In a new report on support for people with, or at risk of, frailty*, the Public Accounts Committee (PAC) voices concern that GPs might not be prioritising care for this group, with limited capacity taken up with delivering NHS England’s priorities on improving patients’ access and digital access to general practice.
GPs are contractually required by NHSE to identify, assess and support people living with frailty. The PAC’s report makes clear that many GPs are not currently able to deliver on these requirements.
The GP contract requires the identification of any registered patient aged 65 years or over who is living with moderate or severe frailty – but just 17% of patients aged 65 or over were assessed for frailty in ’24-’25. Of the 226k people diagnosed with severe frailty in the same year, only 16% had a medication review, and 18% had a falls risk assessment. PAC states that this is not acceptable care. The GP contract sets out that 100% of this group should receive these follow-up actions.
In evidence to the PAC’s inquiry, NHSE recognised that it had pushed GP practices very hard over the past couple of years to improve access, and that pushing to improve one aspect of care inevitably causes consequences to appear elsewhere – in this case, support for people with frailty.
It told the PAC that it is looking at other healthcare professionals sharing the service, such as community pharmacists undertaking medication reviews – but the inquiry received evidence from pharmacists keen to do this work who told the PAC it is not adequately funded.
The PAC is calling on NHSE to set out the basis on which it considers GPs have the capacity to deliver the full range of services and responsibilities expected from them.
The report further highlights significant and unexplained regional variation in support for people with frailty. In ’24-’25, 32 of 106 local NHS areas assessed less than 10% of their registered patients aged 65 or over. Better performance is clearly possible with existing resources, as nine of these areas assessed 90% or more of this group.
While NHSE accepted that the position with regard to frailty is “not acceptable,” the PAC’s report warns that it is not clear exactly who is responsible for improving performance between local health boards who commission services, and those, including GPs, who deliver these services. The PAC warns that this divided system could lead to no-one being responsible.
The report comes in the context of NHSE’s planned 50% cuts to local health boards, announced in April 2025. Boards will be planning large-scale redundancies to achieve these, with some current functions to be transferred away from them.
The PAC has deep concerns that the government’s planned cuts to local health boards are insufficiently thought-through, and will harm their ability and capacity to carry out their important work. Further, it risks undermining well-performing boards, while limiting the ability of poorly-performing ones to improve. The PAC expects to return to this issue during the current Parliament.
Sir Geoffrey Clifton-Brown MP, Chair of the Public Accounts Committee, said: “Those at risk of frailty need preventative and follow-up care – indeed, the value of this kind of care is so well-established that it is a requirement in GPs’ contracts. Yet our report shows that in too many parts of the country GPs are simply unable to do this important work, overloaded as they have been with new and expanding priorities from NHS England.
"NHSE needs to take a long hard look at what it expects from both the wider health system and from GPs, who are only human beings, running already complicated operations, and with limited resources.
“NHSE and government must also closely assess the impacts of changes they wish to make, including the cuts to local health boards, the concerns around which we have raised since they were announced and to which we will keep returning until we secure true reassurance.
"NHS England has been hyper-focused on ensuring people’s access, and digital access, to general practice. Given the well-established challenges in these areas, this is of course understandable.
"However, we have an ageing population in this country, with millions of people at risk of frailty. Our report must act as a warning that any success in ensuring such access must not be built by a system turning its face away from older people as it prioritises other things.”
