Shielded Patient List

Between March 2020 and September 2021, the UK Chief Medical Officers (CMOs) identified and regularly reviewed the underlying clinical conditions for which people should be considered at high risk of complications from COVID-19 infection.  

NHS Digital developed a clinical methodology, a ruleset to identify patients who met these clinical conditions based on coded information in their health records. This methodology was updated as appropriate to reflect the guidance provided by the CMOs. 

NHS Digital created and maintained a Shielded Patient List (SPL) for England. The SPL included patients registered for healthcare in England and identified nationally using the clinical methodology, as well as patients routinely identified as at high risk by their General Practice or hospital specialist. Patients considered at high risk were also referred to as clinically extremely vulnerable. The list was updated weekly from March 2020 to September 2021. 

As part of the government’s shielding programme, the SPL was used by specific partner organisations across the NHS and government to provide advice, guidance and support to help people at high risk to protect themselves from COVID-19 infection during and between periods of national restrictions.

The SNOMED codes were introduced for the purposes of identifying those who were at high risk will remain in GP patient records. However, these codes are not used nationally as an indicator of clinical vulnerability or as an indicator of eligibility for any type of support.

The SPL was established in response to the COVID-19 pandemic, with data dissemination being underpinned by NHS Digital’s COPI notice or the Health and Social Care Act 2012. Organisations with whom NHS Digital shared personal data had obligations to keep it for no longer than was necessary for the agreed purposes and in compliance with any terms of release issued by NHS Digital.

At the expiry of the COPI notice (on 30 June 2022) organisations who received the NHS SPL needed to securely delete the information held except where it formed part of the patient’s medical record. NHS Digital issued further guidance on the process to those who had received data during June 2022.

Control of patient information (COPI) notice

The coronavirus (COVID-19) shielded patient list enabled partner organisations across government to support and protect those who needed shielding. The open data about the Shielded Patient List (SPL), and how it had been used, will remain available until 31 March 2023. 

A set of clinical conditions and a supporting methodology were used to determine whether a patient was at high, moderate or low risk of complications from COVID-19 infection.  

The list was dynamic and changed each week to reflect the changing status of patients’ risk from COVID-19 infection. Each week, individuals were: 

• added to the high-risk category by the national methodology 
• added to or removed from the high-risk category by their general practice or hospital consultant depending on their changing health circumstances 
• removed from the SPL where a patient had died or no longer registered for care within the NHS in England 

GPs, hospital trusts and mental health providers were informed of the risk status of their patients through routine provision of SPL data. This was to enable them to be aware of COVID-19 risk to those patients in their care. 

Others involved in the pandemic response for whom 'letters of release' were put in place to support dissemination of SPL data for specific purposes, were also routinely provided with relevant SPL data.

The Cabinet Office 

The Cabinet Office received the list for the purpose of delivering the government's extremely vulnerable persons service, which provided additional support to clinically extremely vulnerable people (including food parcels) as well as to the local authorities affected by national and local restrictions. This sharing ceased on 17 September 2021 based upon the government’s announcement of the end of shielding in England. 

Supermarkets did not receive the SPL. When patients registered with the government’s extremely vulnerable persons service, they were able to request support for food deliveries. It was this information that flowed to supermarkets and/or food distributors.

Local authorities 

Local authorities received the list to identify clinically extremely vulnerable people and provide targeted support as part of the local COVID-19 response. This included offering help, social care and support in coordination with other relevant organisations.   

Local authorities were permitted to link SPL data with local authority NHS Test and Trace data to identify people who were clinically extremely vulnerable that came into contact with people recorded by NHS Test and Trace. They could then identify people who were clinically extremely vulnerable that were directed to isolate by the NHS Test and Trace Service. In both cases, this was to offer them appropriate advice and direct care. 

NHS clinical commissioning groups

Clinical commissioning groups (CCGs) received the list for the purpose of providing GP practices with support, and patients in their CCG area with support and care. 

Capita 

Capita received the list for the purpose of distributing letters to shielded patients, on behalf of NHS England and Improvement, as their data processor. 

