Improving frailty detection and management in primary care with the Electronic Frailty Index

Older people living with frailty account for around £6 billion of annual NHS spending. These patients have a high risk of poor health outcomes.

The eFI was first developed by Leeds academics from NIHR ARC Yorkshire & Humber and introduced in 2016 across the UK. In just one year of use by NHS England, more than 25,000 people with frailty were referred to a falls service, with an estimated prevention of around 2,300 future falls. Researchers estimate that in 2018 alone, these interventions saved the NHS nearly £7m – an example of the benefits of moving from analogue to digital.

Given this tangible success, there was value in developing the eFI further. The NIHR ARC North Thames team collaborated closely with the NIHR ARC Yorkshire and Humber (YHARC) team – including the original developers of the eFI – throughout the project. Together, the team developed the eFI2 to improve its accuracy, specifically by integrating data on 36 health problems including dementia, falls and fractures, weight loss and the number of regular prescriptions people have.

The ARC North Thames team determined the best combination of mental health and social variables to predict frailty outcomes.

There was especially close collaboration around optimising those variables that are time-dependent, with NIHR ARC North Thames consulting with health and social care professionals, while NIHR ARC Yorkshire and Humber also lead on consulting patients and the public.

The team also externally validated the eFI2 using routine primary care electronic health record databases.

The eFI2 has already been made available to 60% of GPs, and an analysis of the work has proven that the eFI2 can more accurately predict older people’s need for home care, risk of falls, care home admission or death. The eFI2 is also soon to be implemented into System One, meaning it will be available to almost all GP practices.

The eFI2 has been put into national contract guidelines for delivery of enhanced services for frailty by GPs in England.

The project team has also given guidance to local councils about how to use the eFI2 as part of their anticipatory care service, using the eFI2 to identify populations at risk.

This early intervention will help doctors and social care workers to personalise and improve care. This benefits patients by maximising independence, preventing falls and improving quality of life for older people. It also helps reduce costs to the public associated with the impacts of frailty. 

NIHR ARC Yorkshire and Humber

London Clinical Frailty Network