Update on guidance for clinically extremely vulnerable individuals and actions for GPs


Dear Colleagues,
Update on guidance for clinically extremely vulnerable individuals and actions for GPs
We are very grateful for the considerable work you have undertaken over the last seven months to identify, notify and care for people who are clinically extremely vulnerable to COVID-19.


As you will be aware, on 31 October the Government announced new national restrictions to help control the spread of the virus that will apply from 5 November. The reason we are writing is that the government, advised by the Chief Medical Officer:


• will be updating the advice and support available for people who are clinically extremely vulnerable alongside the new national restrictions
• has identified two additional groups of people who should now be considered as clinically extremely vulnerable to COVID-19:
- adults with stage 5 chronic kidney disease
- adults with Down’s syndrome
• has highlighted the urgency of clinicians completing the process of reviewing – and, where appropriate, removing – children and young people on the Shielded Patient List (SPL).


We know this is an extremely challenging time for practices. However, given the vulnerable nature of those on this list, we are asking your practice to take the following specific actions:


1. Familiarise yourself with the updated guidance for clinically extremely vulnerable people when it is published here. Publication is expected imminently and will be communicated to all patients on the SPL by letters, which we expect will begin arriving from the middle of this week. These letters will provide evidence for Statutory Sick Pay purposes if required. We will seek to provide primary care with any additional information following that publication here.

2. Immediately review any children and young people remaining on the SPL who your practice added and, where appropriate, remove them from the SPL. You should also plan to urgently respond to calls from parents and guardians of children on the SPL seeking a review – parents and guardians will be advised by Government to contact their child’s specialist or their GP, if they are still unsure whether their child should remain on the SPL (Annex 1).
a. We want to highlight that the vast majority of children and young people who have been reviewed to date using the Royal College of Paediatrics and Child Health (RCPCH) guidance have been found to be no longer considered clinically extremely vulnerable. Given the detrimental impact to children’s wellbeing of following unnecessary additional restrictions, it is important we complete this exercise as soon as possible.


3. Urgently identify, contact and flag adults with Down’s syndrome. You may also want to take the opportunity to ensure they receive a flu vaccine and to schedule an annual health check if these are needed (Annex 2).


4. Ensure you continue to maintain the SPL by adding a high risk flag for patients you identify as being clinically extremely vulnerable, and notifying the patient of their status and the advice they should follow. Information on maintaining the SPL can be found on the NHS Digital website.


I know all of us want to ensure that those who are clinically extremely vulnerable continue to fully access appropriate NHS care. We have previously published best practice guidance on providing NHS care for those who shielded during the initial wave of COVID (see Annex B in 4 June letter).


Thank you for all your continued work to identity and support our patients at greatest risk in a week when I know that there are multiple requests on your time.


Yours sincerely,
Dr Nikita Kanani