ArticleBMJ open2021
Identification and management of frail patients in English primary care: an analysis of the General Medical Services 2018/2019 contract dataset.
Article in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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3 citing papers in PubMed, 6 citations in OpenAlex.
- Frailty and transitions across cardiometabolic disease states: evidence from multistate models in a 16-year Chinese cohort.npj aging · 2025Article
- Real-World Implementation of PRISMA-7 and Clinical Frailty Scale for Frailty Identification and Integrated Care Activation: A Cross-Sectional Study in Northern Italian Primary Practice.Journal of clinical medicine · 2025Article
- IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study.BMC geriatrics · 2024Article
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThe aim of this study was to explore the extent of implementation of the General Medical Services 2018/2019 'frailty identification and management' contract in general practitioner (GP) practices in England, and link implementation outcomes to a range of practice and Clinical Commissioning Group (CCG) factors.
designA cross-sectional study design using publicly available datasets relating to the year 2018 for all GP practices in England. SETTINGS: English general practices. DATA: The analysis was conducted across 6632 practices in 193 CCGs with 9 995 558 patients aged 65 years or older. OUTCOMES: Frailty assessment rates, frailty coding rates and frailty prevalence rates, plus rates of medication reviews, falls assessments and enriched Summary Care Records (SCRs). ANALYSIS: Summary statistics were calculated and multilevel negative binomial regression analysis was used to investigate relationships of the six outcomes with explanatory factors.
results14.3% of people aged 65 years or older were assessed for frailty, with 35.4% of these-totalling 5% of the eligible population-coded moderately or severely frail. 59.2% received a medications review, but rates of falls assessments (3.7%) and enriched SCRs (21%) were low. However, percentages varied widely across practices and CCGs. Practice differences in contract implementation were most strongly accounted for by their grouping within CCGs, with weaker but still important associations with some practice and CCG factors, particularly healthcare demand-related factors of chronic caseload and (negatively) % of patients aged 65 years or older.
conclusionCCG appears the strongest determinant of practice engagement with the frailty contract, and fuller implementation may depend on greater engagement of CCGs themselves, particularly in commissioning suitable interventions. Practices understandably targeted frailty assessments at patients more likely to be found severely frail, resulting in probable underidentification of moderately frail individuals who might benefit most from early interventions. Frailty prevalence estimates based on the contract data may not reflect actual rates.
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