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• Adult Patients with Down's Syndrome - All adults in England with Down’s Syndrome should be identified and reviewed by practices for inclusion on the Shielded Patient List (SPL). • Stage 5 Chronic Kidney Disease (CKD) – All patients with Stage 5 CKD are being contacted with regards to Coronavirus shielding. For your information the definition of Stage 5 CKD is: • Chronic kidney disease is defined as a reduction in kidney function or structural damage, or both, present for more than 3 months. • CKD stage 5, or G5 A1-3, is defined as a GFR less than 15 ml/min. Note - Stage 5 CKD excludes individuals who transiently drop below 15 ml/min, for example, acute kidney injury, acute on chronic kidney disease. We have updated the Coronavirus clinical audits to support these updates: • Click here for the latest In Practice Systems Daily audit. • Click here for details on how to download audits. NHS Digital have provided us with an updated Shielded Patient letter for your patients who qualify for the SPL and for patients that newly qualify for the SPL based on the above criteria. We have turned these into Vision template letters, which can be downloaded from the following links: • High risk patients - 201104_Highest_risk_additions_letter_1K. • Down’s Syndrome Patients: • Standard - 201104_Highest_risk_additions_letter_Downs_syndrome. • Easy Read - EasyRdLetter_DownSyndrome_Final 02 11 20. Important - We recommend that both Down’s syndrome letters are provided to the patient. • Stage 5 CKD - 201104_Highest_risk_additions_letter_CKD. Remember – These are templates, you can update them to your practice format as required.

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