This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Mass diagnosing frailty does not meet contract requirements, GPs warned

NHS England has warned GPs not to batch diagnose elderly patients as frail using the electronic frailty index (eFI), saying that to do so is in breach of contract.

In a letter sent to GPs, NHS England said that is was 'aware that some practices have batch-coded a read code diagnosis of frailty'.

But it said doing this:

  • Will lead to inappropriate diagnosis; and
  • Does not meet the contractual requirement which includes clinician judgement to diagnose severe or moderate frailty.

It also warned that patients 'incorrectly diagnosed' with frailty 'may be subject to inappropriate clinical interventions or future care planning based on a wrong diagnosis'.

GPs are meant to record patients as frail when they speak to them, not mass diagnose patients searching their system.

It added: ‘It is important to understand that eFI identifies people at risk of frailty, but cannot on its own make a diagnosis of frailty. The diagnosis of frailty requires the judgement of a clinician, taking into account an individual’s complete clinical picture.’

Dr Andrew Green, GPC clinical and prescribing lead said: ‘The eFI tool can only be a guide, it can both under and overestimate the degree of frailty. Ultimately, the decision is clinical and should be made by a clinician who is guided by but not constrained by the numerical score.’

GPs have to review patients for frailty under new contractual rules which came in earlier this year.

Readers' comments (12)

  • AlanAlmond

    Getting paid to 'diagnose' frailty. What complete cobblers. Half baked and ludicrous. Like paying workmen to dig holes in order other workmen can be paid to fill them in again. No better demonstration of the utter stupidity that has totally glued up general practice and brought it to its knees. Who ever dreamt this crap up needs to be put in front of a peer group of front line GPs to explain exactly why they aren't a complete prat.

    Unsuitable or offensive? Report this comment

  • At risk of frailty, what next?

    Unsuitable or offensive? Report this comment

  • Readers might be interested in this summary of recent publications on Frailty:

    Frailty - nothing about us without us:

    Dr Peter J Gordon

    Unsuitable or offensive? Report this comment

  • AlanAlmond

    OBVIOUSLY frailty is important. As is hypertension, obesity, kidney disease, dementia, meningitis, Parkinson's disease, multiple sclerosis, polycystic ovarian syndrome, obsessive compulsive disorder, fungal nail infections, osteoarthritis, reflux in the neonate, pre menstual syndrome, alcoholism , drug abuse and prostrate name but a small fraction of all the important problems that afflict human kind and fall under the umbrella of general practice to some degree or other.
    What I have a problem with are single issue specialists suggesting we pay more attention to their small slice of human illness at the expense of everything else. This does not mean frailty is not important ...just that I don't agree we shoI'll be being paid to diagnose 'the latest thing' at the expense of everything else we do.

    Unsuitable or offensive? Report this comment

  • I share the concerns expressed by "A virtual nobody" and I have argued that this latest "improvement drive" risks over medicalising ageing into a singular, deficit-based, and difficult to define concept.

    For putting forward my views I have encountered what seems to be rather defensive responses by "improvement scientists" and some Geriatricians:

    aye Peter J Gordon

    Unsuitable or offensive? Report this comment

  • Perhaps in future we will also be asked to screen for ''pre-frailty''...think I might apply to patent the phrase just in case.

    Unsuitable or offensive? Report this comment

  • You are too late (7.21pm)! "Pre-frailty" has entered the medical dictionary and I gather has some determinism about it.

    Unsuitable or offensive? Report this comment

  • so how on earth are we meant to do it then?
    they want us to call in every old patient, including those we dont see often, run the eFI tool (which is validated, and good marker of what they are defining to be frailty), then have the chat?

    surely if the algorithm has taken into account the 30-odd factors it says it does, and we have a chat with the patient about falls and SCA inclusion, then thats that.

    When the spec first came out, no-one said we couldnt batch add, and in fact EMIS does it automatically.

    Im not gonna change it

    Unsuitable or offensive? Report this comment

  • GPs will now be asked to record Pre-Death Risk on every member of the population, because the Health Secretary has been advised by experts that Life has a 100% mortality rate - this shocking statistic should make GPs realise how incompetent and stupid they have all been.

    Unsuitable or offensive? Report this comment

  • OMG are right!....what about 'pre pre frailty'?

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say