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

[Pipp]

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.

I think in that situation I would ask the doctor at the blood clinic to ensure you are placed on the government at risk list, and your GP should be informed too.
As for future blood tests, some people deemed to be at high risk are having the blood taken at home. Perhaps this would be an option for you?

 

[Pipp]

I have today received another text from NHS No Reply

“Next week you should be able to register on the Government COVID website for high risk patients if you need support. We’ll contact you when this is confirmed. If you have an urgent non-medical need now and relatives / friends can’t help, contact the council on ***********. If you have a medical need contact your GP.”

All I can say is that I hope this is not the sort of message being sent to really frail, lonely, elderly and disabled folks. I am fortunate in that I am able to source food and supplies from local independent suppliers, but fear there are many truly vulnerable and helpless folks less fortunate. If they, like me, are following instructions to stay home this last 4 weeks, and supermarkets are only registering people for home deliveries when the Government registers them, they will be in a sorry state by the time they get help.

 

[Deleted member 475901]

My daughter was expecting the letter, but it was delayed and we had to organise food for her until she finally started getting the food boxes - even with those she still needs some shopping because they don't cover a week's food, but it took a while before any of the supermarkets contacted her.

The boxes have little in the way of fresh fruit and veg, and are totally unsuitable for anyone one a special diet - they cannot be tailored.

I am not classed as extremely vulnerable - but I take two different steroids and they only look at each in isolation, I can't get a figure for the combined dose equivalent.
However, after registering on the gov.uk site just in case, they did pass my info onto a supermarket who offered me priority delivery slots. Good thing as the supermarket delivery I've used for over 15 years cancelled my deliveries from the end of March.

 

[JohnEGreen]

If you have a medical need contact your GP

Sounds OK just found out my GP is working from home he talked to my daughter by phone yesterday and for her iron deficiency as he had recieved a letter from one of her consultants so he recommended she buy some 200mg tablets he would not prescribe them as the pharmacist is having trouble sourcing them.

 

[DavidGrahamJones]

Personally, I would love people to post once they know they are on the Shielding list

Just got my letter, just as well I didn't wait for their advice although I have been making one trip a week to the shops at 07:00 in an effort to avoid as many people as possible. I've now decided to get the local co-op to do my shopping for me and deliver it. I'll lose out on my 10% discount (Tuesday over 60s) but avoiding this virus is more important.

Apart from being overweight, my high BP for which I take medication is usually around 130/75, my BG for which I take Metformin, last HbA1c 44, my liver isn't 100% thanks to Rosiglitazone, diagnosed prostate cancer a year ago but PSA less than one so no treatment. Currently taking zinc, magnesium, Berocca (fed up with water), CoQ10, Vit D.

 

[Awty]

I have type 1 with just above hba1c average. 44 years old with no other issues. Got a letter this morning to say I am in the extremely vulnerable category. Surely this can’t be right!?

 

[Brunneria]

Thank you to everyone still keeping this thread alive.

Out of curiosity, I checked back on the NHS link (see 1st post on thread) and found a new letter dated 9th April

Very informative.
I encourage anyone to read it here, https://www.england.nhs.uk/coronavi...tes/52/2020/03/SPL-Letter-to-GPs-09042020.pdf and check out the references and additional info at the bottom of the doc.
The letter itself is copied and pasted below. Apologies for the clumsy paragraphing. The entire thing copied across as a single wodge of text, and I have attempted to break it back up for ease of reading, and had to break it into two posts because it was too long to fit into one post:

To: General Practice From NHS England and NHS Digital

Dear Colleagues,

Thank you for your considerable patience as we work to improve the process for identifying individuals at highest clinical risk from Covid-19, following our letters of 21st March and 3rd April.

As you know, we are asking this group who are at highest clinical risk of mortality and severe morbidity from COVID-19 to shield, stay at home and avoid face-to-face contact for a period of at least 12 weeks. The Government has established a national support offer to make sure they have access to medicines and basic supplies during this time. This letter now confirms the specific tasks we need GPs to complete in this process, and by when they need to be completed.

As set out in the FAQs shared with you on 3 April, there are three parts to this work:
• Part 1: Nationally held data was used to identify patients, based on criteria agreed by the United Kingdom Chief Medical Officers (CMOs) (see annex for list and the associated codes)
• Part 2: Primary care data extracted centrally to identify additional patients, based on the same clinical criteria
• Part 3: Hospital specialists and GPs adding or subtracting individual patients from this register

We now need all practices to complete the work involved for them in parts 1-3 of the patient identification process, as set out in this letter as soon as possible, and by no later than 17:00 Tuesday 14 April. This is to ensure that all relevant patients have been given essential advice on shielding. It will ensure all patients added locally will be able to access the government support offer.

