Leading the way in identification and management of frailty



Development of the second iteration of the electronic Fralty Index (eFI2), a tool that uses routine GP data to identify frailty.


Older people living with frailty account for account £6 billion of annual NHS expenditure. We led the development and national implementation of an electronic frailty index (eFI). The national implementation of the eFI – a global first – led to a major NHS policy impact as it enabled a standardised approach to identifying nationally. The eFI has been implemented into 100% of general practices across England. This has successfully enabled the identification of older people with mild, moderate or sever frailty for appropriate services, for example, medicine reviews and falls assessments. By 2019, approximately 2.5 million older people in England had been assessed for the presence of frailty.

Outline of our project

We are leading the development of the eFI2, a second iteration of the original index, in partnership with ARC North Thames. This will improve on the eFI by including new frailty-related outcomes, having better identification of mild, moderate and severe frailty, taking account of time constraints of some health conditions, and including more mental health outcomes in the modelling.

Our impact and next steps

  • The eFI has made a huge impact nationally. It has:
  • Been included in various national guidance and contract documents (2016 NICE multi morbidity guidelines; identification and management in GP contacts guidance 2017/18; 2019 NHS Long Term Plan; Royal College of Anaesthetists and British Geriatrics Society 2021 perioperative care guidelines).
  • Won national awards and recognition (Healthcare IT Product Innovation category, EHU Live 2016; Royal College of Physicians Excellence in Patient Care 2017; national impact case study, UK Medical Schools Council 2022).
  • Supported national programmes (NHS England Ageing Well Programme through the Anticipatory Care Framework and the national medicines optimisation policy through inclusion in the Primary Care Network Structured Medications Review contract).

eFI2, the new improved version of eFI, will be in practice in late 2023.



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