against any impact on mental and physical wellbeing
  • The decision to shield is not an all or nothing choice. Patients choosing to leave home can still adopt a number of behaviours that offer important protection from infection
  • Only the individual patient can determine what degree of restriction they are prepared to accept for the degree of risk reduction it would offer
  • The decision for most individuals will be influenced by an estimation of their personal risk; this varies widely between individuals currently in the shielding cohort
  • If a patient has a terminal illness, or have been given a prognosis of less than 6 months to live, or have some other special circumstances, they may decide not to undertake shielding. This will be a deeply personal decision

NHS Volunteer Responders can provide support for vulnerable people who are shielding

PHE have produced guidance for the public on shielding

See also: QCovid Risk Calculator