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Copy of letter sent out to NHS GPs re Shielding (03/04/20)
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<blockquote data-quote="Brunneria" data-source="post: 2253709" data-attributes="member: 41816"><p>cont...</p><p></p><p><em>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:</em></p><p><em></em></p><p> <em>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. </em></p><p><em></em></p><p><em>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. </em></p><p><em></em></p><p><em>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. </em></p><p><em></em></p><p><em>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).</em></p><p><em></em></p><p> <em>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. </em></p><p><em></em></p><p><em>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. </em></p><p><em></em></p><p><em>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. </em></p><p><em></em></p><p><em>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 </em></p><p><em></em></p><p><em>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 [<a href="https://www.england.nhs.uk/coronavirus/wpcontent/uploads/sites/52/2020/03/at-risk-patient-letter-march-2020.pdf" target="_blank">https://www.england.nhs.uk/coronavirus/wpcontent/uploads/sites/52/2020/03/at-risk-patient-letter-march-2020.pdf</a>]. 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. </em></p><p><em></em></p><p><em>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. </em></p><p><em></em></p><p><em>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: <a href="mailto:splquery@nhs.net">splquery@nhs.net</a>. This mailbox will be monitored and responses provided asap throughout the Easter period. </em></p><p><em></em></p><p><em>Dr Nikita Kanani Medical Director for Primary Care NHS England and NHS Improvement </em></p><p><em>Mark Reynolds Workstream Lead, Shielded Patient List NHS Digital</em></p><p><a href="https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/SPL-Letter-to-GPs-09042020.pdf" target="_blank">https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/SPL-Letter-to-GPs-09042020.pdf</a></p></blockquote><p></p>
[QUOTE="Brunneria, post: 2253709, member: 41816"] cont... [I]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 [[URL]https://www.england.nhs.uk/coronavirus/wpcontent/uploads/sites/52/2020/03/at-risk-patient-letter-march-2020.pdf[/URL]]. 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]splquery@nhs.net[/email]. 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[/I] [URL]https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/SPL-Letter-to-GPs-09042020.pdf[/URL] [/QUOTE]
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