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Over 400,000 patients given inflated Covid risk scores due to missing data

Over 400,000 patients given inflated Covid risk scores due to missing data

Exclusive Over 400,000 patients may have been given an inflated risk score under the new QCovid algorithm, Pulse has learned.

Where certain information is missing from a record held by NHS Digital or is recorded as unknown, default values are used by the algorithm – taking a ‘precautionary approach’ with regards to their Covid risk.

NHS Digital explained that this means that patients for whom no weight has been recorded are analysed as if they are obese (BMI 31), as this patient group are the most vulnerable to severe Covid illness. 

Likewise, if no ethnicity data is available the patient is analysed as if they are Black; and if no postcode is available they are analysed as if they live in an averagely deprived area.

NHS England last month approved the use of the long-awaited QCovid risk tool to identify patients who should be shielding because they are at higher risk of complications from Covid-19.

As a result, 1.7 million patients were added to the list, 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 – including gender, ethnicity, deprivation, BMI and underlying health conditions.

NHS Digital told Pulse that approximately 430,000 patients had one or more default value used because of missing data, and admitted that the risk assessment result may therefore overestimate risk for some of these individuals.

However NHS Digital argued it was ‘highly unlikely’ that people with defaults applied would meet the threshold for addition to the shielding patient list based on a single default alone.

And a spokesperson told Pulse that any patient who felt they were wrongly told to shield should contact their GP and asked to be removed.

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They said: ‘Patients can speak to their GP or specialist clinician if they have questions, or if they feel they should no longer be identified as clinically extremely vulnerable. 

‘As they have always done, GPs and specialist clinicians can make their own assessment and are able to add and remove individuals from the Shielded Patient List.  GPs can also review the free text entry alongside the high-risk flag on individual records to identify whether or not default values were used.’

NHS Digital stressed that the Department of Health and Social Care had opted for the precautionary approach to ensure at-risk people are not inadvertently excluded from vaccination prioritisation and the shielding patient list.

However some GPs argued this issue could cause unnecessary work in general practice and it comes as GPs have already been asked to review patients with Down’s syndrome and past gestational diabetes after QCovid coding errors.

Dr Lucy Martin, a GP in Dudley, said: ‘This is a workload pressure that we could do without, as it depends on pre-existing coding which is patchy in some places, and the continued changing evidence means that the patients have been re-classified.

‘The piece of work needing doing again took us many hours and still didn’t resolve it all – there are many patients calling in asking: “Why am I in group six, I don’t have a problem” or: “I should be in a different group”.

She added: ‘GP workload has been increasing year on year for so long, but the pandemic and Covid vaccine programme seems to have influenced workload in different ways.’

Dr Simon Hodes, a GP in Watford, said: ‘The QCovid is a great concept to try and risk stratify those most in need of a Covid vaccine. However, once again, we have seen centrally created “at risk” lists being inaccurate, causing anxiety and uncertainty for patients and more chaos for grassroots GPs.

‘All the patient enquiries and concerns ultimately fall back to GP teams to deal with once again. The phone traffic and enquiries regarding the recent shielding letters, asthma eligibility and QCovid invitations have been huge and ultimately is increased workload for all our staff without any additional resources. Perhaps if the Government wants this done, it could be offered as a DES and properly resourced and funded?’

Note: This article was updated at 15.00 on 11 March to reflect a clarification from NHS Digital regarding the deprivation score. NHS Digital had initially told Pulse the algorithm defaulted to the highest deprivation score.



Please note, only GPs are permitted to add comments to articles

Patrufini Duffy 11 March, 2021 3:25 pm

What’s the score if you don’t put a mask on in Lidl, or top deck of a bus? Tools can be tools.