Practices should use an appropriate tool to identify patients that fall into this category, such as the Electronic Frailty Index (eFI). The BMA says these tools should be used as a guide only, and 'the decision to code some as moderately or severely frial should be made by an experienced clinical guided by, but not restricted by the electronic score.'
The BMA also points out that it is likely these patients will be seen on a regular basis, so coding can take place opportunistically over the course of the year.
- For more information on identifying frailty and how the eFI tool was developed see the BMA focus on identification and management of patients with frailty
For those patients identified as living with severe frailty, practices should provide a clinical review, which should include an annual medication review and, where appropriate, discuss whether the patient has fallen in the last 12 months. Any other clinically-relevant intervention should also be provided.
In cases where these patients do not have an enriched Summary Care Record (SCR), the practice should promote the benefits of this and seek informed consent to activate the enriched SCR.
It is for clinicians to determine whether it is clinically appropriate to code patients who have been identified as being moderately frail.
Practices should code clinical interventions for this group appropriately, however there will be no additional reports to produce or claims to make.
This requirement under the contract replaces the unplanned admissions enhanced service (ES), which does not apply in 2017/18. The £156.7m funding for this enhanced service will be added to the global sum for 2017/18 in order to cover the work associated with managing patients with severe frailty. The BMA says that the percentage of patients with severe frailty is estimated to be a significantly smaller cohort than the number of patients that were covered by the unplanned admissions ES.
Data will be collected from practices to enable NHS England to understand interventions within this patient group and the prevalence of frailty. This will not be used for performance management purposes.
Data will be collected on the number of patients:
- recorded with a diagnosis of moderate frailty and severe frailty
- with severe frailty with an annual medication review
- with severe frailty who are recorded as having a faill in the previous 12 months.
- with severe frailty who have provided consent to activate their enriched SCR.
- Identification and management of patients with frailty - summary of requirements
- BMA focus on identification and management of patients with frailty