APS Group Limited 

APS Group received the list for the purpose of distributing letters to shielded patients, on behalf of the Department of Health and Social Care (DHSC) as their data processor. 

NHS Business Services Authority

The NHS Business Services Authority received the list for the purpose of sending text messages to shielded patients, on behalf of DHSC as their data processor. 

NHS Business Service Authority also operated the Prescription Payment Verification assurance function and following direction by NHS England and Improvement, included those functions for shielded patient pharmacy, post payment verification. This was to ensure that the prescription delivery services provided to previously clinically extremely vulnerable patients, who were shielding and required prescription delivery support were operating effectively, and to ensure that public funds assigned for COVID-19 services to patients were being managed appropriately. 

Gov.Notify 

On behalf of DHSC and NHS England and Improvement, NHS Digital’s data processor Gov.Notify, received the list for the purpose of sending letters, emails and text messages to patients previously identified as clinically extremely vulnerable. 

Emails were used in addition to letters to ensure patients received timely information on their risk status, shielding policy, advice and guidance. 

NHS England and Improvement and TPP Group Ltd

NHS England/NHS Improvement and TPP received the list for the purpose of identifying patients on the SPL who were in the detained estate and who needed advice, support, and care. 

NHS England and Improvement 

Data was disseminated to NHS England and Improvement for the purposes of strategic commissioning. Data was pseudonymised and held on the NHS England data warehouse - the National Central Data Repository or NCDR. The NHS COVID‑19 Reference Library described the datasets used in the NHS COVID‑19 Data Store, and the sources of those datasets. 

Data was also disseminated to NHS England and Improvement for the purposes of providing an SPL feed into the COVID-19 vaccination programme (using National Immunisation Management System (NIMS)). This supported the Joint Commission for Vaccinations and Immunisations (JCVI) who identified that patients who are clinically extremely vulnerable should be offered a priority vaccination. 

National Services Scotland

National Services Scotland (NSS) were responsible for the Scottish Shielded Patient List. The purpose of sharing this information was so that NSS could contact Scottish residents who were identified as clinically extremely vulnerable as a result of direct care received in the NHS in England, to provide them with details of support they could obtain locally from Scottish local authorities where they were resident, including food parcels. 

NHS Wales Informatics Service

NHS Wales Informatics Service (NWIS) were responsible for the Welsh Shielded Patient List. The purpose of sharing this information was so that NWIS could contact the Welsh residents who were identified as clinically extremely vulnerable as a result of direct care received in the NHS in England, to provide them with details of support they could obtain locally from Welsh local authorities where they were resident, including food parcels. 

Redbridge CCG 

Redbridge CCG were responsible for the 111 call handling systems for London. The purpose of sharing this information was to support an NHS England and Improvement pilot programme, so that patients on the Shielded Patient List who called 111 and required referral to an emergency department would be flagged as being on the Shielded Patient List - enabling clinicians to make appropriate care arrangements. 

Mental health providers 

Mental health providers were responsible for mental health services commissioned by CCGs. The purpose of sharing this information was to support an NHS England and Improvement policy, so that patients on the Shielded Patient List in receipt of mental health services from the provider could be proactively contacted and have their care plans reviewed. This was because shielding was an extreme course of action likely to have had significant impact on the shielding individual’s mental health before, during and after periods of national and local restrictions. 

Public Health England  

Data was disseminated to Public Health England (PHE) for the purposes of COVID-19 vaccination programme surveillance. PHE had a role to monitor the delivery, safety and effectiveness of immunisation programmes in England and required the SPL Data to improve the data set in order to analyse the impact of COVID-19 vaccines for people previously identified as clinically extremely vulnerable.  

Department of Health and Social Care (DHSC)

Data was disseminated to DHSC’s service provider, Paragon, for the purposes of supplying a vitamin D supplement to those who were clinically extremely vulnerable and who had registered for a free vitamin D supplement been December 2020 and February 2021 via the 'Get Vitamin D Supplements' service.  

University of Oxford 

SPL data was shared with the University of Oxford, for the development and validation of a risk prediction QCovid® risk calculator to estimate short term adverse outcomes from COVID-19. This was a risk stratification tool to support national shielding policy.