2021 Junior Research Award Runner-up 2: Ebrahim Mulla

Awarded project: „Proactive frailty identification – a good idea? A sequential mixed-
methods study of GP”
Dr Ebrahim Mulla achieved his MRCGP in 2021 and is working as an NHS General
Practitioner in the East Midlands region of England.  He is the First5 representative for
the Leicester Faculty of the Royal College of General Practitioners and is a Committee
member for the Primary Care Academic Collaborative, a UK-wide primary care research
network.
Proactive frailty identification – a good idea? A sequential mixed-methods study of GP
Background In England, GPs are independent contractors working to a national contract.
Since 2017, the contract requires GPs to use electronic tools to proactively identify
moderate and severe frailty in people aged ≥65 years, and offer interventions to help those
identified to stay well and maintain independent living. Little is currently known about GPs’
views of this contractual requirement.
Aim To explore GPs’ views of identifying frailty and offering interventions for those living
with moderate or severe frailty.Design and setting A sequential mixed-methods study of GPs in the East Midlands region
of England — namely Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire, and
Northamptonshire — undertaken between January and May 2019.
Method GPs were made aware of the study via professional organisations’ newsletters
and bulletins, GP email lists, and social media, and were invited to complete an online
questionnaire. Responses were analysed using descriptive statistics and, based on those
survey responses, GPs with a range of GP and practice characteristics, as well as views
on identifying frailty, were selected to participate in a semi-structured telephone interview.
Interview transcripts were analysed using framework analysis.
Results In total, 188 out of 3058 (6.1%) GPs responded to the survey and 18 GPs were
interviewed. GPs were broadly supportive of identifying frailty, but felt risk-stratification
tools lacked sensitivity and specificity, and wanted evidence showing clinical benefit.
Frailty identification increased workload and was under-resourced, with limited time for,
and access to, necessary interventions. GPs felt they lacked knowledge about frailty and
more education was required to better understand it.
Conclusion Proactively identifying and responding to frailty in primary care requires GP
education, highly sensitive and specific risk-stratification tools, better access to
interventions to lessen the impact of frailty, and adequate resourcing to achieve potential
clinical impact.
More:  https://bjgp.org/content/71/709/e604