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

jane1950 said:

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

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Well I guess nobody HAS to but the guidance for GPs would appear to allow them the discretion to ask their patients to shield if their hb1ac is high. At the end of the day it's down to individuals but I know for a fact if I was told to shield by my GP, I would. x

Brunneria said:

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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I found this on the Versus Arthritis website. (Google Versus Arthritis). It has been developed by The British Society for Rheumatology for those with arthritis, but it seems to me to cover many of our co-morbidities. The really useful thing is that it names a lot of the drugs, and in the case of predisolone gives 2 levels of risk for different doses.

I scored 5, so I filled in the the government form. This satisfied. Sainsbury so I get deliveries, but I’ve not had a letter from the NHS or the GP

Apologies for the lack of a link, I tried but failed.



Risk calculator

Even if you have not had a letter from the NHS, you can estimate your risk level by answering the questions below.
If yes, score
Have you had cyclophosphamide tablets and/or infusions in the last six months? 3

Have you been taking prednisolone 20mg (or more) daily for more than four weeks? 3

Do you regularly take prednisolone 5mg (or more) daily? 2
Do you have any of the following problems: diabetes, lung problems, heart disease, high blood pressure?

Or even if you do not have any of these problems, are you over 70 years old? 1

Are you on just one immune suppression drug and/or injection (other than sulfasalazine or hydroxychloroquine) 1

Are you on two or more immune suppression drugs and/or injections (other than sulfasalazine or hydroxychloroquine)? 2

Add up the numbers above, to make your total:


If you score of 3 or more:
You're likely to be at ‘extremely vulnerable’ and probably need to shield yourself. Register for this help on the gov.uk website. If you're unsure whether you fall in this category, register for help first and then contact your rheumatology department. Do not wait to hear from your rheumatology department before registering for help, register now.
If you score 2:
You're unlikely to need to shield yourself. You should practise very careful social distancing, and self-isolate at your discretion. If you're unsure whether you fall in this category, you can contact your rheumatology department.
Score of 0 or 1:
You should continue to practise social distancing. If you're unsure whether you fall in this category, you can contact your rheumatology department.
Where has this information come from?
The British Society for Rheumatology developed this risk scoring guide and shared it with rheumatology teams across the country. We’ve worked with the British Society for Rheumatology to develop this content.

Pipp said:

Yes, even though it is a bit of a shock to be told I am vulnerable, (despite not having outrageously high HbA1c , ) as I have other conditions, I am, for once in my life, not going to be a rebel, and will do as I am told.

I am really grateful to those, who are making the sacrifices, including adhering to the social distancing stuff, that make a safer world for me.

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I am a little like you Pipp, I normally growl through the day at anyone who so much as gives me a sympathetic look when they find out I have diabetes! I'm super fit, healthy, on top of the world.....BUT for this I would never take a chance and none of us know how our bodies will react to such a virus (and we don't want to put it to the test either). x

Well I scored 3 on that would have been more but have reduced Prednisolone from 20 to 15 mg per day recently and have been taken of Azathioprine because it reduced my leucocyte count to near zero.

I have started getting text messages now, with an option to opt out. I can open a window but not leave the property.

I received my letter today. I have heart disease and diabetes. But the sole reasons I qualify (!) are 1. age, and 2. taking two autoimmunity pills (Prednisolone and Micophenolate Motefil). Was already shielding in anticipation.

I have had type1 for 44 years, elevated HbA1c, mild bronchiectasis, angina and take hydroxychloroquine but have not had any advice either email or nhs letter about shielding. I’m isolating myself but it irritates me that I’m obviously not considered to be vulnerable.

My son received an email today telling him he is in the high risk vulnerable group, we knew this anyway and has to isolate for 12 weeks, he lives on his own too and is already finding it difficult..
His message to me was, 'just got this, better late than never lol'

TInastamper_ said:

I have had type1 for 44 years, elevated HbA1c, mild bronchiectasis, angina and take hydroxychloroquine but have not had any advice either email or nhs letter about shielding. I’m isolating myself but it irritates me that I’m obviously not considered to be vulnerable.

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Sorry to read of your medical conditions, some people, who are not in the very high risk vulnerable group, don't receive a notification to isolate themselves and other's who are not in that group have been sent a notification or their Gp has said they are, very confusing and to some, very frustrating too.

I think if someone just has diabetes, an A1c over 77 or DKA in last year qualifies the person for shealding.

Any thoughts that if one is on the extremely vulnerable list they may not get on a ventilator if they become ill with covid19?
D.

Brunneria said:

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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I have been shielded because I take chemo tablets for a blood condition so my immune system is shot. I am also asthmatic as well as diabetic. I got two texts. One from nhs directly, I assume that was the chemo. The second, three days later from thr go practice. I do suffer terribly from post viral bronchitis and had something with the same symptoms over the new year. If you are in the shielded category sign in to the government website for extremely vulnerable even if you do not need weekly food boxes. I hope everyone is staying safe.

xfieldok said:

I have started getting text messages now, with an option to opt out. I can open a window but not leave the property.

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That’s what I got. Luckily after the second week, when I had to phone my son to shop and drive for an hour to bring me fresh food, I then got an email from Tesco offering a special slot for deliveries. They have been given 110,000 names so far. These must be the people contacted on the Monday. Hopefully all supermarkets will offer their regular customers a slot if needed.

type 2 HBa1c 6.8%. But with asthma and compromised immune system due to taking chemo tablets (for the rest of my life).

jane1950 said:

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

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That's not the advice have received from Gp occupational health and practice nurses. A1c above 70 high risk

hi brunneria thanks for starting this thread. Also to Josie66 hi. Thanks for your contribution. I have hba1c of 80 and spoke to my nurse this week - she has never heard of this and could only say they have just sent out the first lot of letters last week. Being a key worker I feel very scared at the moment especially as my partner is vulnerable too. I shall look on govt website and try contact my HR but it is Bank Holiday Weekend!

I received my letter today.

Bluetit1802 said:

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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I wrote the above post on 7th April. It seems some GP's are more on the ball than others.

I haven't received a letter or text so assumed I wasn't a high risk. Among other things I am over 70, I have diabetes but the main thing is I was diagnosed with Myelodysplasic Syndrome which is a form of blood cancer in 2017. I have been on immunosuppressant tablets for about 18 months and have regular blood tests. It was only when I received a call from the blood clinic doctor last week with the results of my latest blood test and I said that I assumed I was low risk as I hadn't received a letter she said she was going to throw a spanner in the works as I was VERY high risk and to stay at home. i have already stayed in for three weeks but will need to go for more blood to be taken in three weeks. I am glad I read the information here which gives a clearer picture of what I must and must not do.