Routine Identification of Frailty – Requirements of the new GP contract 2017/2018

5th July 2017

The new 2017/2018 GP contract introduces routine frailty identification for patients who are 65 and over, from 1 July 2017.

Around 10% of people aged 65 and over are living with frailty and 25-50% of those aged 85 and older. Frail older people have reduced resilience and increased vulnerability to stress – even minor events can trigger large changes in health status and subsequent failure to return to baseline level of health.

The introduction of routine identification of frailty into the GP contract aims to provide an opportunity for general practices to target and improve care and support for those older people with the greatest need by:

  • Proactively identifying older people (aged 65 and older) who are living with frailty and stratifying populations by severity, using an evidenced based tool, such as the electronic Frailty Index (eFI) supplemented by clinical judgement.
  • Focusing on a small number of key evidence-based interventions that is, falls risk identification and annual medication review to support people living with severe frailty.
  • Promoting use of the additional information in the Summary Care Record (with appropriate patient consent) to share key healthcare information across different care settings thereby supporting more integrated and appropriate care for people living with frailty.

Moving from opportunistic to systematic population based identification of frailty can help reduce inequalities, improve access to care, and enable the needs of individuals to be met though early, proactive targeted and appropriate interventions.

NHS England and NHS Employers have put together a range of resources to support the introduction.

Supporting Resources from NHS England and NHS Employers

GMS Contract requirements for the identification and management of people with frailty – NHSE publish guidance on Batch-coding

NHS England have published a statement which clarifies the importance of clinical judgement being applied before coding of frailty scores. Some GP practices may have batch-coded a Read code diagnosis of frailty based solely on an eFI score, without clinical judgement confirming a diagnosis.  This statement confirms the importance of clinical judgement to ensure there is not inappropriate follow up action for patients, including unnecessary clinical interventions; and services, including future care planning based on an undiagnosed wrong identification.

Details of the statement:

Name: GMS Contract requirements for the identification and management of people with frailty – guidance on Batch-coding

Description: NHS England is aware that some practices have batch-coded a Read code diagnosis of frailty based solely on eFI score. Automated diagnostic coding without clinical judgement may lead to inappropriate clinical interventions and future care planning based on a wrong diagnosis. Therefore, NHS England’s advice supported by the GPC and NHS Employers is to not to code until a diagnosis is confirmed by a clinician.

More info: https://www.england.nhs.uk/publication/supporting-routine-frailty-identification-and-frailty-through-the-gp-contract-20172018/

Webinars

NHS England has held a series of webinars to help with implementation,

Past Webinars

Introductory webinar

28th April 2017

Hosted by Dawn Moody, a GP and NHS England’s Associate National Clinical Director for Older People. The webinar slides and audio recording can be accessed through the following links:

Dawn Moody’s presentation: https://healthsector.webex.com/healthsector/ldr.php?RCID=18267d709ba5fc5f7502d5978273a351

Q&A session: https://healthsector.webex.com/healthsector/ldr.php?RCID=3e02ed91a70ae8a9c45066b9f617bd2d

(please note the reduced sound quality in parts of this recording)

Enriching the Summary Care Record with additional information

14th June 2017

Hosted by Dr Emyr Wyn Jones, NHS Digital’s Clinical Ambassador for Summary Care Records and Dr. Robert Jeeves SCR Primary Care Clinical Lead, Summary Care Records Team, NHS Digital. The webinar is aimed at anyone working in general practice with an interest in frailty and/or how to introduce this change to the contract.

The presentation and Q&A session can be accessed through the following links.

Presentation – https://healthsector.webex.com/healthsector/ldr.php?RCID=ce75a201febae9469bf5d7c215b6c17d

Q&A – https://healthsector.webex.com/healthsector/ldr.php?RCID=dbec13835d750db0820e360b95055b92

Electronic Frailty Index with the 3 software providers  

3 separate webinars from 3 of the software providers, SystmOne, Vision and Emis. The webinars will provide a presentation and demonstration of the Electronic Frailty Index software systems followed by Q&A and will be aimed at anyone working in general practice with an interest in frailty and/or how to introduce this change to the contract. Please see below dates and times for each software provider that is relevant to you plus a link to register.

Vision

20th June 2017

Emis

17th July 2017

The webinar was hosted by Sean Morrison, Online Communications Analyst, Customer Experience at Emis Health

Demo and Q&A – https://healthsector.webex.com/healthsector/ldr.php?RCID=68d13370a597ed649eb4fa6eb6a09766.

