Frailty Considerations

Frailty Considerations

Frailty Considerations

Overview/Purpose

These patient status alerts support QOF optimisation for 2026/27 by helping users identify patients where frailty coding may affect achievement of blood pressure and diabetes indicators.

Frailty affects blood pressure targets across CD001, CD002, HYP010, HYP011 and DM036. It also affects HbA1c targets for DM020 and DM021, where patients coded as frail may have higher HbA1c thresholds.

What does it do?

These alerts identify patients on the Coronary Heart Disease (CHD), Hypertension (HYP), or Diabetes registers where there is a potential mismatch between the patient's recorded frailty diagnosis and their most recent Rockwood Clinical Frailty Score. The alerts either inform the user there is a frailty coding mismatch and the patients Rockwood score is either higher or lower than the recorded frailty diagnosis.

Why is it important?

Some patients may have frailty recorded using Rockwood coding, but this may not be the same as a QOF-counting frailty code.

This can affect QOF performance, particularly in harder-to-achieve blood pressure indicators. The alert helps users opportunistically identify patients whose frailty coding may need review, so that the record accurately reflects the patient’s frailty status and QOF logic is applied correctly.

What will the user see?

The alert appears as:

      

Users should:

  • review the frailty information shown in the alert
  • consider whether the patient’s current frailty status is accurately coded
  • check whether Rockwood coding needs to be translated into a valid QOF frailty code
  • use the linked template to update frailty coding where clinically appropriate
  • remember that recording moderate or severe frailty may remove eligibility for relevant QOF blood pressure indicators

System Dependencies

This protocol relies on accurate coding of:

  • QOF frailty codes
  • Rockwood frailty scale codes
  • Rockwood frailty scores/values
  • relevant QOF disease registers and indicator logic
  • blood pressure and HbA1c achievement data

System Triggers

This is an alert protocol which loads on loading the patient record

Change management considerations

Practices should ensure clinical teams understand:

  • the difference between QOF frailty codes and Rockwood frailty coding
  • that Rockwood coding may not count for QOF
  • how frailty affects QOF blood pressure and HbA1c indicators
  • when it is appropriate to update frailty coding
  • that frailty coding should reflect the patient’s clinical status, not just QOF optimisation

How to get it

These alerts will automatically be in your system when you join our organisation group.