Coronavirus: GPs given just days to identify all remaining vulnerable patients after thousands missed by government ‘shield’ advice

Family doctors ‘need the appropriate time and support to get this right,’ says professional body

GPs have been given just days to identify thousands of vulnerable patients who may need to “shield” themselves from coronavirus.

Family doctors had been calling for clear guidance from NHS England after swathes of the population were missed from the list of people told to stay indoors for 12 weeks.

Officials previously admitted that “mixed messages” had been sent on how doctors should tackle the problem, and have now ordered GPs to complete the work by 5pm on Tuesday – described by doctors as “a very tight deadline”.

People with serious underlying conditions like cancer are thought to be at the highest risk of complications from Covid-19, and government officials said in March that they planned to contact 1.5 million thought to fall into the category.

Earlier this week, The Independent reported how a woman who was housebound, blind, deaf, on heart medication and had breathing problems was not on the “vulnerable” list. The woman’s daughter said the family doctor had been told to wait to add her.

Other vulnerable people may have inadvertently put themselves at risk because they were not aware they should have been shielding themselves.

A letter to doctors from NHS England and NHS Digital dated 9 April has been seen by The Independent.

It reads in part: “This is to ensure that all relevant patients have been given essential advice on shielding. It will ensure all patients added locally will be able to access the government support.

“There will be a time lag between you flagging any additional patients, and the information being processed centrally, and if in the meantime any of these patients require urgent additional support they should contact their local [council].

“We appreciate that this is a bank holiday. We are asking for considerable work to now be finalised by practices in a short space of time. We are hugely appreciative of the efforts you have already made and the extra final effort that this will involve you making.”

GPs must now sort through a list of their patients identified by a national “clinical algorithm” to find out which are at heightened risk, and amend that designation if necessary. Further, they have been told to flag patients they personally know to be vulnerable; both these tasks must be finished by Tuesday evening.

Reviewing the claims of people who have self-identified as vulnerable should be completed by 5pm on 20 April, the letter said. Updating the records of people identified as vulnerable by secondary care providers – such as a cancer patient’s hospital doctor – should be done on an “ongoing” basis.

NHS Digital’s website said its algorithm at first identified 900,000 of the 1.5 million thought to be at high risk of Covid-19 complications and had now found 1.28 million.

The body said that it used administrative data sets it already had to compile the initial list within a 48-hour period, adding that the process would normally take weeks. Some errors were inevitable because the databases were not designed for this purpose and relied on the quality of individual data entry, it said.

Professor Martin Marshall, chair of the Royal College of GPs, said: “The guidance for identifying patients who are at highest clinical risk is complex, and we are concerned that GPs have been given a very tight deadline to review their lists, especially when, in many cases, this will involve large numbers of patients.

“It’s important that this is done in a practical way that takes into account the human resource that practices have, especially when GP teams will have staff off sick or self-isolating.

“We have already raised this with the Department of Health and Social Care, and we hope that some degree of proportionality will be applied.

“A top priority for GPs is to ensure that their most vulnerable patients are kept as safe as possible during the pandemic. They will continue to do the best they can, but they need the appropriate time and support to get this right.”

Dr Nikki Kanani, medical director of primary care for NHS England and NHS Improvement, said: “GPs, like all our staff from across the NHS, are pulling out all the stops to respond to the biggest global health emergency in a century and while this is an additional task, the vast majority are working over Easter to look after their patients as usual.

“The government has established a national support offer to make sure those who are at highest risk from Covid-19 have access to medicines and basic supplies and as part of that, GPs are working hard to ensure all relevant patients have been identified as soon as possible.”