URGENT: Guidance on shielding patients defined as extremely vulnerable from COVID-19 (Update Weds 27th May)
Publish Date: 27/05/2020 16:30:00 BST
Yesterday (26th May) we updated your EMIS Web system with the latest weekly Shielded Patient List (SPL) data, which as of last weeks’ update now includes patient subtractions (those who are being removed from the SPL) as well as new additions to the list. This latest cohort of SPL additions and subtractions is collectively referred to as SPL8.
As with previous updates, new additions have been identified centrally by NHS Digital and NHS England, and these patients will be contacted by NHS England this week via a central letter; practices do not need to contact these patients unless clinical review indicates that they should be considered as either moderate- or low-risk instead.
EMIS Health have not been involved in the methodology behind identifying these patients.
As usual, we have added the approved high-risk code (shown below) to any patient identified as an SPL addition in this update, so that GP systems are in-sync with the national SPL, and those patients will then be included in our corresponding EMIS Library search, ‘Patients at high risk of complications from COVID-19 infection’ once that search is re-run:
High risk category for developing complication from COVID-19 infection
Concept ID: 1300561000000107
Description ID: 2601331000000112
As with all previous SPL updates, practices should clinically review any patient identified as an SPL addition. If practices disagree with the high-risk categorisation then they should recode the patient as either moderate- or low-risk using the codes show below, which will remove them from the national SPL:
Moderate risk category for developing complication from COVID-19 infection
Concept ID: 1300571000000100
Description ID: 2601371000000114
Low risk category for developing complication from COVID-19 infection
Concept ID: 1300591000000101
Description ID: 2601431000000117
It is the practices’ responsibility to inform the patient of any such change (a standard letter has now been provided by NHS Digital and will be made available as a Document Template in EMIS Web – more detail below). All decisions should be made in line with the published CMO guidance. Changes will not be reflected in the national SPL until the next GPES data extraction to NHS Digital, which takes place weekly (details regarding the timings of data flows can be found here).
Patients identified as being subtracted from the SPL in SPL8 have been coded with the appropriate moderate-risk or low-risk code according to the data we have received from NHS Digital, and therefore will no longer be included in the results of our ‘Patients at high risk of complications from COVID-19 infection’ search. Practices do not need to contact any patient identified as being subtracted from the SPL in this update; it is the responsibility of the consultant removing the patient to make contact and inform the patient of this decision. Similarly, if you recode a patient as moderate- or low-risk then it is your responsibility to inform them.
As well as the usual SPL additions and subtractions, NHS Digital have this week identified a group of patients who were flagged by NHS Secondary Care Trusts for addition to the national SPL between 1st – 18th April 2020, but due to a processing delay were not included in the SPL cohorts given to us and flagged in your EMIS Web system during that period. NHS Digital have stated that this delay has only affected a small proportion of patients, all of whom have now received a shielding letter from their secondary care organisation and have been added to the national SPL.
These extra patients will be added to your system later today (27th May). The date that the patient was originally identified as needing to shield will be included in additional text alongside the code that we add to the care record. Please clinically assess these patients alongside any other patients identified in as SPL8 additions.
How are these patients identified in my system?
Your SPL8 updates, including the additional list that we will provide today, may include up to three new lists of patients in total, all of which will be added to the folder titled ‘EMIS Health: COVID-19 searches’ within your local Population Reporting folders. Note that we will not create any lists where there are no patients to populate them; the number of patients included in the SPL8 update, both additions and subtractions, is much smaller than previous updates, therefore it is possible your practice may not receive one or more of the lists described below.
The list of new SPL8 additions is titled ‘Shielding patients identified centrally, added 26th May 2020 (SPL8)’.
The list of subtractions (patients who have been removed from the SPL) is titled 'Patients removed from SPL 26th May 2020 (SPL8)'.
The list of additional NHS Trust additions from April will be titled 'Shielding patients identified centrally, added 27th May (April Trust Additions)'.
These lists will be in the following location in your EMIS Web system - these lists are NOT in the EMIS Library:
EMIS Ball > Reporting > Population Reporting > *your practice name* > EMIS Health: COVID-19 searches
Clinicians may continue to flag any additional patients that they feel need to be included on the SPL but have not been identified in any previous cohorts, using the ‘High risk category for developing complication from COVID-19 infection’ code. Patients flagged in this manner will be added to the SPL following the weekly data extract to NHS Digital.
Patients identified locally should be contacted by the practice; please use the provided letter, available as a Document Template within the EMIS Library, titled ‘COVID-19 High risk patient letter’:
EMIS Ball > Configuration > Template Manager > Document Templates > EMIS Library > COVID 19
Document templates for informing patients about their shielding status can be found in this folder.
NHS Digital have also now provided us with a standard letter to be used when contacting patients that you have recoded as either moderate- or low-risk, and are therefore removing from the national SPL; this letter will be made available as a Document Template within the same folder, and will be titled ‘COVID-19 Removal from SPL notification’. This template may take up to 48 hours to appear in your system.
General information and guidance relating to the Shielded Patient strategy:
The latest guidance and updates for GP staff can be found on the NHS England website. The websites below also contain helpful information about this process:
Queries about the SPL methodology or process should be directed to the NHS Digital Shielded Patients Helpdesk: SPLQuery@nhs.net
We will issue further communications if any further SPL updates are received.