New models of frailty care need physios, King’s Fund hears

Frailty takes 5-15 years to develop and clinicians must think about prevention early in the trajectory

After people reach 80 between a quarter and half of them will display some degree of frailty, delegates at the event in London on 15 March heard.

‘We know that frailty is progressive, typically taking 5-15 years to develop,’ said Helen Lyndon, clinical lead for frailty at NHS England. ’So the clues are there early, which is why we need to think more about preventive, proactive work early in that trajectory.’

She called for health services to broaden the range of professionals involved in frailty care, and said ‘this is not just more geriatricians, more nurses, etc’.

Speaking after the event to Frontline, Ms Lyndon said physiotherapists had a huge role in providing support and advice for frail older people, including through comprehensive geriatric assessments. ‘Physiotherapists should be working in advice roles,’ she emphasised.

Many of NHS England’s ‘vanguard’ models of care are piloting new ways to deliver physiotherapy. Ms Lyndon pointed out that 95 per cent of the vanguards are about frailty.

Proactive care models

The conference heard about pre-exisiting work to provide proactive care for older people with frailty. Dr Sunil Hindocha, the clinical chief officer at Lincolnshire West clinical commissioning group (CCG), spoke about a service in his area which started some six years ago.

He said frailty was not inevitable, but that clinicians must actively seek it. ‘The other important thing is that once you have recognised it, you can do something about it,’ he said.

Dr Hindocha called for a consistent, shared care plan for each individual, not a range of care plans. And he emphasised the importance of information sharing among health professionals, saying that his CCG was developing a single care portal that would ‘sit above’ other IT systems.

Karen Goudie, national clinical lead at Healthcare Improvement Scotland, told delegates about the country’s frailty screening tool. NHS organisations were not mandated to adopt this. But at NHS Fife all patients - regardless of age – undergo frailty screening when they arrive at hospital.

She added: ‘Scotland’s improvement programme would not be successful without the clinicians who work across the NHS.

‘If there is key thing you need in your toolkit it is a network of clinicians willing to share and learn from each other, who are willing to take ideas and spread them across other areas that are perhaps struggling to implement it.’

Delegates heard that a new mind set around older people with frailty was emerging. Only two or three years ago people did not know what frailty was, but that was really changed, according to Dr Maggie Keeble, clinical lead for proactive care at South Warwickshire CCG.

‘We have to go out there and be ambassadors for frailty as a diagnosis, as a long-term condition, and stop being anxious about using it as a descriptive term,’ she said.

‘In general practice have all got obesity registers. Now obesity is a definition … but we need to start being courageous and using frailty as a definition and be less anxious about the label.’