Last reviewed 15 April 2020

NHS England and the Deputy Chief Medical Officer (CMO) Professor Chris Whitty wrote to GP practices on 3 April advising them to "disregard" previous advice on adding further patients to the register of patients most at-risk during the COVID-19 outbreak.

The letter from Deputy CMO Dr Jenny Harries and NHS England Medical Director for Primary Care Dr Nikki Kanani stated that previous guidance, which was produced by NHS England, the British Medical Association (BMA) and the Royal College of General Practitioners (RCGP), which suggested the patient groups to be added to the register of those who need to "shield", should now be disregarded.

The current letter dated 3 April is available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0178-letter-to-gps-on-clinically-highest-risk-patients-3-april-2020.pdf

GPs will still be able to add people to the register but an FAQ for clinicians published alongside the letter says that this is a "clinical decision" and asks GPs to wait until they have a final list of patients identified by NHS England and have been advised by system suppliers how to code patients before they do this.

The letter said, in addition to the list of patients who were automatically added to the very high risk group at the end of March, patients have also been self-identifying via the government website. Practices should receive a list of their patients who have done this, from 7 April, and are expected to establish which of these patients should be added to the register.

Patients added to the register should be sent a shielding letter by the GP practice. The guidance adds that GPs "may wish to contact the people who self-referred and who you consider to not be the highest clinical risk group to confirm that they do not need to shield".

NHS England's latest, "Guidance and Standard Operating Procedures (SOP) - General Practice in the Context of Coronavirus (COVID-19)", updated 6 April 2020, highlights the role that GP practices should play in supporting vulnerable patients during the pandemic: https://www.england.nhs.uk/coronavirus/publication/managing-coronavirus-covid-19-in-general-practice-sop/

Full guidance on this was updated on 11 April and includes template letters for vulnerable patients at: https://www.england.nhs.uk/coronavirus/publication/guidance-and-updates-for-gps-at-risk-patients/

NHS England and NHS Improvement have also published "Caring for People at Highest Clinical Risk from COVID-19: Updated 11 April 2020" is available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/20200402-FAQs-Patients-vFINAL.pdf

And "Identifying Highest Risk Patients who Need to Shield – Actions for GP Practices: 10 April 2020" at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/SPL-Letter-to-GPs-09042020.pdf

The NHS is now providing support to those at highest clinical risk via the Goodsam App and NHS Volunteer Responders Service. Health professionals and local authorities can refer people who need assistance, and these can be made via the NHS Volunteer Responders Portal at: https://goodsamapp.org/

Local government is also working with the voluntary sector to set up local support systems for vulnerable and at-risk groups, which includes support for those feeling isolated.

There is not a government dedicated food and medicine delivery service to those outside the shielding group. However, people who have significant care needs not already addressed and/or whose family/carers can't provide for them should seek help from their local authority.