There will be a time lag between you flagging any additional patients, and the information being processed centrally, and if in the meantime any of these patients require urgent additional support they should contact their local authority.

We appreciate that this is a Bank Holiday. We are asking for considerable work to now be finalised by practices in a short space of time. We are hugely appreciative of the efforts you have already made and the extra final effort that this will involve you making. New codes are being set-up on GP systems to capture Covid-19 vulnerability, testing and other factors. NHS Digital has defined a new SNOMED CT code set related to Covid-19 and all GP suppliers are adding these codes to their systems.

These codes are being added in 09 April 2020 2 two waves: the implementation of the most critical flag (“High risk category for developing complication from Covid-19 infection”) has been completed first. The additional codes, including flags for medium and low risk Covid-19 risk, are being implemented subsequently. The high-risk codes are in place in all systems. The medium and low risks codes are already available in TPP systems and will be made available in other systems by 14/04.

 

[Brunneria]

cont...

The full set of new codes being deployed are detailed in an Annex at the end of this letter. The work we need you to do falls into the following four categories:

1. Reviewing individuals identified nationally through the clinical algorithm (Parts 1 and 2 of the patient identification process) NHS Digital identified individuals with the conditions defined in the clinical algorithm.

Part 1 was conducted on 20/03 on a fast-track basis, using data from Hospital Episode Statistics, Primary Care Prescribed Medicines, the Personal Demographic Service and the Maternity Services Dataset. This identified approximately 900k individuals.

Part 2 analysis was completed on 06/04 using more granular data from general practice data sets, at which point the count of individuals identified grew to approximately 1.3m. GP records for all the individuals identified through the clinical algorithm (Parts 1 and 2) will be updated through national updates. In all these cases the new flag “High risk category for developing complication from COVID-19 infection” will be set. These updates have already been made for the first 900k individuals identified in part 1 and will be complete by the end of day on 10/04 for the second set of individuals in part 2. The reason the individual has been identified as “high risk” will also be entered, and in some cases visible to patients. We appreciate that because we have relied on routine data there will be inaccuracies, and some patients who should be included will be missed whilst others will have been flagged incorrectly. We have included some text to indicate that this assessment is based on a central assessment of national data and may be subject to modification. All newly identified individuals will receive SMS communications and letters from the Government informing them that they have been identified as vulnerable and provided with guidance on self-isolation and information about how to access the many support systems being made available for them.

What do GPs need to do? In order to identify the individuals within your practice who have been identified as vulnerable through the clinical algorithm, please run the search process as defined by your system provider. For your convenience, we have added the current search guidance from each supplier in an Annex to this letter (below).

3 If you feel any of these patients have been inappropriately identified as high risk, then you should flag these individuals as medium or low risk once those flags are available within your system (note that the ‘high risk’ flag will remain set). In these cases, you may wish to contact these patients to discuss your revised assessment of them.

When must this work be done? This work can commence immediately since the individuals identified in the first phase are already flagged, and by Saturday morning it will be possible to identify all individuals flagged nationally since all updates will have been applied. The task needs to be completed as soon as possible and no later than by 17:00 Tuesday 14 April. 2.

Reviewing individuals identified nationally by secondary care providers (Part 3a of the patient identification process) It has always been clear that the clinical algorithm will inevitably not capture every individual who is at highest clinical risk. Additional provision has therefore been made for secondary care clinicians to add patients to the registry. In many cases these are individuals undergoing cancer treatment and, in some cases, they are individuals with complex conditions or combinations of conditions. Patients identified via this route should receive letters directly from their secondary care clinician, who should also inform the GP that they have designated the patient as someone at highest clinical risk. Trusts are providing lists of these patients back to NHS Digital so that the patient’s GP record can be updated with the same new flag “High risk category for developing complication from COVID-19 infection”. In addition, where Trusts have provided free text information detailing the basis of the judgement or additional information about the reason for the individual being at highest clinical risk, that information will be transcribed into the text field associated with the high risk Covid-19 flag.

