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Recommendations for continued care and support of people who are clinically extremely vulnerable

We are extremely concerned about people who are clinically extremely vulnerable, unable to work from home and are losing income protection that was put in place at the beginning of the pandemic.

In this statement, the Royal College of Physicians, Royal College of Emergency Medicine, Royal College of General Practitioners, Royal College of Paediatrics and Child Health, National Voices and specialist societies highlight challenges faced by both doctors and patients in identifying and reducing the risks associated with COVID-19 for the most clinically vulnerable people.

These patients are seeking advice from their doctor and we are keen to help them. They need to understand that many factors contribute to overall risk and any assessment will involve some uncertainty. We invite people receiving specialist care  to reach shared decisions with their clinician about their level of risk. They should also discuss how to minimise potential physical and psychological harms of shielding.

But it is difficult for clinicians to identify the risk for an individual. Much of the clinical advice to shield is based on the severity of their condition(s) or intensity of treatment(s). As further evidence has emerged it is clear that other risk factors play a role.

In summary, we recommend that the government, chief medical officers and central NHS bodies must together:

  1. Put in place arrangements so that people who are deemed by clinicians to be at very high risk do not have to return to work if they cannot work from home.
  2. In addition to workplace assessments, support employers to conduct risk assessments for people who are CEV before they return to work.
  3. Support people who are CEV if they are unable to return to work safely.
  4. Put in place a transitional arrangement for younger people no longer advised to shield.
  5. Equip clinicians with the latest intelligence and public health advice to support informed discussions with patients.
  6. Continue to work closely with medical specialist societies and medical royal colleges to support a standardised approach to assessing levels of risk.
  7. Make sure that primary care, secondary care and community services work together locally to reduce the risk for people who are CEV.
  8. Make sure services do not delay or defer urgent and non-urgent treatment.
  9. Make sure researchers encourage and enable people who are CEV to take part in research, including those who choose to continue shielding.
  10. Strongly advise people who are CEV, their carers, family and those living with them to have a flu vaccination.

To discuss anything in this statement, or for more information, please contact us via policy@rcplondon.ac.uk.