Frailty is the most problematic expression of ageing we are facing. The aim of this contractual requirement is to proactively identify older people (65+) living with severe or moderate frailty. Those identified will then be offered a medication review (severe) and an annual falls risk assessment (severe & moderate where clinically appropriate) with promotion of assess to the SCR.
Patients should be identified using the electronic frailty index (eFI). This alone will not make a frailty diagnosis, the diagnosis requires the judgement of a clinician. NHS England have issued a notice with regards to batch-coding a diagnosis for patients using the eFI result only. It is recommended practices DO NOT batch code for the following reasons:
- eFI is not a clinical diagnostic tool: it is a population risk stratification tool;
- Automated diagnostic coding without clinical judgement will lead to inappropriate diagnosis of frailty with direct consequences for patient care;
- Such practise does not meet the contractual requirement which includes clinician judgement to diagnose severe or moderate frailty;
- Patients incorrectly diagnosed with frailty may be subject to inappropriate clinical interventions or future care planning based on a wrong diagnosis.
Practices are advised to consult the guidance document produced for this requirement – https://www.england.nhs.uk/wp-content/uploads/2017/04/updated-supporting-guidance-frailty-identification-may-17.pdf
Once patients have been identified using the eFI, practices should then undertake a secondary check using direct assessment with Clinical Frailty Scale (CFS), clinical knowledge of patient or information available in the Health Care Record to validate eFI result. Patients should then be coded appropriately:
Practices will code clinical interventions for this group appropriately. Data will be collected on:
- The number of patients recorded with a diagnosis of moderate frailty
- The number of patients with severe frailty
- The number of patients with severe frailty with an annual medication review
- The number of patients with severe frailty who are recorded as having had a fall in the preceding 12 months
- The number of severely frail patients who provided explicit consent to activate their enriched SCR