Frequently asked questions

We have put together answers to our most frequently asked questions about supporting older people living with frailty.

If you need any more information, please email us: england.longtermconditions@nhs.net.

The ageing population living with varying degrees of frailty presents one of three key challenges in the 5YFV along with mental health and cancer.  Many STPs are focused on better supporting older people living with frailty.  This approach will help target existing resources more effectively and draw on clinical judgement and skills available in primary care.  In addition, through quantifying the scale and distribution of frailty by degree, will help with the development of commissioning plans to address the challenges and opportunities arising from an ageing population.

Whilst there will be overlap in some patients covered through this approach and the AUA ES there are significant differences, most importantly the intent to identify people at risk of, but not yet experiencing a sudden increase in care needs. By focusing on frailty specifically, this importantly provides a proactive, validated and streamlined approach to support the health and care system to meet the demands from a growing ageing population with higher health and care needs by:

  • Promoting a validated and evidence-based proactive approach to systematise frailty identification by degree at population level and better target diagnosis and management in primary care.
  • Using a tool within GP software using existing Read codes which gives GPs control of the process to identify people with the greatest needs.
  • Promoting a consistent approach to frailty identification and diagnosis across STP footprints and nationally which will help inform future local and national planning (e.g. workforce roles, housing, social care, rehabilitation and recovery service capacity and skills development).
  • Promoting coding of frailty and the use of the enriched Summary Care Record (with appropriate patient consent) to share data across different care settings thereby supporting more integrated and appropriate care for people living with frailty
  • Being clearer that whilst accountability continues to reside with the GP that other clinical roles may be best placed to provide care for older people living with frailty

The eFI will be available to around 99% of GP practices during 2017/18 (SystmOne, EMIS and Vision).  Where available, we would encourage its use as:

  • it has been externally validated using routine primary care data its use is recommended in NICE Guideline 56 on Multimorbidity [insert link]
  • is widely available and therefore promotes consistency
  • is increasingly used by GPs already
  • it uses existing GP data and therefore requiring no additional resource.

Around 1% of practices are unlikely to have access to the Electronic Frailty Index.  For these practices, they can use an alternative approach such as the clinical frailty scale (CFS) to identify people living with frailty. The advantage of the eFI is that it enables systematic population based case finding, whereas approaches such as the CFS will still rely predominantly upon opportunistic assessment for frailty.

We expect that this approach will reduce unwarranted hospital admissions as it will reduce the risk of people experiencing two of the major frailty syndromes, i.e. falls and adverse effects of medication, which often result in hospital admission. It will also ensure that those most at risk of unwarranted outcomes from admission to hospital are identified early in their admission and their care appropriately tailored to meet their needs and preferences.