Extra 800,000 shielding patients to be prioritised for Covid vaccination

Another 1.7 million patients will be added to the shielding patient list as the Government has cleared the QCovid risk algorithm for use in England, with practices asked to prioritise 820,000 of these for Covid vaccination.

The tool, which the Government had initially expected to implement last year, takes into account a number of clinical factors which in combination make patients more likely to suffer severe illness, hospitalisation and death from Covid-19.

Risk factors include age, ethnicity, deprivation, BMI and underlying health conditions such as diabetes and heart disease.

NHS England will write to patients this week to inform them of their new shielding status, while practices should make sure these patients receive their Covid vaccinations as soon as possible.

The additional patients will be added to the shielded patient list in two groups – starting with 820,000 aged 19-69, who will receive notifications from this week.

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The remaining over-70s are expected to be added ‘as soon as possible after that’, according to a letter sent to practices by the Department of Health and NHS England. This is because over-70s have already been offered a Covid vaccination.

Affected patients will be contacted centrally to inform them, the letter said, adding that practices need not contact patients about this themselves. It added that practices can continue to add or remove patients from the shielding patient list at any time based on clinical judgement and patient request. 

Patients will receive a letter to inform them that they have been identified by the Department of Health and Social Care and NHS Digital as ‘being of similar risk’ to clinically extremely vulnerable (CEV) patients.

The letter said: ‘It will explain that patients will be offered priority Covid-19 vaccination, and will give details of the support available and the additional shielding advice to those who are CEV. It will note that adding people to the SPL is the easiest way to ensure earlier vaccination and emphasise that following shielding advice is voluntary.’

To make sure patients receive the information as soon as possible, they will receive their letter at the same time as GP IT system administrators receive the information. There will therefore be a delay ‘up to five working days’ before patient records are flagged to GPs with the update, NHSE said.

The letter added: ‘In practical terms, this means that those under 65 should be prioritised ahead of others in cohort 6, once the new high risk flags are visible on your system.

‘Individuals aged 65-69 will already be called to vaccination centres as part of cohort 5, but may now be more inclined to use local vaccination services. We ask that Primary Care Network local vaccination services support such requests.’

The QCovid risk tool has been developed by University of Oxford researchers, commissioned by the chief medical officer.

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Last summer, the Department of Health and Social Care said it was ‘still being finalised’ with NHS Digital but with a view to having it embedded in GP systems ‘probably by September.

In the letter to GPs, DHSC and NHSE said it is now being implemented because it the ‘model has now been validated using an independent dataset by the Office for National Statistics and shown to perform in the excellent range (as judged by Harrell’s C statistic)’.

Professor Kamlesh Khunti, a GP who helped develop the QCovid system, told Nursing in Practice sister publication Pulse that the algorithm gives the NHS ‘precision’ in terms of identifying the population’s risk level.

Professor Khunti, who is a professor of primary care diabetes and vascular medicine at the University of Leicester and a SAGE advisor, said it ‘targets roughly the top 2% of the population that is at the highest risk from Covid who were outside the shielding list’.

He said: ‘We know age is the biggest risk factor… Now that we’re going to the lower age groups, it suddenly becomes very difficult to say who is the highest or lowest risk within these groups.

‘Covid has shown that people who are elderly, have chronic conditions and ethnic minorities, for example, are all higher risk, but that different risk-factors work differently in different individuals. What this gives us is precision in terms of a population’s level of risk.’

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Announcing the update on Tuesday, deputy CMO for England Dr Jenny Harries said: ‘For the first time, we are able to go even further in protecting the most vulnerable in our communities.

‘This new model is a tribute to our health and technology researchers. The model’s data-driven approach to medical risk assessment will help the NHS identify further individuals who may be at high risk from Covid-19 due to a combination of personal and health factors.

‘This action ensures those most vulnerable to Covid-19 can benefit from both the protection that vaccines provide, and from enhanced advice, including shielding and support, if they choose it.’