96 Will Routine Frailty Identification by GPS Improve Patient Care? A Review of the 2017 GMS Contract For General Practitioners (GPS) Using Pestle Analysis Tool

Abstract

Abstract Introduction It is well established in the literature that frailty is associated with high health costs (Bock 2016, England: BioMed Central). Early identification improves patient outcomes. The 2017 GMS contract for General Practioners’ (NHS England 2017) had tried to implement this. This is a result from the government wanting to improve care for frail patients from the “Five Year Forward Review”. This is first policy worldwide to introduce a policy on frailty screening (Reeves, 2018, BMJ, 362, pp. k3349). Majority of frail patients’ first contact with the NHS is through Primary Care. However, with ever reducing number of GPs and increasing work burden, is it appropriate to ask GPs to undertake this? Methods This review uses the policy analysis tool PESTLE (Political, Economical, Social, Technological, Legal, and Environmental) (Visconti 2016, Corporate Ownership and Control,13), to assess the implications of this new contract obligation on GPs and patients. Results Once frail patients are identified, it is advised that they are reviewed by GPs annually. Whether this actually benefits patients are not clear (Page 2017 British Journal of Clinical Pharmacology, 82(3), pp. 583–623). The evidence for interventions being cost-effective is also inconsistent (Hamilton 2017, BMJ, 358, pp. j4478). Alternative methods include implementing a nurse-led community frailty service, has shown some benefit in Netherlands (Bleijenberg 2017, JAMDA). Clinical Pharmacist can aid with medication reviews and focusing on Geriatrician “outreach” clinics in primary care can improve patient care and outcomes (Goldstein 2014, CJEM, 16(5), pp. 370). Due to the work burden, GPs are often seen to be reactive rather than proactive (Goodwin 2010, The King’s Fund). The shift in focus on frailty can simulate more constructive dialogue between primary care, secondary care, patients and their carers. The BMA has also tried to reassure GPs this is not an added burden, but this is controversial (BMA 2017). Conclusions To successfully implement such a policy, emphasis on clear objective outcomes and strategy is needed. There is a risk of frailty identification becoming a tick box exercise.