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GPs told to prioritise an extra 800,000 new shielding patients for Covid vaccination


shielding patients


Another 1.7 million patients will be added to the shielding patient list as the Government has cleared the QCovid risk algorithm for use in England, with GPs asked to prioritise 820,000 of these for Covid vaccination.

The tool, which the Government had initially expected to implement last year, takes into account a number of clinical factors which in combination make patients more likely to suffer severe illness, hospitalisation and death from Covid-19.

Risk factors include age, ethnicity, deprivation, BMI and underlying health conditions such as diabetes and heart disease.

NHS England will write to patients this week to inform them of their new shielding status, while GPs should make sure these patients receive their Covid vaccinations as soon as possible.

The additional patients will be added to the SPL system in two groups – starting with 820,000 aged 19-69, and they will start to receive notifications from this week.

The remaining over-70s are expected to be added ‘as soon as possible after that’, according to a letter sent to GPs by the Department of Health and NHS England. This is because over-70s have already been offered a Covid vaccination.

Affected patients will be contacted centrally to inform them, the letter said, adding that GPs need not contact patients about this themselves. It added that GPs can continue to add or remove patients from the shielding patient list at any time based on clinical judgement and patient request. 

Patients will receive a letter to inform them that they have been identified by the DHSC and NHS Digital as ‘being of similar risk’ to clinically extremely vulnerable (CEV) patients.

‘It will explain that patients will be offered priority Covid-19 vaccination, and will give details of the support available and the additional shielding advice to those who are CEV. It will note that adding people to the SPL is the easiest way to ensure earlier vaccination and emphasise that following shielding advice is voluntary,’ the letter to practices said.

To make sure patients receive the information as soon as possible, they will receive their letter at the same time as GP IT system administrators receive the information. There will therefore be a delay ‘up to five working days’ before patient records are flagged to GPs with the update, NHSE said.

The letter added: ‘In practical terms, this means that those under 65 should be prioritised ahead of others in cohort 6, once the new high risk flags are visible on your system.

‘Individuals aged 65-69 will already be called to vaccination centres as part of cohort 5, but may now be more inclined to use local vaccination services. We ask that Primary Care Network local vaccination services support such requests.’

The QCovid risk tool has been developed by University of Oxford researchers, commissioned by the chief medical officer.

Last summer, the Department of Health and Social Care said it was ‘still being finalised’ with NHS Digital but with a view to having it embedded in GP systems ‘probably by September.

In the letter to GPs, DHSC and NHSE said it is now being implemented because it the ‘model has now been validated using an independent dataset by the Office for National Statistics and shown to perform in the excellent range (as judged by Harrell’s C statistic)’.

Professor Kamlesh Khunti, a GP who helped develop the QCovid system, told Pulse that the algorithm gives the NHS ‘precision’ in terms of identifying the population’s risk level.

Professor Khunti, who is a professor of primary care diabetes and vascular medicine at the University of Leicester and a SAGE advisor, said it ‘targets roughly the top 2% of the population that is at the highest risk from Covid who were outside the shielding list’.

He said: ‘We know age is the biggest risk factor… Now that we’re going to the lower age groups, it suddenly becomes very difficult to say who is the highest or lowest risk within these groups.

‘Covid has shown that people who are elderly, have chronic conditions and ethnic minorities, for example, are all higher risk, but that different risk-factors work differently in different individuals. What this gives us is precision in terms of a population’s level of risk.’

Announcing the update on Tuesday, deputy CMO for England Dr Jenny Harries said: ‘For the first time, we are able to go even further in protecting the most vulnerable in our communities.

‘This new model is a tribute to our health and technology researchers. The model’s data-driven approach to medical risk assessment will help the NHS identify further individuals who may be at high risk from Covid-19 due to a combination of personal and health factors.

‘This action ensures those most vulnerable to Covid-19 can benefit from both the protection that vaccines provide, and from enhanced advice, including shielding and support, if they choose it.’

Note: This article was updated at 14.45 on 16 February to reflect that 1.7 million people will be added to the SPL, however only 820,000 of these are expected to not yet have received an offer of vaccination.

READERS' COMMENTS [5]

Philip Williams 16 February, 2021 8:35 pm

Utterly brilliant that poverty and ethnicity is finally being taken into account. It’s shameful that it’s taken so long

Richard Greenway 17 February, 2021 10:35 am

I have no issue about re-calculating actual risks, and offering people vaccines in group 6.

But we need guidance to prevent deluge of employment / sick note / sick pay queries.
As ever – the press release to the public comes before any guidance to the profession.
Many of these 1.7 million have already been vaccinated. The main difference for them vs lockdown regulations is ability to go to work.

This is now a working age group that we are calling Shielded (I’m assuming the CEV still means High Risk). Telling people that they can no longer go to work at this point in the pandemic will cause economic hardship, and unfortunately this hits people in the lowest paid and most vulnerable groups. Employers won’t risk taking on Shielded employers. Think also teachers and nurses.

This is at a point where we are trying to vaccinate and decrease risk. Can’t GPs just continue with the vaccination campaign please?

Dylan Summers 17 February, 2021 2:21 pm

“Risk factors include age, ethnicity, deprivation, BMI and underlying health conditions such as diabetes and heart disease.”

And gender, presumably.

I find it odd how little media mention is made of gender risk in Covid compared to other risk factors. This article continues the trend.

Jeremy Platt 19 February, 2021 9:17 pm

When you prioritise everyone you prioritise no one. History of gestational diabetes over being 65 years old. For goodness sake.

terry sullivan 19 February, 2021 10:50 pm

and when they say jump–gps to say how high?