Shielding vulnerable patients during the COVID-19 pandemic

8 April 2020

Professor Martin Marshall and Dr Steve Mowle of the RCGP discuss identifying people at greatest risk and planning for their care.

Vlog transcript

Dr Steve Mowle: My name is Steve Mowle. I'm here today with our RCGP Chair Martin Marshall. Today's focus is shielding for vulnerable patients. Martin, what are you hearing?

Professor Martin Marshall: This is a really important issue, and it's an important part of the Chief Medical Officer’s (CMO) policy across all four countries to essentially flatten the curve by focusing attention and resources on those who are at greatest risk of COVID-19, at greatest risk of requiring NHS services. 

We're hearing across all four nations that the guidance and expectations of general practice, as far as this is concerned, are not yet clear, and in particular there's uncertainty about when vulnerable patients, ie those we regularly give flu jabs to, become shielded patients? This is an issue across all four nations that we've been bringing to the attention of NHS leaders and to government as well.

Dr Steve Mowle: What is the guidance Martin?

Professor Martin Marshall: The guidance focuses on very specific groups actually. So, those who've had solid organ transplants, those who've got specific cancers who are on active treatment, those with severe long-term disease, and those with congenital disorders like sickle cell disease, those who are pregnant, and those who've got heart disease.

These have all been identified through an initial trawl of hospital records. This has been done and letters have been sent to those patients, and it's now being refined through a second process of checking GP records. That's ongoing at the moment, in England and in the other three countries as well. GPs are being asked to use their personal knowledge to check these lists, both the hospital lists and our own lists, and to respond to patient queries when people think they should be on the list but actually aren’t.

Dr Steve Mowle: What's actually being done for these patients? 

Professor Martin Marshall: So, this is this is quite an intense intervention actually. It's a very specific offer for those people who are on the shielded list. It includes 12 weeks of what you might call extreme isolation. So, this is isolation, absolutely housebound, and separation from family members as well, where at all possible, living as much as possible in your own room.  

It also requires medical review, and it requires a dedicated medicines and shopping service, delivered by neighbours and family where that's possible, or by NHS volunteers where that isn’t impossible.

Dr Steve Mowle: That sounds pretty clear. Are there any difficult things that GPs have to do as part of this?

Professor Martin Marshall: There are there are a couple of issues that we're continuing to push on and to address. The first is how we respond to patients who aren't on the shielded list. We’ve heard stories of, for example a 93-year-old woman with comorbidity, very frail. You would think that she'd be on the high-risk list, but she isn't at the moment, and she would like to be, or her family would like her to be so that she gets access, in particular, to the social care. So, there is a question I think about the nature of this list, and I wouldn't be at all surprised to see the list being modified and changed over time. 

The challenge here, of course, is that a time of limited resources we need to identify those who are very much at the highest risk and that’s what this list is about. 

The second challenge is the expectation that we in general practice should be having conversations with all the people on the shielded list, and actually people on the more vulnerable flu jab list as well, about advanced care planning and about do not attempt to resuscitate guidance. 

This is clearly a very sensitive thing for us to do in general practice at the best of times, but particularly when things are under enormous pressure, and it requires the exceptional skills that we bring as GPs, but also resources, time in particular, to do this properly. 

I'm not sure that's properly recognised within government at the moment. I don't think the sensitivity of these discussions is properly recognised. I don't think the population in general have been prepared for it. So, we're asking for some kind of public campaign to help people, so that when we start those conversations, they don't come as complete shock.

Dr Steve Mowle: Many thanks Martin and until next time, to all our colleagues and patients, please do be careful and stay safe.

Vlog with 

Professor Martin Marshall, Chair of the RCGP

Professor Martin Marshall is a GP in Newham in east London and Professor of Healthcare Improvement at UCL, Programme Director for Primary Care at UCLP Partners. He leads Improvement Science London, an initiative to promote and embed the science of improvement across the health service and academic sectors. 

Previously, he was director of research and development at the Health Foundation, Deputy Chief Medical Officer for England, and Director General in the Department of Health, a clinical academic at the University of Manchester and a Harkness Fellow in Healthcare Policy.

He has been a GP for 28 years. He is a fellow of the Royal College of Physicians of London and of the Faculty of Public Health Medicine and was a non-executive director of the Care Quality Commission until 2012.

He has over 200 publications in the field of quality of care and in 2005 he was awarded a CBE in the Queen's Birthday Honours for Services to Health Care.

Dr Steve Mowle, Honorary Treasurer of the RCGP

As Honorary Treasurer, Dr Mowle has responsibility for all matters relating to the College finances. He was Vice Chair of the RCGP from 2011-13 and was the lead officer for Commissioning, GP Nursing, the RCGP Annual National Conference, Patient and Carer Partnership Group and GPC liaison. He has also previously chaired South London Faculty Board and RCGP London.

He trained in Wales and has been a GP Partner at the Hetherington Group Practice in South London since 2000. Dr Mowle has held a number of different educational roles including GP Trainer, Programme Director and most recently Associate Dean for HEE, with lead roles around recruitment and supporting trainees in need of support. He currently works as an RCGP International Tutor in South Africa.

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