Part of COVID-19 clinical risk groups cohort 2023: Cohort identification methodology
Non-digital pathways
View the table below for information on the conditions that are not included in the digital cohort.
People with these conditions may be identified locally by their GP clinical system and could be invited by local GP led call/recall for COVID-19 vaccination.
Centrally held data sources do not contain complete medical records. It is therefore anticipated that the digital patient cohort will not have captured a percentage of the patients identified within the clinical policy.
If you believe you are entitled to an NHS COVID-19 vaccination and you have not been included in the digital cohort, you can visit the NHS website COVID-19 vaccination pages.
Asplenia or dysfunction of the spleen
| Description | Conditions following a non-digital pathway |
|---|---|
| Sickle cell disease and hereditary spherocytosis. | All conditions included in digital pathway. |
| Asplenia; splenic dysfunction such as thalassemia major and coeliac syndrome. |
NHS England clinicians have striven to include all conditions that may cause asplenia or splenic dysfunction. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with asplenia or splenic dysfunction due to diseases not listed within the code clusters may not be included in the digital cohort. |
Chronic kidney and liver disease
| Description | Conditions following a non-digital pathway |
|---|---|
| Congenital malformations of the organs, metabolic disorders and neoplasms, and conditions such as severe gastroesophageal reflux that may predispose to respiratory infection | NHS England clinicians have striven to include conditions that may cause congenital malformations of the organs, metabolic disorders and neoplasms, and conditions such as severe gastroesophageal reflux that may predispose to respiratory infection. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with these conditions not listed within the code clusters may not be included in the digital cohort. |
Chronic neurological disease
| Description | Conditions following a non-digital pathway |
|---|---|
| Neurological disability contributing to compromised respiratory function. Conditions in which respiratory function may be compromised due to neurological or neuromuscular disease (for example polio syndrome sufferers), multiple sclerosis, Parkinsons disease, motor neurone disease and related or similar conditions; or hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability. | Conditions where respiratory compromise is variable (such as in multiple sclerosis and cerebral palsy), where the GP has not indicated respiratory compromise in coded data in the GP records, may not included in the digital cohort. |
| Other rare neurological diseases. Hereditary and degenerative disease of the nervous system or muscles; or severe neurological disability. | NHS England clinicians have striven to include conditions that may cause hereditary diseases of the nervous system or muscles. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with these conditions not listed within the code clusters may not be included in the digital cohort. |
Chronic respiratory disease
| Description | Conditions following a non-digital pathway |
|---|---|
| Those with poorly controlled asthma (≥2 courses of oral corticosteroids in the preceding 24 months or those with poorly controlled asthma on maintenance oral corticosteroids within the last month). |
Prescribing data for systemic steroids is not held centrally in a format whereby duration and dose of treatment can be ascertained. The current digital ruleset of all people over 5 who have had four steroid prescriptions on separate days in the last 6 months will not identify all people in this group. NHS England is unable to identify children who are about to receive planned immunosuppressive therapy and who should be considered for Covid-19 vaccination prior to commencing therapy. |
| Those with poorly controlled asthma (≥1 hospital admission for asthma in the preceding 24 months). | Coded data held in GP records does not reliably contain coded data on hospital admissions so people whose eligibility is solely based on hospital admission data may not be included in the digital cohort. |
| Ciliary dyskinesias. | There is no coded data being used to specifically identify patients with ciliary dyskinesis. However, people with ciliary dyskinesis will most likely have developed bronchiectasis which will be identified within the Chronic Respiratory Disease cohort. |
Immunosuppression
| Description | Conditions following a non-digital pathway |
|---|---|
| Genetic disorders affecting the immune system (for example, IRAK-4, NEMO, complement disorder, SCID). | NHS England clinicians have striven to include codes for genetic disorders which might affect the immune system. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with these conditions not listed within the code clusters may not be included in the digital cohort. |
| Serious genetic abnormalities that affect a number of systems. | NHS England clinicians have striven to include codes for genetic abnormatities which might affect a number of systems. As there is no clinically agreed list of these conditions, the code clusters may not be complete. Some people with these conditions not listed within the code clusters may not be included in the digital cohort. |
| Patients undergoing chemotherapy leading to immunosuppression and patients undergoing radical radiotherapy. |
As there is a time lag between people undergoing chemotherapy or radiotherapy and this coded information being received centrally some people may not be included in the digital cohort. NHS England has used Hospital Episode Statistics to try and identify additional people. However, some people eligible for Covid-19 vaccination under this category may not be identified in this digital cohort. NHS England is unable to identify children who are about to receive planned immunosuppressive therapy and who should be considered for Covid-19 vaccination prior to commencing therapy.
|
| Individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults, and children treated with or likely to be treated with high or moderate dose corticosteroids. |
Prescribing data for systemic steroids is not held centrally in a format whereby duration and dose of treatment can be ascertained. The current digital ruleset of all people over 5 who have had four steroid prescriptions on separate days in the last 6 months will not identify all people in this group. NHS England is unable to identify children who are about to receive planned immunosuppressive therapy and who should be considered for Covid-19 vaccination prior to commencing therapy.
|
| Individuals who are receiving immunosuppressive or immunomodulating biological therapy including, but not limited to, anti-TNF, alemtuzumab, ofatumumab, rituximab, patients receiving protein kinase inhibitors or PARP inhibitors, and individuals treated with steroid sparing agents such as cyclophosphamide and mycophenolate mofetil. |
At present there is no database for hospital prescribed immunosuppression medication, so people who only qualify on these criteria will not be identified in this digital cohort. NHS England is unable to identify children who are about to receive planned immunosuppressive therapy and who should be considered for Covid-19 vaccination prior to commencing therapy. |
| Those who require long term immunosuppressive treatment for conditions including, but not limited to, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, scleroderma and psoriasis. |
At present there is no database for hospital prescribed immunosuppression medication, so people who only qualify for a COVID-19 vaccination only because of their medication will be missed from this digital cohort. However, people on GP prescribed medication are included in this cohort, which covers the majority of disease-modifying anti-rheumatic drugs prescribing, although this cohort will be incomplete until GPES V5 extract is available. NHS England is unable to identify children who are about to receive planned immunosuppressive therapy and who should be considered for Covid-19 vaccination prior to commencing therapy. |
Severe mental illness
| Description | Conditions following a non-digital pathway |
|---|---|
| Individuals with schizophrenia, bipolar disorder or any mental illness that causes severe functional impairment. | As there is no clinically agreed set of codes for people with severe mental illness causing severe functional impairment some people may be missed from this digital cohort. The cohort will be increased when GPES V5 extract is available. |
Pregnancy
| Description | Conditions following a non-digital pathway |
|---|---|
| All stages (first, second and third trimesters). | On the advice of NHS England, pregnant people, where pregnancy is the only criteria with which they qualify for a COVID-19 vaccine, are not included in the digital pathway. |
Last edited: 20 September 2023 1:02 pm