GPs should review 1.5 million patients identified by NHS England as the most vulnerable to the coronavirus (Covid-19).
NHS England will send a standard letter to these patients asking them to stay at home at all times and avoid any face-to-face contact for at least 12 weeks.
GPs will be able to access a report on which patients will be contacted with specific advice from today – with NHS England directing GPs to review the list and provide additional support to patients.
The patients, who are at ‘the highest risk of severe illness that would require hospitalisation from coronavirus’, include those who have had an organ transplant; people with specific cancers; people with severe respiratory conditions; people with rare diseases; people on immunosuppression therapies; and pregnant women with significant heart disease.
NHS England said in a letter to GPs: ‘We ask that you review this report for accuracy and, where any of these patients have dementia, a learning disability or autism, that you provide appropriate additional support to them to ensure they continue receiving access to care.’
GPs can identify the patients contacted by NHS England through an ‘at high risk’ indicator code that has been applied to each patient record by the practice’s clinical system supplier.
‘Your supplier will inform you of the code they have used, which should be treated as temporary until a definitive list of Covid-19 “at risk” SNOMED codes is released,’ NHS England said.
‘Your GP System supplier will also provide a report that will list those patients that have been centrally identified as being at high risk. You should have this by 23 March.’
But NHS England said central datasets were ‘not sophisticated enough to identify all categories of patients who should be included in the vulnerable groups list’ and it was therefore calling on GPs and specialist consultants to help identify patients who may have been missed.
The letter said: ‘We appreciate this is a complex task requiring difficult judgements, and we ask for your help, as the GP central to the care of these patients, in achieving this.’
In a separate letter, England’s chief medical officer Professor Chris Whitty asked GPs to add to the list of most vulnerable patients using their ‘clinical judgement’.
The letter said: ‘You may know of specific additional patients in your practice who you think are particularly high risk.
‘On the other hand there are a limited number of people that we can shield effectively or for whom this highly socially isolating measure would be proportionate on health grounds; many patients who fulfil the criteria may after discussion with you prefer not to be placed under such strict isolation for what will be a prolonged period.’
Patients who will be contacted by NHS England
1. Solid organ transplant recipients
2. People with specific cancers
• People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
• People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
• People having immunotherapy or other continuing antibody treatments for cancer
• People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
• People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.
3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD
4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease)
5. People on immunosuppression therapies sufficient to significantly increase risk of infection
6. People who are pregnant with significant heart disease, congenital or acquired
Source: NHS England