Services and Coronavirus

Non-urgent advice: Shielding Letters

We are receiving large numbers of requests for letters around shielding and the risk group people are in, NHS England has unfortunately had some logistical difficulties in sending these out.

They will be sent out by 24th April. If you have not received one by that date, then we are happy to hear from you, but please do not contact us before then.

Apologies for the inconvenience, but this is beyond the control of the practice.

 In the mean time, you can self-register with the government if you believe yourself to be a clinically extremely vulnerable person, by following this link.

The information you need about the who is classified as extremely vulnerable (shielding) and increased risk (stringent social distancing) is below.

Patient Vulnerability Classification

Extremely Vulnerable Patients – Shielding

(Stay at home at all times and avoid any face-to-face contact for at least 12 weeks)

  1. Solid organ transplant recipients
  2. People with specific cancers:
    • People with cancer who are undergoing active chemotherapy, or radical radiotherapy for lung cancer
    • 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 (requiring hospitalisation in the last 12 months or ever admitted to intensive care) and severe COPD (requiring hospitalisation in the last 12 months or have required 2 or more courses of steroids and/or antibiotics in the last 12 months).
  4. People with rare diseases and inborn errors of metabolism that significantly increase the risk of infections (such as SCID, homozygous sickle cell disease)
  5. People on immunosuppression therapies sufficient to significantly increase risk of infection: azathioprine, mycophenolate, cyclosporin, tacrolimus, sirolimus, cyclophosphamide, leflunomide, methotrexate
  6. People who are pregnant with significant heart disease, congenital or acquired
  7. People on dialysis
  8. People with severe heart failure (requiring hospitalisation for heart failure in the last 12 months)
  9. People with poorly controlled diabetes (HbA1c over 75), recent diabetic ketoacidosis, or who don’t take their medication reliably
  10. Patients without a spleen or with sickle cell disease
  11. Patients taking oral steroids at a dose of/equivalent to 20mg per day of prednisolone or more for over 4 weeks
  12. Severe dementia

Vulnerable Patients – Stringent Social Distancing

  1. Aged 70 or older, regardless of medical conditions
  2. Aged under 70 with an underlying health condition (i.e. anyone advised to get a flu jab each year on medical grounds)

Health grounds include:

  • COPD (not severe), asthma (not severe), emphysema, bronchitis
  • Heart failure (not severe)
  • Chronic kidney disease
  • Chronic liver disease
  • Neurological conditions: Parkinson’s disease, MND, MS, cerebral palsy, learning disability
  • Diabetes
  • Pregnancy
  • Being seriously overweight – body mass index (BMI) of 40 or above.

Frequent requests we receive

As you can imagine, we are getting high volumes of requests for information and advice; as a result we are needing to prioritise care for the people and illnesses with the greatest need.

In order to free up time, please be advised of the following:

You do not need to obtain a summary of your health conditions from us/a letter stating whether you are fit to work or not

The list of your conditions and medications can be obtained via the NHS App or EMIS Patient Access (although you will need to be registered already for the latter).

The requirements for social isolation, shielding and distancing are set out below. If your employer needs further information then they will need to arrange for an occupational health assessment themselves; this website may be helpful for employers.

We don’t have capacity to issue letters about medical history and isolation and the information is clearly set out by the Government.

Fit (sick) notes

You must self-certificate for the first 7 calendar days of an illness. You can find the form here. If you are in isolation for more than 7 days, then it is hoped that time away from work will be with your employer’s understanding. However, if a note is needed due to isolation, it can be obtained here.

‘Rescue packs’

There have been reports circulating of all patients with asthma and COPD being issued with rescue packs.

This is incorrect and the advice is dangerous.

In line with national guidance, steroids should be avoided in Covid-19 as they may make things worse. Antibiotics are ineffective against coronavirus.

If someone is experiencing a flare then it is important they have a discussion with a medical professional; the exception to this is patients with COPD who are used to having rescue packs.

These patients are already known to us and the decision is made an a case-by-case basis as clinically appropriate. No other patients will be issued with rescue packs.

Please request medication responsibly

There are no issues with medication supply, provided that everyone requests at the time their repeat is due.

Increased requesting and stockpiling of medication puts pressure on the supply chain, therefore we will not issue medications early and such requests will be rejected. 

In addition, we have had patients requesting blue inhalers when they have not had them for some time, this puts pressure on the supply for asthmatics who do need them. We will not automatically issue requests for repeat blue (reliever) inhalers for patients who have not been seen by our asthma team for over a year.

For other patients, again, please do not request extra; there is adequate supply if everyone is responsible in their requesting.

We may challenge requests that appear unnecessary.

Hospitals are cancelling all non-urgent (elective) procedures due to the pressure on beds

In general practice, we are having to prioritise the care that we are able to give.

Therefore we request that if you have a problem that has been going on for some time, if it is possible to put it off or follow self-help guidance (e.g. or the NHS website) then we would be very grateful.

In some cases we may only be offer online or telephone advice at this time.

Please be aware that there are some services that we cannot provide at present/do not routinely provide as they are not part of our contract, and we need to focus on what we are being asked to do.

Please see the list below. We have had to temporarily suspended joint injection clinics.

Thank you for your understanding.

Services We Can and Cannot Provide

For reasons of capacity and insurance, we cannot undertake any of the following

  • Treatment for any dental issues, including infections or abscesses.
  • Drugs such as diazepam to help with anxiety around things like seeing dentists (the dentist can prescribe if required), scans, flying and such like.
  • A statement to say that you are ‘fit to’ do anything – for example, run a marathon, do a parachute jump etc. This is because risk varies and we are not qualified or indemnified to make such judgements. You can show them your list of medical conditions and they can make an assessment of whether it is appropriate for you to partake in the activity.
  • Letters for non-attendance at school – this is not a legal requirement. The school can write to us for further information, but this is a private request so they will be charged.
  • Letters for cessation of membership of clubs, such as gyms. The club/organisation can write to us if required, but this is a private request so they will be charged.
  • Letters for suitability for a particular treatment, e.g. chiropractors, osteopaths, massage or beauty treatments. You can show them your list of medical conditions and they can make an assessment of whether it is appropriate for you to partake in the activity.

For reassurance, services we will continue to provide include

  • Immunisations.
  • Smears.
  • Injections of drugs, e.g. Prostap, B12, contraceptives.
  • Dressings.
  • Completion of fitness to drive information requested by the DVLA.
  • Medical exemption prescription forms.
  • Council tax exemption forms on the grounds of severe mental impairment.
  • Fit (sick) notes, in line with statutory guidance on issue (click for information on when fit notes are needed and the rules about issue.) Remember, isolation notes can be obtained here – they are not sick notes.
  • Death certificates.
  • Cremation paperwork.
  • Travel insurance claim forms (although this may take up to a month). NB Please ensure you complete the date you booked the holiday, the date you cancelled the holiday, and the date you purchased the insurance otherwise there will be a delay in processing the paperwork.*
  • Life/critical illness application insurance forms (although this may take up to a month).*

*We are not contracted to provide these services, therefore they will attract a cost as they are additional work, sorry.

Price lists are available from reception.