Abstract
BackgroundIn England, GPs are independent contractors working to a national contract. Since 2017, the contract requires GPs to use electronic tools to proactively identify moderate and severe frailty in people aged ≥65 years, and offer interventions to help those identified to stay well and maintain independent living. Little is currently known about GPs’ views of this contractual requirement.AimTo explore GPs’ views of identifying frailty and offering interventions for those living with moderate or severe frailty.Design and settingA sequential mixed-methods study of GPs in the East Midlands region of England — namely Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire, and Northamptonshire — undertaken between January and May 2019.MethodGPs were made aware of the study via professional organisations’ newsletters and bulletins, GP email lists, and social media, and were invited to complete an online questionnaire. Responses were analysed using descriptive statistics and, based on those survey responses, GPs with a range of GP and practice characteristics, as well as views on identifying frailty, were selected to participate in a semi-structured telephone interview. Interview transcripts were analysed using framework analysis.ResultsIn total, 188 out of 3058 (6.1%) GPs responded to the survey and 18 GPs were interviewed. GPs were broadly supportive of identifying frailty, but felt risk-stratification tools lacked sensitivity and specificity, and wanted evidence showing clinical benefit. Frailty identification increased workload and was under-resourced, with limited time for, and access to, necessary interventions. GPs felt they lacked knowledge about frailty and more education was required to better understand it.ConclusionProactively identifying and responding to frailty in primary care requires GP education, highly sensitive and specific risk-stratification tools, better access to interventions to lessen the impact of frailty, and adequate resourcing to achieve potential clinical impact.
Highlights
With there being an ageing population that is living longer with more comorbidities, frailty — defined as a state of increased vulnerability to adverse outcomes following stressor events1 — is a major concern to the NHS in England.[2]
Proactively identifying and responding to frailty in primary care requires GP education, highly sensitive and specific risk-stratification tools, better access to interventions to lessen the impact of frailty, and adequate resourcing to achieve potential clinical impact
Diversity was achieved in terms of GP characteristics (Table 3), most practice characteristics (Table 3), and four of the five questions on views about frailty (Table 4) — the exception being that all GPs interviewed agreed that the advantages of identifying frailty outweighed the disadvantages
Summary
With there being an ageing population that is living longer with more comorbidities, frailty — defined as a state of increased vulnerability to adverse outcomes following stressor events1 — is a major concern to the NHS in England.[2]. The services provided by GPs are specified in a nationally agreed General Medical Services (GMS) contract. An addition to this contract in 2017/2018 required general practices to use an evidence-based electronic frailty identification tool, such as the electronic Frailty Index, to risk stratify patients aged ≥65 years.[2,9] For those stratified as moderately or severely frail, clinical assessment is required to confirm frailty status; those confirmed as severely frail require a clinical review. Since 2017, the contract requires GPs to use electronic tools to proactively identify moderate and severe frailty in people aged ≥65 years, and offer interventions to help those identified to stay well and maintain independent living. Little is currently known about GPs’ views of this contractual requirement
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