GPs Failing Frail Older Patients: NAO Report Exposes Care Crisis

Published: 05 December 2025. The English Chronicle Desk. The English Chronicle Online.

Older people living with frailty are being let down by general practitioners across England, according to a hard-hitting report from the National Audit Office released today. The independent public spending watchdog has revealed that GPs are identifying and supporting far fewer frail patients than they did just a few years ago, leaving hundreds of thousands at greater risk of falls, hospital admission, and loss of independence.

Frailty is not simply old age. It is a distinct medical syndrome where the body gradually loses its built-in reserves, making everyday tasks harder and recovery from illness slower. People living with frailty often feel exhausted, move more slowly, and can become housebound. Even a minor infection or fall can trigger a rapid decline.

Under NHS rules, every GP practice must proactively identify patients aged 65 and over who may be living with moderate or severe frailty. Once identified, these patients should receive regular medication reviews, fall-risk assessments, and tailored support. Yet the NAO report paints a bleak picture of how rarely this is happening in practice.

In 2024/25, only one in six eligible older patients was assessed for frailty – a sharp drop from one in four in 2017/18. Of the 226,000 patients who were eventually diagnosed with frailty this year, a mere 18 per cent had their fall risk checked and only 16 per cent received a proper medication review. The watchdog described the variation in care across the country as “worrying inconsistency” that cannot be explained by local need alone.

Gareth Davies, head of the National Audit Office, did not mince words. He said it was “crucial that people with frailty are supported effectively and consistently across the country”. He warned that the NHS must use the upcoming 10-year health plan to build services that truly meet the needs of an ageing population, rather than leaving vulnerable older people without the proactive care they are entitled to receive.

Doctors have responded by pointing to unbearable workload pressures. Professor Victoria Tzortziou Brown, chair of the Royal College of General Practitioners, acknowledged that the findings must be taken seriously. However, she stressed that GPs and their teams are working under intense strain. A full-time GP in England now looks after an average of 2,241 patients – 304 more than a decade ago, a rise of nearly 16 per cent. That increase, combined with years of under-investment, makes it almost impossible to deliver the time-intensive, personalised care that frail older patients desperately need.

Professor Tzortziou Brown said GPs desperately want to do more for their frail patients. Yet without a larger workforce and proper funding, continuity of care, comprehensive assessments, and regular follow-up appointments are becoming increasingly difficult to sustain. Many practices are forced to focus on urgent problems rather than prevention, even though early intervention in frailty can prevent costly hospital stays and preserve quality of life.

The Department of Health and Social Care insisted it is already taking action. A spokesperson said the government had inherited a broken system in which too many elderly people were failed, but claimed ministers are now “working at pace” to help older people live well for longer with the care and support they deserve.

Campaigners for older people have reacted with anger and dismay. Caroline Abrahams, charity director at Age UK, called the figures “deeply disturbing”. She said the decline in frailty assessments shows that primary care for older patients is going backwards at exactly the moment the population is ageing fastest. She urged the government to treat the NAO findings as a wake-up call and to make good on promises to shift resources towards community services and prevention.

The NAO report comes at a critical time. The government is finalising its long-awaited 10-year plan for the NHS in England, with a heavy emphasis on moving care out of hospitals and closer to home. Yet today’s findings raise serious questions about whether general practice – the frontline of community care – has the capacity to deliver that vision without significant new investment and workforce growth.

For the hundreds of thousands of older people currently living with undiagnosed or unsupported frailty, the stakes could not be higher. A missed assessment can mean a fall that shatters a hip, a medication mix-up that lands someone in A&E, or a gradual slide into dependence that could have been prevented. As England’s population ages, the human cost of failing frail older patients is only set to grow.