Intended for healthcare professionals


The challenge of ageing populations and patient frailty: can primary care adapt?

BMJ 2018; 362 doi: (Published 28 August 2018) Cite this as: BMJ 2018;362:k3349
  1. David Reeves, reader12,
  2. Stephen Pye, research fellow12,
  3. Darren M Ashcroft, professor3,
  4. Andrew Clegg, clinical senior lecturer4,
  5. Evangelos Kontopantelis, professor12,
  6. Tom Blakeman, clinical senior lecturer12,
  7. Harm van Marwijk, professor15
  1. 1University of Manchester-NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Manchester, UK
  2. 2University of Manchester, Division of Population Health, Health Services Research and Primary Care, Manchester, UK
  3. 3University of Manchester-School of Pharmacy and Pharmaceutical Sciences, Manchester, UK
  4. 4University of Leeds-Academic Unit of Elderly Care and Rehabilitation, Leeds, UK
  5. 5Brighton and Sussex Medical School-Division of Primary Care and Public Health, Brighton, UK
  1. Correspondence to: D Reeves david.reeves{at}

Making frailty an integral part of primary care is not without considerable challenges, explain David Reeves and colleagues

Healthcare systems worldwide are challenged to meet the needs of increasingly ageing populations, characterised more by multimorbidity and declining physical and mental function than by the individual acute diseases for which these systems were originally designed.1 Especially problematic is the increasing number of frail elderly people. Frailty is a condition characterised by age related decline across multiple physiological systems,2 resulting in high vulnerability to adverse health outcomes, including dependency, need for long term care, and mortality.3

Responding to these challenges, healthcare policy in the UK and many other countries4 has increased its focus on the complex interplay between the multiple health problems frequently encountered in older people and the need to develop integrated and multidisciplinary health and social services. In the NHS, primary care is mainly delivered by general practitioners, medical generalists who also act as gatekeepers to specialist service providers. Primary care is typically the first point of contact for NHS patients (the majority of the population) so is considered the natural hub for integrated activity. Most GPs work in group practices, where several GPs are supported by ancillary medical and administrative staff. Practices are organised into Clinical Commissioning Groups responsible for planning and commissioning local healthcare services. Although practices are independent contractors, almost all practice funding comes from the UK government through the general medical services (GMS) contractual arrangement.

The UK primary care model, with its emphasis on holistic care and centralised policy, would seem well suited to meet the changing healthcare needs of an ageing population. In this context, the 2017 GMS contract for England introduced a new requirement for general practices to identify and appropriately manage all patients aged 65 or over with moderate …

View Full Text

Log in

Log in through your institution


* For online subscription