Confusion as practices told they can leave moderately frail patients off new register
Exclusive Practices 'don't need to do anything' with patients identified as moderately frail, says the GPC after confusion regarding the requirements of the new GP contract in England.
From 1 July, practices are required to use an appropriate tool 'to identify patients aged 65 and over who are living with moderate or severe frailty' but GP leaders have said that no follow-up is required in those patients with moderate scores.
A summary of the frailty requirements says GPs will need to make a ‘clinical judgement’ on whether patients identified as moderately frail using the prescribed electronic Frailty Index tool have an appropriate diagnosis.
The summary, published by NHS Employers and the BMA, states: ‘Patients identified by the tool as living with moderate frailty, clinical judgement will be required to determine whether that diagnosis is appropriate.’
Pulse has asked NHS England for further clarification, however GPC deputy chair Dr Richard Vautrey told Pulse: 'The moderately frail patients you don't need to do anything with. The only requirement is to focus on severe frailty. The moderately frail ones you could code if you wanted to, if it's clinically appropriate.
'It's a much larger group and a much more disparate group, so the tool may not be quite so specific for those.'
The guidance indicates that for the average practice, 3% of their over-65s will be identified as severely frail and 12% as moderately frail – roughly 2.5% of the average practice patient population by GPC estimate.
These recorded diagnoses are extracted and reported to NHS England quarterly along with the more exacting requirements for patients with severe frailty who require an annual medicines review and falls discussion when they have contact with the practice.
But although they will extract the information the guidance says that 'the data will not be used for performance management or benchmarking purposes'.
LMC leaders told Pulse their local practices had concerns about the GMS contractual standards on frailty introduced in April and the expectations on practices to review all their frail patients.
GPC representative and Sussex LMC leader Dr Russell Brown said some of his colleagues were concerned 'about the quality of care this contractual obligation suggests we must provide'.
But he added that ‘if it isn’t resourced then it’s not a product that NHS England is buying from GPs'.
The new core requirement replaced the unpopular Avoiding Unplanned Admissions DES, which was criticised for being too complex and not sufficiently evidence based.
What information will be reported to NHS England via CQRS?
- The number of patients recorded with a diagnosis of moderate frailty.
- The number of patients recorded with a diagnosis of severe frailty.
- The number of patients with severe frailty with a record of 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 patients with severe frailty who provided explicit consent to activate their enriched summary care record
Source: NHS Employers