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Shielding, Isolating and Social Distancing - LMC advice

There has been a great deal of anxiety surrounding identification and coding of those patients at the highest clinical risk.  To relieve some of that anxiety I would like to suggest a pragmatic approach.


Background


Where a patient is flagged as the highest level of risk, they will be expected to be shielded and will receive support to assist with this.  These patients are issued a letter to verify their status in order to qualify for support.


There are three ways that these patients have been identified


1) NHSEI identified patients

- Patients who are already identified on national databases

- A code has been added to the patient clinical record by NHSX


2) Specialist identified patients

- Patients who have been identified by Hospital Specialist teams

- A code has been added to the patient clinical record by NHSX


3) Self identified patients

- Patients who have self declared via a national website

- A list of these patients is pending


NHSEI guidance requires



Pragmatic suggestions



http://www.doncasterlmc.co.uk/at-risk-patient-letter-march-2020.pdf






Extremely vulnerable patients.



1.     Solid organ transplant recipients.


People with specific cancers:


- people with cancer who are undergoing active chemotherapy

- people with lung cancer who are undergoing radical radiotherapy

- people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment

- people having immunotherapy or other continuing antibody treatments for cancer

- people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors

- people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs


3.     People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe COPD.


4.     People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell).


5.     People on immunosuppression therapies sufficient to significantly increase risk of infection.


6.     Women who are pregnant with significant heart disease, congenital or acquired.