What do GPs need to do? If you feel any of these patients have been inappropriately identified as high risk, then you may wish to discuss this with the patient and/or the Trusts who have identified them. If different opinions persist, categorise the individual using the highest risk category view. When should this work be done? This work needs to be done on an ongoing task. Updates will soon be received from hospitals on a regular basis and will regularly be updated into GP systems. 4

3. ** Adding flags for individuals who you know to be vulnerable ** (Part 3b of the patient identification process) The full list of individuals identified via the clinical algorithm and the additional names provided by secondary care clinicians will still be incomplete. GPs will be aware of a relatively small number of additional individuals who have not been captured though either of these practices but who they consider in their professional judgement to be at high clinical risk and should therefore be shielded. What do GPs need to do? For all individuals within your practice who you view to be at high risk from Covid-19, please ensure they are flagged as high risk, if they have not already been flagged nationally. For those patients you flag as high risk, you will also need to send them a copy of the patient letter giving advice on shielding [https://www.england.nhs.uk/coronavi...2020/03/at-risk-patient-letter-march-2020.pdf]. NHS Digital will pull the details of these flags from GP IT systems weekly. Once this has happened these individuals will be able to access the government’s shielding support offer (which they may have already registered for). There will be a lag in processing this information and if in the meantime any of these patients require urgent help they should contact their local authority. When should this work be done? This work can commence immediately since GPs will already be aware of their most vulnerable patients. The sooner flags are applied the faster individuals can be offered shielding support. The task needs to be completed as soon as possible and by no later than 17:00 on Tuesday 14 April. 4. Reviewing individuals who have self-identified as vulnerable A number of patients have been able to self-identify as clinically extremely vulnerable via the Cabinet Office website. The names of individuals who registered on the website prior to 29 March but have not been identified through the central process, will be communicated to each GP Practice shortly. This list will be sent to you within your GP IT system on or around 17th April. The number of patients is relatively small, and it is unlikely you will be adding any or many of these, given the review you will have already completed of patients the practice has added.

What do GPs need to do? Once you receive the list, please review these individuals, determine their appropriate Covid-19 risk category and flag them as high, medium or low risk as 5 appropriate. For any of these patients you flag as high risk, you will need to send them a copy of the patient letter giving advice on shielding. NHS Digital will pull the details of these flags from GP IT systems weekly and individuals who you flag as high risk will receive the full government shielding service. Individuals who you flag as medium or low risk will not receive a shielding service. When should this work be done? This work can commence after 17th April. The task will need to be completed by 17:00 on Monday 20th April.

We recognise the pressure General practice is under and we are grateful for all your efforts to help protect the most vulnerable patients during these difficult times. Thank you very much for your support. If you have any questions, please contact the NHS Digital Shielded Patients List Hub: [email protected]. This mailbox will be monitored and responses provided asap throughout the Easter period.

Dr Nikita Kanani Medical Director for Primary Care NHS England and NHS Improvement
Mark Reynolds Workstream Lead, Shielded Patient List NHS Digital
https://www.england.nhs.uk/coronavi...tes/52/2020/03/SPL-Letter-to-GPs-09042020.pdf

 

[JohnEGreen]

Well they make it sound so simple in the most complicated way as GPs dont have enough on their plate.
Anyway letter or no letter list or no list I know what I'm going to do and that's stay in shelter till the all clear is sounded.

I just realised the other day that as a myasthenic I've been practicing a form of social distancing for years about fifteen years or so, I'm just stepping that up a notch or two. This will probably be the same for many people on the forum.

 

[Awty]

Thanks for the letter. Interesting. Still don’t understand why I have been given a letter, but I guess that’s something I need to take up with my GP!

 

[xfieldok]

Thanks for the letter. Interesting. Still don’t understand why I have been given a letter, but I guess that’s something I need to take up with my GP!

After I got my letter, I got a text to say I could opt out.

 

[JohnEGreen]

Though I have not so far got a letter I did just get a phone call from the council asking if I was OK did I need food supplies as I am isolating for the twelve weeks gave me a number to call if I need help and told me how to access help from the local volunteer force.

Nice of them to call like that sort of cheered me up.

 

[xfieldok]

Just this minute got a call from a lovely lady. Was offered food parcels. I said as T2 I can't eat carbs, so I can't eat 90pc and husband is highly allergic to malt. She said nightmare! She said if needed she could arrange for a volunteer to collect a shopping list.

 

[Bluetit1802]

Though I have not so far got a letter I did just get a phone call from the council asking if I was OK did I need food supplies as I am isolating for the twelve weeks gave me a number to call if I need help and told me how to access help from the local volunteer force.

