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:

• Gait Speed Test
• PRISMA-7
• Timed Up and Go test

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

• NHS Digital publish relevant local, regional and national data on frailty
• NHS England guidance for general practices on Supporting routine frailty identification and frailty through the GP Contract 2017/2018
• NHS England Toolkit for general practice on supporting older people living with frailty
• Yorkshire and Humber Academic Health and Science Network on Recognising and managing frailty