SystmOne – Date to be confirmed

Clinical focus webinar

Date: 5th July 2017

This webinar was an opportunity to highlight the opportunities for an integrated and multidisciplinary approach to the care of people with frailty. The webinar was hosted by Dawn Moody, a GP and NHS England’s Associate National Clinical Director for Older People and Eileen Burns, President of the British Geriatrics Society. The webinar was aimed at anyone working in general practice with an interest in frailty and/or how to introduce this change to the contract.

Recorded Presentation – https://healthsector.webex.com/healthsector/ldr.php?RCID=80f35fe1d6706caf22082a2fd2c85945

Presentation PDF – http://old.ahsn-nenc.org.uk/wp-content/uploads/2017/07/Clinical-focus-webinar.pdf

Q&A – https://healthsector.webex.com/healthsector/ldr.php?RCID=6dae83a8e5196d32a14d9beeeab5c3c6

Falls webinar

Date: 18th July 2017

The webinar was hosted by Daniel Macintyre, Population Health Services Manager at Public Health England and Shelagh O’Riordan, Consultant Community Geriatrician at Kent Community Trust, Whitstable and Tankerton Hospital. The webinar is aimed at anyone working in general practice with an interest in frailty and/or how to introduce this change to the contract.

Presentation and Q&A – https://healthsector.webex.com/healthsector/ldr.php?RCID=8f2c9ad045d2a3d318a9249fc072c01d

Presentation PDF – http://old.ahsn-nenc.org.uk/wp-content/uploads/2017/07/Identfy-frailty-by-identifying-falls-what-next.pdf

Frailty and What it Means to Older People

26th July 2017

The webinar was hosted by Tom Gentry Joint Head of Health Influencing Age UK and was aimed at anyone working in general practice with an interest in frailty and/or how to introduce this change to the contract.

Main Presentation – https://healthsector.webex.com/healthsector/ldr.php?RCID=bc736d2f6672f637fe4c925c9d7d6b81

Q&A – https://healthsector.webex.com/healthsector/ldr.php?RCID=c158bc9dfeec1670b7b185f8ea2e4cf8

Presentation PDF – http://old.ahsn-nenc.org.uk/wp-content/uploads/2017/07/Living-with-frailty-presentation-NHS-England-webinar-26-July-2017.pdf

Consistent Coding and Data Webinar

8th August 2017

Hosted by Ross Ambler, Senior Information Analyst, Primary Care Domain at NHS Digital. Chris Harris, Programme Support Manager, Long Term Conditions Team, NHS England and Mark Brodigan, Senior Programme Manager GP Contracts, NHS England were also on hand for the Q&A session.

The presentation and Q&A session can be accessed through the following links.

Main presentation – https://healthsector.webex.com/healthsector/ldr.php?RCID=5c7d39f3bbb3f5f787a96e449c746f5d

Q&A – https://healthsector.webex.com/healthsector/ldr.php?RCID=7d01ebe8a246d8bf6c918a6b9fe9edcf

Medication Reviews and Polypharmacy webinar

31st August 

NHS England hosted a Medication Reviews and Polypharmacy webinar associated Routine Frailty Identification in the GP contract. The webinar was hosted by Lelly Oboh, FRPharmS, Consultant Pharmacist, Care of Older People at Guys & St Thomas NHS Trust (Adult Community Health Services), NHS Specialist Pharmacy Services. The webinar was aimed at anyone working in general practice with an interest in frailty and/or how to introduce this change to the contract.

Main Presentation – https://healthsector.webex.com/healthsector/ldr.php?RCID=cd20ee2384d299826d1a7e52f5374986 

Q&A – https://healthsector.webex.com/healthsector/ldr.php?RCID=7b3d3611823d0eaf15621f58d45084e6

Sharing Resources, Templates and Best Practice

Much relevant work is also taking place at a local level and NHSE have set up a platform on Kahootz (futureNHS collaboration platform) to facilitate the sharing of resources, templates, best practice and relevant pieces of work.

They are encouraging interested parties to try this platform and to consider building an informal frailty network or community that can share and discuss issues and good practice quickly and easily. Highlights to date include information about a complete set of resources – for SystmOne – for identifying, assessing (including STOPP/START medication assessment) and care planning for frailty; and an EMISWeb work around solution which enables the generation of a population level eFI report. Both resources come from Dr Gareth Forbes, a GP in our region (Leadgate Surgery in Consett and Derwentside Healthcare GP Federation).

If you would like to join, please email frailtyinprimarycare-manager@futurenhs.kahootz.com  with your role, and an indication of your interest in the topic and one of the site managers will send you an invitation to join.