Identification and management of patients with frailty
The 2017 GMS contract requires GP practices, from 1 July 2017, to use an appropriate tool (e.g. Electronic Frailty Index - eFI) to help identify patients aged 65 and over who are living with moderate and severe frailty.
For those patients identified as living with severe frailty the practice should record this in the patient's record and deliver a clinical review providing:
Practices are expected to code clinical interventions for this group appropriately. Data will be collected automatically by NHS England who will use this to understand the nature of the interventions made and the prevalence of frailty by degree among practice populations and nationally. This data will not be used for performance management purposes
In QOF 2019-20, Frailty became relevant to blood pressure and HbA1c targets too, making it even more important to ensure that patients are correctly identified and coded.
For those patients identified as living with severe frailty the practice should record this in the patient's record and deliver a clinical review providing:
- An annual medication review
- Where clinically appropriate discuss whether the patient has fallen in the last 12 months and provide any other clinically relevant interventions.
- Where a patient does not already have an enriched Summary Care Record (SCR) the practice will promote this, seeking informed patient consent to activate the enriched SCR.
Practices are expected to code clinical interventions for this group appropriately. Data will be collected automatically by NHS England who will use this to understand the nature of the interventions made and the prevalence of frailty by degree among practice populations and nationally. This data will not be used for performance management purposes
In QOF 2019-20, Frailty became relevant to blood pressure and HbA1c targets too, making it even more important to ensure that patients are correctly identified and coded.
Ardens-QMasters' and frailty tools
Clinicians are expected to use the eFi score, alongside clinical judgement, to record a diagnosis of moderate or severe frailty in appropriate patients. The eFi score alone should not be used to make this diagnosis. This score is based on a multiple factors within a clinical record and will change as the clinical record changes.
Since the migration to Snomed, the protocol we produced for coding an eFI score on a patient record no longer works. However, EMIS have provided some very useful searches in their EMIS Library search folder.
To find them, navigate to EMIS Library> Read Searches> eFI searches.
To find them, navigate to EMIS Library> Read Searches> eFI searches.
Run the whole folder called ‘eFI searches’.
In the sub-folder named ‘eFI’ (circled above), you will find searches which interrogate the coded data on a patient’s record and work out which patients have an eFI which indicates possible frailty.
The ‘patients included’ of searches 1, 2 and 3 as per the screenshot below will provide lists of patients with an eFI score which indicates severe / moderate / mild frailty respectively.
A clinician should then review these patients and make a clinical decision as to whether or not to code them with a frailty code.
In the sub-folder named ‘eFI’ (circled above), you will find searches which interrogate the coded data on a patient’s record and work out which patients have an eFI which indicates possible frailty.
The ‘patients included’ of searches 1, 2 and 3 as per the screenshot below will provide lists of patients with an eFI score which indicates severe / moderate / mild frailty respectively.
A clinician should then review these patients and make a clinical decision as to whether or not to code them with a frailty code.
The Frailty GMS template
The Ardens-QMasters Frailty template give the option of recording either eFI or Rockwood scores and also helps with management of frailty.
The Ardens-QMasters Frailty template give the option of recording either eFI or Rockwood scores and also helps with management of frailty.