Nice of them to call like that sort of cheered me up.

Someone must have told your council you were in the 12 week group, so it is odd you haven't had a letter.

 

[JohnEGreen]

weird isn't it the council seems to know more than me about my status in the coronovirus stakes,

 

[Baz-]

Received the letter on the 27th of March
Stay at home for at least 12 weeks
Phoned GP to ask why?
Reason - HbA1c 9.8% (December 2019)
No other underlying illness
Age - 59

 

[Max68]

Received the letter on the 27th of March
Stay at home for at least 12 weeks
Phoned GP to ask why?
Reason - HbA1c 9.8% (December 2019)
No other underlying illness
Age - 59

Funny how there seems to be such a difference in opinion in the medical fraternity. My HBA1C in December was 58, which is what 9.3%? plus I'm on BP meds and no shielding letter. Got a sick note from GP saying to work at home but as per my thread I'm being reduced to SSP as others with underlying conditions are going back to work at school. I guess if I had a shielding letter work wouldn't have been able to SSP me. Unfortunately Government guidelines of "just to social distance" and a mere sick note won't wash with employers especially if they claim you can social distance at work.

What I can't understand is these tables you constantly see stating the top three risk factors are "allegedly" cardiovascular disease, hypertension and diabetes and yet neither diabetes or hypertension are on the shielding list. Probably down to the fact that's probably what 30% of the population - at least!

 

[DCUKMod]

Funny how there seems to be such a difference in opinion in the medical fraternity. My HBA1C in December was 58, which is what 9.3%? plus I'm on BP meds and no shielding letter. Got a sick note from GP saying to work at home but as per my thread I'm being reduced to SSP as others with underlying conditions are going back to work at school. I guess if I had a shielding letter work wouldn't have been able to SSP me. Unfortunately Government guidelines of "just to social distance" and a mere sick note won't wash with employers especially if they claim you can social distance at work.

What I can't understand is these tables you constantly see stating the top three risk factors are "allegedly" cardiovascular disease, hypertension and diabetes and yet neither diabetes or hypertension are on the shielding list. Probably down to the fact that's probably what 30% of the population - at least!

Max, I think you have your HbA1c conversion a bit muddled:

https://www.diabetes.co.uk/hba1c-units-converter.html

At 58 your HbA1c is 7.5%, which is equal to an average blood glucose of 9.3.

I don't know how you're doing managing your diabetes, but it could be significantly lower already, if you've managed to work out a way of eating that works for you..

 

[Max68]

@DCUKMod It's so confusing. My GP just uses the 58 number HBA1C so I get really confused with all the percentages! Yeah I'm trying to get it down. It was 48/49 for two years after reducing it from 64 which was the highest. It was 48 last June and had jumped to 58 in December. Only thing I can think is it was a stressful 6 months when mum was diagnosed with dementia and I had to sort everything out like care homes and her personal stuff which probably meant I took my eye off the ball and comfort ate etc. Since the Covid thing hit I've been trying to eat far less carbs and have bacon, eggs, sausages that sort of thing along with fresh fruit although not sure how that will react, but I'm trying and doing some miles on an exercise bike each night and try and walk a few times a week. Not sure if 58 is a disaster but I was really gutted it jumped 10 points in 6 months! Was due another check in June.

By the way love to know how you got the little slider to appear on that table as I tried three different browsers yesterday and it didn't appear on any!!!

 

[HSSS]

@DCUKMod It's so confusing. My GP just uses the 58 number HBA1C so I get really confused with all the percentages! Yeah I'm trying to get it down. It was 48/49 for two years after reducing it from 64 which was the highest. It was 48 last June and had jumped to 58 in December. Only thing I can think is it was a stressful 6 months when mum was diagnosed with dementia and I had to sort everything out like care homes and her personal stuff which probably meant I took my eye off the ball and comfort ate etc. Since the Covid thing hit I've been trying to eat far less carbs and have bacon, eggs, sausages that sort of thing along with fresh fruit although not sure how that will react, but I'm trying and doing some miles on an exercise bike each night and try and walk a few times a week. Not sure if 58 is a disaster but I was really gutted it jumped 10 points in 6 months! Was due another check in June.

By the way love to know how you got the little slider to appear on that table as I tried three different browsers yesterday and it didn't appear on any!!!

Unless it’s berries I’d drop the fruit. Not only for the carbs but the fructose does your type 2 liver no favours, adding to insulin resistance