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Copy of letter sent out to NHS GPs re Shielding (03/04/20)

Discussion in 'Diabetes Discussions' started by Brunneria, Apr 7, 2020.

  1. Brunneria

    Brunneria Other · Guru
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    Hi All,

    Found the letter below today. Thought you might all be interested to read it.
    Clearly the identification of those who need to Shield is ongoing, and it suggests to me that if you feel like you should be shielding, then contacting your GP would be a good idea, as would self identifying on the www.gov.uk website.

    I guess we all have to accept that this is a HUGE task for all concerned, and it is something that is taking time, and a lot of effort on the part of our docs and consultants and other healthcare workers.

    So I am also thinking that people who don't fit the extremely high risk criteria are better off not bothering their docs, since all those extra calls will just clog up the phones and prevent the health care professionals from assessing those at extremely high risk.

    Personally, I would love people to post once they know they are on the Shielding list, to say what they think the criteria was that got them put on it. It would help others to understand the process.
    High HbA1c? If so, what was your HbA1c?
    COPD? If so, mild? severe?
    Asthma? If so, mild? severe?
    and so on...

    https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk-patients/

    https://www.england.nhs.uk/coronavi...ically-highest-risk-patients-3-april-2020.pdf

    CEM/CMO/2020/015 3 April 2020
    FAO: GP Practices Update on the Government’s shielding policy and implications for General Practice
    Please note, the group of people the shielding policy applies to is referred to interchangeably as ‘at highest clinical risk’ and ‘extremely clinically vulnerable’.

    Dear colleague,

    Professor Chris Whitty (Chief Medical Officer) and Professor Steve Powis (NHS England Medical Director) wrote to you on 21 March with information about the Government’s shielding policy, which aims to identify and give advice to the 1.5 million individuals at highest clinical risk of mortality and severe morbidity from COVID-19.

    Shielding involves staying at home and avoiding face-to-face contact for a period of at least 12 weeks.

    We know that there have been mixed messages about this patient group.
    To clarify the process of identification of patients and next steps you should take in your practice, we have developed a set of Frequently Asked Questions (FAQs) aimed specifically for a GP and hospital clinician audience. We have also developed a separate set of FAQs for patients.

    In summary:
    • Most patients in the highest clinical risk group, who have been advised to shield, have been identified and contacted either centrally by the NHS or by secondary care clinicians. This week we expect more people to be identified as we are validating the centrally-held list against general practice data. People identified through this process will be sent a letter in the post and these will also be flagged in your GP system.
    • The letter sent to you on 21 March asked you to identify additional patients who may be known to your practice as being at highest clinical risk (referred to as Group 4 in that letter). We are aware that there have been other sources of guidance asking you to identify and contact large numbers of extra patients. We ask you to disregard this.
    • A number of patients have self-identified as being in the highest clinical risk group on the government website. Next week, you will be sent details of the patients in your practice who have self-identified in this way. We ask that you review this list and consider if any of them should be included in the highest clinical risk group. Please send a letter to any you consider to be at highest clinical risk and add a flag to their record. You may wish to contact the people who self-referred and who you consider to not be the highest clinical risk group to confirm that they do not need to shield
    . • Secondary care clinicians are reviewing people across specialties such as rheumatology, dermatology, gastroenterology, renal, respiratory, neurology, obstetrics, maternity and patients with severe specific diseases who cannot be identified through the central dataset. These patients will be flagged on the GP system.

    After reading the FAQs, if you have any further questions relating to the shielding process, please contact (email removed because it is for NHS professional use only)

    We want to thank you for your ongoing support and patience at this very difficult time. We understand the pressures you are under in primary care, and this is foremost in our minds as we navigate the national response to COVID-19.

    We are hugely appreciative of all your efforts to deliver the best care in these difficult circumstances.

    Kind regards,
    Dr Jenny Harries OBE
    Dr Nikita Kanani MBE
    Deputy Chief Medical Officer for England Medical Director for Primary Care NHS England and NHS Improvement
     
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    #1 Brunneria, Apr 7, 2020 at 10:03 AM
    Last edited: Apr 7, 2020
  2. Brunneria

    Brunneria Other · Guru
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    #2 Brunneria, Apr 7, 2020 at 10:05 AM
    Last edited: Apr 7, 2020
  3. xfieldok

    xfieldok Type 2 · Well-Known Member

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    I registered last week, it said to phone gp or clinic. Phoned gp, nowt to do with us. I see a neurologist but not a clinic as such. Phoning surgery later to see if they have received further instructions.
     
  4. Brunneria

    Brunneria Other · Guru
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  5. KK123

    KK123 Type 1 · Well-Known Member

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    Thank you for the post Brunneria, I note you have done a lot of work on this subject! It goes to show what a mammoth task it must be for the NHS, it was probably easy enough to classify the very vulnerable groups but every individual sitting just below that must have a wide ranging and sometimes complicated set of health conditions that taken together would place them into that category. I can just imagine my own Dr sitting there trying to work out an individual risk assessment that may not necessarily be able to be described as one 'condition' and doing the same for thousands of patients.
     
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  6. zand

    zand Type 2 · Master

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    Yes thank you for this thread and all of your other informative posts about COVID19. They are much appreciated.:)
     
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  7. Pipp

    Pipp Type 2 · Expert
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    Thanks for your diligence in getting relevant, concise, information to us @Brunneria.

