Following the NHS England technical requirements for frailty, practices are required to create a frailty register and review severely frail patient, to support this Ardens has created the following resources.
For QOF 2019-20, frailty became relevant to blood pressure and HbA1c targets too, making it more important to ensure that patients are correctly identified and coded.
Step 1 – Frailty Register
Practices must record a diagnosis of moderate or severe frailty where appropriate. To do this, you can use the Electronic Frailty Index.
The eFi score alone should not be used to make this diagnosis. This score is based on multiple factors within a clinical record and will change as and when the clinical record changes.
The Ardens Frailty Suite makes the identification and management of frailty easy.
- A protocol allows automatic addition of an eFi score code to all patients over 65 years old, so that GP practices can plan how they will review patients who may have severe frailty. The eFi score can be updated whenever a GP practice chooses to do so.
- Comprehensive reports allow easy review of those patients diagnosed with severe frailty who have outstanding actions.
If you wish to add the eFi score to all patients over 65 years, please follow the instructions in this article. Please note - that some organisations, including EMIS Health and the BMA, do not endorse doing this. This is due to concerns about clinicians misunderstanding what an eFi score is.
- An eFi score does not mean a patient is frail. It is simply a calculation based on data within their clinical record indicating their risk of frailty.
- The eFi score should be used as a guide to identify patients who may be suffering from frailty.
- Clinical judgement, alongside knowledge about the patient, should be used before recording a formal diagnosis of moderate/severe frailty.
The benefit of adding an eFi score to all patients over 65 is that it allows practices to plan how they might review these patients.
After discussion with your clinicians, if you have decided to add the eFi score to all records please follow these instructions:
- Navigate to the Population Reporting module > Ardens Searches > 1.9 Ardens Frailty Management Searches > 1. Identification folder.
- Run the Patients due an eFi score (no score ever) report.
- Select the Batch Add option on the EMIS ribbon and select the option for Protocol.
- Click on the search icon located to the right of the Batch Add field and search for our Add eFi score to record protocol.
- In the Description field enter text Add eFi score to over 65s.
- In the Search Population (Included) field select the *Patients due an eFI score search (as above).
- Click on the OK button. That's it! Now you can run the searches we have provided to help you plan how you will manage frailty in your GP practice.
We understand that some users are not familiar with the Batch Add feature. Please contact us if you require assistance in following these instructions.
How to use the searches to identify your (potentially) frail population
- Navigate to the Frailty searches located in the Ardens Frailty Management Searches > 1. Identification folder and run the searches with the words ‘Latest eFi ……’ (as per section 1 of the below screenshot). These searches will help to identify which patients have an eFi score which indicates they should possibly have a frailty code on their record. Please note – these patients will need to be clinically reviewed before a frailty code is added to their record.
- Use the report to review and code these patients with the appropriate code – ‘Severely frail’ or ‘Moderately frail’ as / if clinically appropriate.
- Run the searches ‘Patients with ….. frailty diagnosed’ (as per section 2 of the below screenshot). These will produce your frailty registers. The reports provide further information about these patients.
- The severely frail search is further broken down to support you with management of these patients.
Step 2 – Frailty Review
For patients with Severe Frailty, a clinical review is required to:
- Perform an annual medication review
- Where clinically appropriate, a discussion about whether the patient has fallen in the last 12 months and provide any other clinically relevant interventions.
- Seek explicit consent to activate their SCR dataset.
Practices are expected to code clinical interventions for this group appropriately. Data will be collected automatically by NHS England who will use this to understand the nature of the interventions made and the prevalence of frailty by degree among practice populations and nationally. This data will not be used for performance management purposes.
The Arden resources includes a single and simple template to carry out a full frailty assessment, with full instructions for clinicians about what is required. To access the template, search for 'Frailty' within the Template Picker screen. We also have a Falls Assessment template to use if appropriate.