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GP practices spent 26 hours a week reviewing shielded patient lists

by Nicola Merrifield
29 April 2020

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GP practices in England have spent an average of 26 hours a week reviewing whether patients should be shielding during the coronavirus pandemic, according to a survey of the profession by Management in Practice’s sister publication, Pulse.

After assessing the list of shielded patients provided by NHS England, practices have on average each had to remove 30 patients from the list, while adding in 53 patients who have been missed off, the survey results revealed.

GPs have described the list of patients provided to them by NHS England as ‘poor’ due to the number of misidentified patients and some have said practices would have been better off checking their patient lists without NHS England’s help.

GP leaders said verifying shielded patient lists was a ‘complex and timely process’ and that it was crucial NHS England accounted for the time it would take GPs so it did not add to their already higher workload.

NHS England said it is ‘right’ that the most clinically vulnerable patients are ‘supported proactively by their GP practice’.

Its director of primary care, Dr Nikita Kanani, has previously apologised for the delay in NHS England providing lists of shielded patients to practices for them to review, and for the tight deadlines it set GPs to complete the checks by.

GP practices were asked to assess NHS England’s list of patients requiring quarantine for 12 weeks and then decide whether more should be added because they are at the highest clinical risk from Covid-19 – or if some should be removed because they are not in the highest risk category.

In Pulse’s survey of 588 GPs in England, which took place between 17 and 21 April, it was revealed that practices have spent on average 26 hours a week reviewing shielded patients.

Meanwhile, out of around 365 GPs in England responding to a question about shielded patient assessments, the survey results showed practices are on average finding NHS England has wrongly identified 28 of their patients as requiring shielding – while having missed 52 patients who do need to shield.

Dr Julie Kitlowski, a GP based in Sheffield, said this work had created a ‘ridiculous pressure at such a busy time’.

She said: ‘When the Government sent the letters out to patients this immediately cranked up our workload as patients were ringing the practice with questions about why they had or had not had the letter.

‘This put particular pressures on our skeleton reception staff as well as clinicians.’

She added: ‘Then last week we were tasked with ringing all the patients on the very vulnerable lists, which generated a huge number of phone calls and all sorts of long conversations whilst trying to triage all the normal day-to-day enquires.’

Another GP taking part in the survey, Essex-based Dr Sally Dowler, maintains practices could have searched their own patient data more effectively than NHS England.

She said: ‘GPs could have done it much better ourselves if allowed.’

Dr Dowler, who works at a practice with a patient list size of 14,500, added: ‘We had to go through 3,300 patients records over Easter weekend. So that was Saturday and Sunday – as we were working Friday and Monday.

‘That’s about 500 patient records each and it took hours. And now of course they are all phoning to query why as there is no explanation in the letter about complex co-morbidity.’

Dr Kevin Hollier, a GP partner in Worcestershire, described the shielded patient list provided by NHS England to practices as ‘poor’.

He said his practice was refusing to downgrade all patients incorrectly identified by NHS England as requiring shielding, because they would still be at some elevated risk from Covid-19.

Dr Hollier said: ‘We have found that 20-30% of the patients on the list don’t meet the criteria but in many cases we feel reluctant to remove and downgrade them. Many of the patients are still vulnerable even if they don’t need to shield.

‘Once told by the Government to shield there is some feeling of risk in downgrading them because some will inevitably develop severe Covid-19 over time.’

He added: ‘We have only been downgrading some of the patients who are clearly at the lower end of the risk spectrum but haven’t downgraded many of the more vulnerable at the moment.

BMA GP Committee chair Dr Richard Vautrey said: ‘Ensuring the list of shielding individuals is accurate is extremely important to ensure the most vulnerable in society are protected. It is a complex and timely process that does requires the input of GPs, patients and NHS England and Improvement, including clinical and non-clinical systems to ensure it is accurate and maintained.

‘It is vital that NHSEI factors in the time needed for GPs to make adequate patient assessments so as to not add to the additional workload burden being placed on GPs at this time.’

An NHS England spokesperson said: ‘Given that in order to protect particularly clinically vulnerable patients they are being asked to stay at home and stay safe, it is right that they are supported proactively by their GP practice.’

It comes as NHS Digital has now got 1.85 million patients on the shielding lists, as GPs are going through a final smaller cohort of patients who have self-identified as vulnerable. These may or may not get added to the list.

Initially, NHS England had said it expected some 1.5m patients to require shielding.