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Kidney Cancer UK News

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How GP’s should support ‘Shielded’ Patients

Patients who are most at risk of severe complications from COVID-19 have been asked to ‘shield’ themselves. This means that they should stay at home and avoid face-to-face contact with anyone from outside of their household. Members of their household are advised to stringently follow social distancing rules.

Which patients are affected?

The following patients were on the CMO’s original list of high-risk patients:

  • People with a solid organ transplant such as a kidney or liver transplant
  • People with cancer who are undergoing active chemotherapy or radical radiotherapy for lung cancer
  • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • People having immunotherapy or other continuing antibody treatments for cancer
  • People having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
  • People who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.
  • People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD. The criteria to identify severe asthma and severe COPD is here.
  • People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
  • People on immunosuppression therapies sufficient to significantly increase risk of infection. The relevant therapies are listed here (Annex F).
  • People who are pregnant with significant heart disease, congenital or acquired.

The following groups have since been added to the list:

  • Patients who have had a splenectomy*
  • Patients with interstitial lung disease, some with bronchiectasis and those with pulmonary hypertension**
  • Renal dialysis patients#

* During a webinar on Thursday 23 April, NHS England primary care medical director Dr Nikki Kanani said that patients who have had a splenectomy had also been added to the list and had been sent letters. However, this has not been updated on official guidance. She also asked practices to check to make sure that these patients had been added to the list.

**An RCGP learning module on shielded patients has also been updated to advise the patients with interstitial lung disease, some with bronchiectasis and those with pulmonary hypertension should also be included in the group. It adds: ‘These patients will be identified and contacted by secondary care, but you may receive queries from them in primary care.’

#A primary care bulletin on 27 April confirmed that renal dialysis patients have been added to the shielded list. Renal units will contact patients and send them a letter.

How many patients does this affect?

Around 900,000 patients were identified via hospital data at the end of March and received a letter advising them to shield. Flags should have been added to GP systems to identify these people. A second phase identified a further 400,000 patients using primary care data and letters and texts started being sent to this group on 7 April.

Practices should have received advice on how to run a system search for a report containing this list of patients from their system suppliers. Current search guidance for each system provider can be found in the annex to this letter to practices.

If GPs considered there were patients on the register who should not be included, they were advised to code them low/medium risk vulnerability – system suppliers should have advised the practice of which code to use. The original code will remain in the record, but any reports run will use the most-recently added code.

If these patients were on the initial central list they may have already received a letter advising them to ‘shield’. Therefore practices may need to contact these patients to discuss their circumstances.

Other patients

There has been some confusion about adding further patients to this list because practices were initially asked to identify additional people using guidance produced by NHS England, the BMA and the RCGP, which suggested the patient groups this could cover. NHS England later told practices to disregard this.

GPs and consultants will also be able to add additional patients to the shielding group throughout the pandemic by using appropriate codes. Any patient identified by the practice should have been sent a letter (template letters are here). Patients identified in secondary care should receive a letter from their hospital doctor, who should also inform the practice that they have identified this patient.

If GPs don’t agree that a patient identified as ‘high risk’ by the hospital falls into this category they should discuss it with the trust. If different opinions still exist the patient should remain in the highest risk category.

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