Identifying frailty

The NHS in England is the first health system in the world to systematically identify people, aged 65 and over, who are living with moderate and severe frailty using a population-based stratification approach. This can be done using the electronic Frailty Index (eFI) or any other appropriate assessment tool. The eFI uses routine health record data to automatically calculate a score which can identify whether a person in likely to be fit or living with mild, moderate or severe frailty.

Changes to the GP contract in 2017/18 introduced routine frailty identification for patients who are 65 and over. It targets a small number of key interventions (falls assessment, medicines review and promotion of the additional information in the summary care record) at those most at risk of adverse events including hospitalisation, nursing home admission and death.  Early identification coupled with targeted support can help older people living with frailty to stay well and live independently for as long as possible.

The eFI is a risk stratification tool and not intended to be used as a diagnostic tool.

Confirmation of frailty in an individual should be undertaken using a validated tool such as:

To support routine frailty identification in primary care there are a number of resources:


There are a series of webinar recordings available to support the implementation of routine frailty identification into primary care.

Case study

Routine frailty identification can help local clinicians and commissioners to review current service provision.  Public Health Birmingham is working with GP practices across the 3 CCGs in Birmingham using eFI to understand current frailty provision and identify any gaps. This could inform new ways of working and commissioning decisions to improve care for people living with frailty who are at risk of falls and fracture.