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

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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Scientists are now in talks with the government to suggest due to the number of diabetics who have died, that diabetics are included in the extra vulnerable group and asked to shield themselves for a while when the country starts to open up, could be difficult for some

jane1950 said:

Scientists are now in talks with the government to suggest due to the number of diabetics who have died, that diabetics are included in the extra vulnerable group and asked to shield themselves for a while when the country starts to open up, could be difficult for some

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I have taken onboard good personal hygiene, always washing hands, social distancing etc, I go on walks for exercise and shop for food once a week and I would dearly like to continue to do so. I personally don't see myself as extremely vulnerable.

Robinredbreast said:

I have taken onboard good personal hygiene, always washing hands, social distancing etc, I go on walks for exercise and shop for food once a week and I would dearly like to continue to do so. I personally don't see myself as extremely vulnerable.

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As shielding is advice to protect you rather than others there would be no need to comply if you don't want to.

jane1950 said:

Scientists are now in talks with the government to suggest due to the number of diabetics who have died, that diabetics are included in the extra vulnerable group and asked to shield themselves for a while when the country starts to open up, could be difficult for some

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This isn't going to happen. If some diabetics are asked to shield it won't be all of us. There are too many of us, and many are also key workers. I beleieve it is most likely to be those with very high uncontrolled BS levels, and those who already have complications of some sort. They still haven't produced figures to show how many of these diabetics that have died had other illnesses, or how many were otherwise fit and healthy.

Bluetit1802 said:

This isn't going to happen. If some diabetics are asked to shield it won't be all of us. There are too many of us, and many are also key workers. I beleieve it is most likely to be those with very high uncontrolled BS levels, and those who already have complications of some sort. They still haven't produced figures to show how many of these diabetics that have died had other illnesses, or how many were otherwise fit and healthy.

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My understanding is that scientists are reviewing, but nowhere has it been suggested or written that scientists are going to advise all diabetics are shielded. . Partha Kar has suggested on a number of threads that it would be extremely unlikely that there will be a one size fits all approach.. I think there's been some reading of sensationalist headlines being interpreted as fact by some.

I think the research itself was brilliant and very welcome.. Including identifying diabetes as a risk factor in itself and even for myself as under 40 I still think that needs to be adhered to and precautions taken.. However if we are to take the salient points form the data then it must be in its entirety and that is risk differs across the wider diabetic family.

However I do agree that there is some limitation as it doesn't state how many had no other comorbidites/conditions. From first glance it seems a lot suffered from hypertension though.

Yep and hypertension isn't even listed as "clinically vulnerable" let alone "extremely". More than likely due to once again the sheer numbers who would have it, especially undiagnosed I suspect.

From what I can gather you don't have to shield if you wish not to even if suggested. However where it would help is those that are advised to work from home if possible as clinically vulnerable. I know some employers are trying to use the "there is no work from home" excuse to strong arm some clinically vulnerable people back to work with the threat to wages or even jobs. The Shielded List is black and white rather than the Clinically Vulnerable being almost a matter of interpretation so being shielded would more likely safeguard wages and jobs until at least more is known about risks etc.

Jamie H said:

However I do agree that there is some limitation as it doesn't state how many had no other comorbidites/conditions. From first glance it seems a lot suffered from hypertension though.

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Type 2 is one part of the metabolic syndrome. The other parts are hypertension, high cholesterol and triglycerides, and tummy fat. With many (or most) T2s these occur together. A poorly controlled T2 is likely to have all of them. It also concerns me when folk are put on ventilators/induced comas, they are tube fed. It won't be low carb. It will contain glucose.

Bluetit1802 said:

Type 2 is one part of the metabolic syndrome. The other parts are hypertension, high cholesterol and triglycerides, and tummy fat. With many (or most) T2s these occur together. A poorly controlled T2 is likely to have all of them. It also concerns me when folk are put on ventilators/induced comas, they are tube fed. It won't be low carb. It will contain glucose.

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Yup agree with all of that 100%. I know they've identified diabetes as a risk solely so regardless of how low risk an individual is based on age it would be extremely ignorant to ignore that risk altogether however its also ignorant so suggest a blanket policy for all diabetics when risk varies so much.

I think demonstrating how many had other conditions would have been beneficial. Perhaps this feeds into the age correlation.. Young type 1s who are well controlled and not had the condition for a long time (in relative terms) are less likely to have other comorbidties.

Also type 1s 80 plus are less likely to have had access to the technology we have today and could have been diabetic for a very long time etc. The raw data is great but some further commentary would be excellent.

Jamie H said:

. Perhaps this feeds into the age correlation.. Young type 1s who are well controlled and not had the condition for a long time (in relative terms) are less likely to have other comorbidties.

Also type 1s 80 plus are less likely to have had access to the technology we have today and could have been diabetic for a very long time etc. The raw data is great but some further commentary would be excellent.

