GPs in England are so “overloaded” that they cannot help older people who are at risk of falling in what NHS bosses accept is an unacceptable failure of care, the House of Commons’ public accounts committee has said.
Pressure on GPs’ time has intensified as a result of the government’s decision to give patients online access to their services, according to a report by the influential cross-party group of MPs.
The committee found that GPs are doing too little to tackle falls even though they are the most common cause of death from injury among over-65s, cause tens of thousands of hip fractures, add to hospitals’ workloads and cost the UK an estimated £4.4bn a year.
Family doctors in England are obliged under the terms of their contract to identify, assess and support people over 65 with moderate or severe frailty. However, “many GPs are not currently able to deliver on these requirements”. During 2024/25 just 17% of those patients were assessed.
Only 18% of the 226,000 people who were diagnosed with severe frailty that year were assessed for their risk of falling and only 16% underwent a review of the medication they were taking.
The situation has arisen because “NHS England has overloaded GPs, who have limited capacity, with new and expanding priorities”, the committee said.
“NHS [England] has prioritised improving patients’ access and digital access to general practice. It recognises that pushing to improve one aspect of care inevitably causes consequences to appear elsewhere, in this case support for people with frailty”, the committee added.
NHS bosses who gave evidence to the committee inquiry admitted the position they were in was “not acceptable”. Almost one in three local NHS areas are assessing fewer than 10% of over-65s for their risk of frailty and falling although nine other areas assessed at least 90% of such patients, “suggesting that good performance is possible within existing resources”, the MPs said.
Prof Victoria Tzortziou Brown, the president of the Royal College of GPs, said the report vindicated its warnings that “prioritising online access to our services without equal focus on continuity and proactive care may have unintended consequences for other areas of care, and risks disadvantaging some of our most vulnerable patients.
“While most GP practices will always try to offer their older patients the time they need, this is increasingly challenging against a backdrop of intense workloads and workforce pressures while also responding to increasing demand and policy requirements to improve access.”
NHS England is looking into whether other health professionals might be able to take on some of the often undone work about frailty. For example, it may ask pharmacists to conduct reviews of the medications taken by frail older people, as both “polypharmacy” – taking several drugs at the same time – and certain medications can increase the risk of a fall.
Older people with poor balance, weak muscles, impaired sight and certain medical conditions are also at greater risk of falling.
Caroline Abrahams, the charity director at Age UK, said that it was almost 10 years since identification of frailty wad first made a priority in GPs’ contracts. “Yet we are still very far from it translating into improvements for older people.
“Older people living with frailty are at much higher risk of deterioration following even minor health shocks. Having a serious fall can be devastating and in some cases is essentially terminal, and either way increases pressure on an already overstretched NHS.”
NHS England has been approached for comment.
