Four in five elderly patients miss vital frailty checks annually, according to a damning report from Parliament’s Public Accounts Committee that exposes a system failing the very people it is designed to protect.
In 2024-25, family doctors assessed just 17 per cent of patients aged 65 and over for frailty — meaning more than four in five older people received no formal assessment at all. The figure marks a significant decline from 2017-18, when the requirement was first introduced into the GP contract and 26 per cent of eligible patients were assessed. MPs on the committee said the findings raise serious concerns that huge numbers of vulnerable pensioners are slipping through the net as England’s population ages rapidly.
Frailty is a condition linked to ageing that leaves people at greater risk of falls, disability, hospital admission and the need for long-term care. GPs are contractually required to identify older patients living with moderate or severe frailty and provide extra support to those at greatest risk. The assessments themselves are not a quick tick-box exercise. A comprehensive geriatric assessment should include a medication review to check whether prescribed drugs could be contributing to falls or ill health, a falls risk assessment to prevent potentially life-changing accidents, nutrition checks, mobility assessments, care planning, and support aimed at helping older people stay independent and avoid emergency hospital admissions.
Professor Carl Heneghan, Director of Oxford University’s Centre for Evidence-Based Medicine and an urgent care GP, said dealing with frailty requires far more than a brief appointment. “People who are frail and elderly need to see a GP for a comprehensive assessment. This needs to be resourced appropriately, and if you don’t do that, then it’s just a tick box exercise,” he said. “A 10-minute chat with the GP will just not cover this. If you want to institute this, you need to invest more resources in the community and into these assessments.”
The consequences of failing to identify and support frail older people are stark. In 2024-25, around 226,000 patients were identified as living with severe frailty — the group considered most vulnerable to serious health problems. Yet despite being diagnosed, most failed to receive the follow-up support required under NHS contracts. Just 16 per cent received a medication review, while only 18 per cent underwent a falls risk assessment. The committee concluded starkly: “This is not acceptable care.”
Overall, as of March 2025, approximately 1.06 million people had been diagnosed with moderate frailty and 450,000 with severe frailty, though the true number is likely higher because not all eligible individuals have been assessed. Without early intervention, vulnerable patients are more likely to suffer falls, medication problems and worsening health, increasing their chances of ending up in A&E, being admitted to hospital or requiring long-term care. Researchers have estimated frailty already costs the UK healthcare system up to £6 billion a year.
The committee’s report also laid bare an unacceptable postcode lottery. Across England, 32 of the 106 local NHS areas assessed fewer than 10 per cent of patients aged 65 and over who are most at risk. By contrast, nine areas assessed more than 90 per cent of eligible patients, suggesting far better performance is possible. MPs said older people were facing an unacceptable lottery depending on where they lived. Committee chairman Sir Geoffrey Clifton-Brown said GPs are “simply unable to do this important work, overloaded as they have been with new and expanding priorities from NHS England.” He added: “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.”
The situation could worsen. NHS England has ordered local Integrated Care Boards to reduce their running costs by 50 per cent, prompting large-scale redundancy programmes. The committee said it was “deeply concerned” the cuts had not been properly thought through and warned they could undermine the ability of local health leaders to improve services and tackle poor performance. The report also highlighted a lack of clear accountability for frailty care between commissioners and providers, and found that NHS England and the Department of Health and Social Care lack a single, joined-up strategy for dealing with frailty despite its increasing prevalence.
The warning comes as England faces a rapidly ageing population. Official projections show the number of people aged 85 and over is expected to rise by around 73 per cent by 2045, placing ever greater demands on health and care services that are already struggling to meet the needs of the oldest and most vulnerable.