    Putting my usual aversion to sharing personal info aside, in the hope that it will be helpful to others, I believe, (though have letter but haven’t had clarification of reason for it) I am placed in the shielding category for the following reasons:

    • Hypertension for 40+ years, well controlled with medication
    • T2 diabetes for 15 years, no complications, controlled Metformin, most recent HbA1c 51, higher than usual.
    • Asthma, well controlled with preventer inhaler, only needing to use reliever inhaler infrequently, such as when I have a cold, or hay fever. Though have needed steroid tablets a few times over last year.
    • Very recent injection in joint of steroid Kenalog, and allergic reaction to that
    • Immune system disorder of mast cells which produces allergic type reactions to all sorts of stimuli, requiring medication, Montelukast, which suppresses immune system.
    • BMI 30+
    Although I generally feel quite well, I am following the instructions, as is my only other housemate, and isolating.
    Hope this helps.

    edit to add: not bothering GPto ask for reasons, it is fairly obvious to me.

    edit #2 to clarify. Received letter re: shielding on 2nd April. Apologies for any confusion.
    Edit #3 further info in text from NHS received today 7th April. Posted further down this thread.
    https://www.diabetes.co.uk/forum/th...ps-re-shielding-03-04-20.173415/#post-2245820
    Edit #4 further NHS text received 16th April. Posted further down thread post #42
    https://www.diabetes.co.uk/forum/th...shielding-03-04-20.173415/page-3#post-2250034
     
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    #7 Pipp, Apr 7, 2020 at 11:08 AM
    Last edited: Apr 16, 2020
  8. Brunneria

    Brunneria Other · Guru
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    Thanks @Pipp

    I was actually hoping that people would post once they had received a Shielding letter, to explain what criteria they thought had made the NHS send it out to them, so that others could gain a better understand of why they have/have not received one.

    Maybe if your Shielding letter arrives in the next few days you could update your post to say you have actually received one?

    Having said that, I fully appreciate that threads are fluid things, and the OP rarely gets any say in what happens after they press the 'Create Thread' button. :D:D:D
     
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  9. zand

    zand Type 2 · Master

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    One person I know was told to shield himself by phone by his GP. He has a pulmonary embolism. Don't think he had a letter.

    The person I know who had a letter doesn't have a spleen and is on antibiotics for life after a serious illness 10 years ago.
     
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  10. xfieldok

    xfieldok Type 2 · Well-Known Member

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    I have just received a text from the NHS telling me to stay at home for 12 weeks, a letter to follow.

    It's not for diabetes though.
     
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  11. Josie66

    Josie66 Type 2 · Well-Known Member

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    I got a shielding letter last week T2 high hba1c just had metformin increased. Hypertension stable on meds. High BMI. I rang GP surgery to say I thought I needed to be shielded and was told it wasnt required. A week later got the letter telling me to stay home for 12 weeks
     
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  12. jane1950

    jane1950 · Well-Known Member

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    diabetics dont have to be shielded, even if you have high HBa1C levels
     
  13. zand

    zand Type 2 · Master

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    But anyone with a high HbA1c would be wise to shield themselves as much as possible anyway.
     
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  14. Brunneria

    Brunneria Other · Guru
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    The www.gov.uk website clearly explains what the criteria are for Shielding and where people with 'just' diabetes stand.

    However, if you read the forum you will quickly see that there are numerous members posting here who don't 'just' have diabetes. So the more information that is available for those who may (or may not) fall into the Shielding category, the better.

    If you are fortunate to 'just' have well controlled diabetes, then this thread is not relevant to you.
     
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    #14 Brunneria, Apr 7, 2020 at 2:52 PM
    Last edited: Apr 7, 2020
  15. Pipp

    Pipp Type 2 · Expert
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    Yes will edit. Had letter last week. No explanation.
     
  16. Brunneria

    Brunneria Other · Guru
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    Brill - thanks! :)
     
  17. Pipp

    Pipp Type 2 · Expert
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    In addition to shielding letter I received last week, I have, today, received a text message from NHS. This is the content of the text.

    “We have sent you a letter with advice about Coronavirus and the option to register on a government website. Some people are having problems doing this - we will text you again when the problem is fixed. You don’t need to call your GP or the council about this unless you have an urgent medical or social need.”
     
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  18. xfieldok

    xfieldok Type 2 · Well-Known Member

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    For clarity this is the message I got. On steroids and immunosupressants.
    Screenshot_20200407-162023_Messages.jpg
     
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  19. Bluetit1802

    Bluetit1802 Type 2 (in remission!) · Legend

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    My daughter received a letter today (she did not receive the original shielding letter). She has no serious risk illnesses - just a mild form of asthma and colitis. She is not diabetic. For several months she has been on a high dose of steroids for a colitis flare up, and has been slowly reducing the dose. She finished the steroids 3 weeks ago. As she has now finished the steroids she has been told to self isolate for a 3 more weeks rather than shield. After that she can go back to social distancing.
     
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  20. Brunneria

    Brunneria Other · Guru
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    Wow, that is impressive. With the current workloads that her doc must be under, to tailor the instructions to her particular case.
    Well done that doc!
     
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