Letters and Emails to People Saying They are Clinically Extremely Vulnerable and Should Be Shielding

We have had a lot of queries about this in the last few days, and are unable to speak to everyone individually, so I hope you will find this summary helpful and answer some of your questions.

We were informed earlier this week that letters were about to be sent out centrally to people all over the country, informing them that their risk has been assessed as very high risk of serious complications should they catch Covid. Some of the factors that increase the risk have been identified, and an algorithm has been created in order to weigh up the many different factors to estimate the risk for an individual. The algorithm is called QCovid and there is an internet based version of it that can be found on the QCovid® risk calculator website. You can enter information about individuals and see how the risk score comes out. However, it clearly states that the calculator should not be used for supporting or informing clinical decision making and is only for academic research purposes.

The government have used it to identify people who may at higher risk of hospitalisation or death from Covid, and an explanation of how they have done this can be found on the Coronavirus (COVID-19) Risk Assessment page within the NHS Digital website. The aim is to help protect those individuals who can now newly be identified as more vulnerable as we have learnt more about this new virus but unfortunately, with doing this on such a large scale, for most of the population, there are inevitably some unexpected results and we understand this has created confusion and distress for some of our patients.

Some of the problems we have come across are:

1. Some people seem to have been sent shielding letters who have very few or no risk factors and we cannot explain this.

2. The surgery has not received any information on which specific codes or combinations of codes have triggered these letters, so we cannot check if they have been triggered by incorrect codes.

3. We think that women who had diabetes in pregnancy in the past may have old codes interpreted as currently pregnant and diabetic, but we don’t know this for sure and are hoping for further clarification on this.

4. We think that some people who have had mild depression or anxiety may have been picked up as having ‘serious mental illness’ which is one of the criteria, but again, we don’t know for sure.

5. We don’t know how to interpret this research tool for individual people

6. We are receiving many queries about this process, which we have had no input into and have no control over.

We cannot therefore advise you individually, as for the reasons above, we do not have clear information to give you.

For this reason, I suggest that if you have received one of these letters you should:

  • Have your Covid vaccine (it will be offered to you sooner if you have the “clinically extremely vulnerable” code on your notes)
  • Decide for yourself whether you feel your risk is sufficient for you to follow the shielding advice. You may wish to use the QCovid calculator yourself to help you inform your decision making, or you may agree with its creators that it should not be used for making clinical judgements about individuals.
  • We will not remove the clinically extremely vulnerable code from your notes. This is because we cannot see why it has been added, and we cannot therefore safely truly assess whether it has been added in error or shows a genuine possible extra risk level for you.

We appreciate that this is a worrying time for everyone, and that letters being sent out like this cause a lot of extra anxiety. Unfortunately, they were sent out centrally without consultation with your own GP, and we simply have not been given the information we would need to advise you safely. The advice above is simply taking a pragmatic approach which we hope will help you to understand the situation.