Frailty identification in the NHS is often fragmented, inconsistent, and reactive.
In Part 3 of the Frailty Paradox series, we explore how continuous, clinician-led identification through a self-replenishing frailty register can make frailty visible across a population, forming the foundation for effective prioritisation and intervention.
The NHS cannot manage frailty if it cannot see it.
In Part 2 of the Frailty Paradox series, we explore why general practice is best placed to anchor a shared, system-wide view of frailty. We examine the strengths and limitations of current approaches, drawing on real-world experience and published evidence.
The findings suggest that current methods may identify fewer than half of patients living with frailty, and that no single tool meets all four key requirements for effective identification: accuracy, scalability, early detection, and usability in clinical practice.
The NHS is not failing to deliver frailty care. The workforce is already identifying risk, assessing need, and delivering support every day, but this activity is not organised as a coordinated neighbourhood response.
This is the Frailty Paradox: the work exists, but the system to bring it together does not.
This series explores how the NHS can move from fragmented activity to coordinated population health management for frailty through integrated neighbourhood teams.