More than 110,000 shielded patients were identified in North West London during the first wave of the COVID-19 pandemic in 2020. Shielded patients are those at high risk of complications should they contract the virus, and during England’s first lockdown they were advised by the government not to leave their homes for at least 12 weeks to minimise possible exposure. However, this necessary self-isolation posed a difficulty for patients who might have other primary care needs, as well as potentially adversely impacting their health through other factors.
The Shielded Patient Programme (SPP) was established by the North West London Health and Care Partnership (NWL HCP) to reduce unwarranted variation in care for all North West London shielded citizens, ensuring they were contacted and given the support they need.
By June 2020 the Whole Systems Integrated Care (WSIC) team had used the dataset to identify 110,945 shielded patients across North West London. Hounslow and Ealing CCGs were among the top 10 CCGs in England with the highest shielded patient density.
In addition to the direct impact of being at high risk of severe illness from COVID-19, these patients may also be indirectly impacted, by being less likely to access healthcare services if they become unwell, due to real or perceived risks of contracting COVID-19 in healthcare settings. Shielding may also reduce these patients’ ability to self-care, due to stress, poor diet and reduced activity levels.
ICHP was commissioned to deliver the Shielded Patient Programme by the North West London Gold Command Out of Hospital (OOH) Portfolio Leads. The project team included members of the ICHP strategy and information directorates, who worked closely with an ICS programme manager and Clinical Chairs.
The programme had two elements to it:
A matrix approach was used by the ICHP team ensuring the programme worked as a whole and that everyone had a clear understanding of the requirements of each element.
The Primary Care Protocol was launched to NWL GPs on 26 May 2020, and the WSIC dashboard went live on 1 June 2020.
The programme Leads were Claire Wilson (Quality Improvement Lead in the Strategy and Transformation Team) and Jennifer Roye (Deputy Director of Quality, NWL CCGs). Clinical Chairs for the project were Dr Andrew Steeden (Chair WL CCG), Dr M C Patel (Chair, Brent CCG), Dr James Cavanagh (Chair, Hammersmith & Fulham CCG), Ian Goodman (Chair, Hillingdon CCG). The Local Authority lead was Peter Gadson.
A rapid, centralized and data-driven approach to identifying and notifying clinically vulnerable patients of the need to shield may have saved lives at the start of the outbreak. However, as the crisis evolves, we must not bypass GPs and specialists. Local digital tools, such as the Whole Systems Integrated Care COVID-19 ‘shielding radar’, add to NHS Digital lists by providing clinicians with useful contextual information, such as a patient’s purported reason for shielding and deficits in care planning.
“With shielding guidelines likely to change over time, a simple change in process could enhance clinician workflow and prevent confusion and anxiety in patients wrongly told to shield: notify clinicians first!”