StemCell Therapy

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.

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

The following groups have since been added to the list:

* 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.

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.

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 distragard 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.

Patients have also been asked to self-identify via the government website and practices should receive a list of these patients from their system supplier between 17 and 24 April. The guidance says the list of patients who will need adding to the high-risk list is likely to be very small given the review practices will have already completed.

Practices should review this new list by 28 April and determine which patients should be flagged as high, medium or low risk. For those flagged as high risk the practice will need to send them a shielding letter.

If patients not included on the register want to follow shielding advice that is there own choice. However the latest guidance says that those not on the register, but in the broader group of patients at risk (which is effectively the groups entitled to a free flu jab), should be advised to follow social distancing.

NHS Digital will pull details of the patient records that are flagged every week. This means that these people will be able to access the government's shielding support for food and medicines delivery although support is initially focused on people who have no other means of getting food and medicine. The guidance says that there may be a lag in processing this information and, if so, patients requiring urgent help should contact their local authority.

Patients are also required to register for this support here: https://www.gov.uk/coronavirus-extremely-vulnerable If someone does not have access to the internet, refer them to the phone line in the letter.

The NHS is also providing further support to patients at risk via the Goodsam App and NHS Volunteer Responders. Any health professional or local authority can refer people who require assistance. Referrals can be made via the NHS Volunteer Responders portal here https://goodsamapp.org/NHSreferral or by calling 0808 196 3382. This support is available to anyone in need and not just the highest-risk group.

A letter from NHS chief executive Sir Simon Stevens set out the steps practices should take in the second phase of the pandemic. Practices were told that patients who are shielding should be proactively contacted to'ensure they know how toaccess care, are receiving their medications', and practices should provide home visitingwhere clinically necessary.

During a webinar on 23 April, Dr Nikki Kanani said that practices should be contacting these patients to check that they understand what is happening. A presentation during the webinar suggested that these conversations should:

NHS England is setting up an expert group that will be chaired by deputry primary care medical director Dr Raj Patel, and involve input from the RCGP, to consider what healthcare support should be provided to patients who are shielding in the coming months.

According to the latest standard operating procedure (dated 6 April), practices should:

The standard operating procedure advises that these patients should be dealt with remotely wherever possible. However, if they need to be seen face-to-face they should have a home visit.

It also recommends that local areas set up separate home visiting services for these patients for when they do need a face-to-face appointment. They shouldn't attend the surgery. Strict infection control processes should be employed when visiting these patients.

Continued here:
How GP practices should support shielded patients during the COVID-19 outbreak - GP online

This entry was posted on May 5, 2020 at 5:46 am and is filed under Stem Cell Complications. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed. |