GPs lack the time and resource to properly identify and manage frail patients, making it an activity that is ‘unlikely’ to be sustainable, research has found.
Once GPs identify a patient has additional needs there are often not the community services to refer them to, according to the study of GP views, which was published in the British Journal of General Practice.
The survey of 188 GPs and more in-depth interviews with 18, found that while GPs were broadly supportive of being asked to identify frailty – which has been a contractual requirement since 2017/18 – risk stratification tools were not sensitive or specific enough.
More research is needed to show the clinical benefit of the approach before there will be more ‘universal acceptance’ by primary care professionals, the researchers from the University of Nottingham concluded.
One GP respondent said: ‘We can identify and label people with diseases, but actually if there is not much you can do about it… I am not sure who is happier, or if anybody is.’
Others described reviews taking a long time when done properly rather than as a ‘tick-box’ exercise.
The issue of how to properly resource frailty reviews was also raised by many with one GP noting: ‘We actually dedicated a clinic, so we actually saw 12 patients in a morning. They were all half-an-hour appointments. You felt like you were giving really good care, but the problem was it wasn’t sustainable because we just couldn’t keep on giving that amount of time to that activity.’
The researchers concluded there were a range of issues that needed to be addressed for identification of frailty to be of benefit.
‘Although the contractual requirement for identifying and assessing people living with frailty has raised awareness and increased activity in this area, it has added to the primary care workload without being adequately resourced; this is unlikely to be a sustainable model in the long term,’ they added.
Better access to falls prevention programmes or comprehensive geriatric assessments is needed if the issues identified as part of a frailty review are to be dealt with, they said.
The research team added: ‘Unless these issues are addressed, it is likely that any clinical benefit arising from the contractual requirement will be limited.’
It is estimated that around 3% of the over-65s in England live with severe frailty, with 12% and 35% having moderate or mild frailty, respectively.
Under the GP contract, practices should have a system to identify patients living with frailty, review those identified as severely frail and offer appropriate interventions.
In my day we used to refer to such patients as ”bits of old crumble” ——-I and many of my student friends felt very uncomfortable about that term even then