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I'm a 53 year old T1 and in my 36th year, I have no other comorbidities and am reasonably fit, so didn't and still don't expect to be told to shield, work's ok as it's outdoors but gym openings bothers me, I did read about over 50's getting back in later on, but if so I'll cancel and re-join with a later date of birth

If it's ok for dom and all that jazz.....

Bluetit1802 said:

Type 2 is one part of the metabolic syndrome. The other parts are hypertension, high cholesterol and triglycerides, and tummy fat. With many (or most) T2s these occur together. A poorly controlled T2 is likely to have all of them. It also concerns me when folk are put on ventilators/induced comas, they are tube fed. It won't be low carb. It will contain glucose.

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I think that's why we need to know more. I've got the tummy fat, but got my triglycerides down from 8.2 when first diagnosed to 2.6 at last test. (Bizarrely at one point they were 8.9 early June and when retested late June they were 2.8.) Go figure! Cholesterol 3.5 at last test a year ago, down from it's worst at 7.2. (That's non fasting test btw.) Blood pressure fine on a 24 hour monitor last year and Heart CT showed all heart arteries ok bar minor soft plaque on one or two with a calcium score of 0 also last year. Last HBA1c 58 in December after being 48 last June! So where I am on the risk scale - I have absolutely no idea!!!

I think that's the problem we are all facing. So little in the way of real concrete information and half of our GP's seem to have no idea either. That's not just diabetics either it's all those with "underlying conditions". From my point of view anyway I'm siding on the cautious until we know more even though I'm not on the shielded list.

One other thing re the great posts above is that it would be helpful if we all knew what percentage of these underlying conditions were diagnosed or undiagnosed. Meds of course can help reduce the levels in the above co-morbidities so are these people turning up at hospital with undiagnosed out of control BP, hypertension etc? Or are some drugs people take having an adverse effect or have they all gone quiet on that possibility?!

kev-w said:

I'm a 53 year old T1 and in my 36th year, I have no other comorbidities and am reasonably fit, so didn't and still don't expect to be told to shield, work's ok as it's outdoors but gym openings bothers me, I did read about over 50's getting back in later on, but if so I'll cancel and re-join with a later date of birth

If it's ok for dom and all that jazz.....

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I am 9 years older than you and in my 31st year, I haven't expected a shielding letter and don't see my self as extremely vulnerable, I have other medical conditions too.

Does autoimmune disease mean a weak immune system?

Immune system disorders cause abnormally low activity or over activity of the immune system. In cases of immune system over activity, the body attacks and damages its own tissues (autoimmune diseases). Immune deficiency diseases decrease the body's ability to fight invaders, causing vulnerability to infections.14 Aug 2018

Robinredbreast said:

Does autoimmune disease mean a weak immune system?

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Well in my case it wasn't that my immune system was weak or strong just mistaken.

It's now weak because I take medication to keep it that way so as to prevent it making a fatal mistake.

JohnEGreen said:

Well in my case it wasn't that my immune system was weak or strong just mistaken.

It's now weak because I take medication to keep it that way so as to prevent it making a fatal mistake.

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Obviously it depends on the condition or conditions that people have.
My autoimmune conditions seem to have started through shock, worry and stress !

Mine started when I woke up one Thursday morning in May about twenty years ago. Talk about in the blink of an eye.

Max68 said:

Yep and hypertension isn't even listed as "clinically vulnerable" let alone "extremely". More than likely due to once again the sheer numbers who would have it, especially undiagnosed I suspect.

From what I can gather you don't have to shield if you wish not to even if suggested. However where it would help is those that are advised to work from home if possible as clinically vulnerable. I know some employers are trying to use the "there is no work from home" excuse to strong arm some clinically vulnerable people back to work with the threat to wages or even jobs. The Shielded List is black and white rather than the Clinically Vulnerable being almost a matter of interpretation so being shielded would more likely safeguard wages and jobs until at least more is known about risks etc.

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I completely agree with this, I’m self employed and unable to go back to work safely and the pressure is huge, as at the moment if I don’t go back then it’s my own choice (I’d always choose my health first) but at least if I had something official to say “you are in this group, you are allowed to do X & Y, but not Z” then I could show others/my insurance company etc. And, dare I even say it...the government might continue to give some financial help to those who couldn’t safely work?

Thankyou for this post. I've been so stressed about work. I work in a care home. I havent been there since mid march,since then sadly they have had a lot of deaths although when staff and residents tested last week all tested negative. When I spoke to my GP in April things re diabetics bit of grey area for carers. Despite trying to keep up to date I didnt realise advice changed subtly to staying at home as much as possible and avoiding contact other than household. Reckon 12 hours in a hot care home with what's left of residents and a rotation of staff not a good idea then. To be fair to GP and employers they have been trying best in a tricky situation.