Frailty Needs Community Action, Not Just Primary Care

The Public Accounts Committee of the House of Commons has strongly criticised the NHS and primary care for their management of people living with frailty, many of whom also have dementia and whose time and energy are often consumed by the challenges of deprivation.

However, an excellent article by Helen Salisbury, an Oxford GP, clearly explains why GPs no longer have time to visit older people with frailty.

"The main reason for the lack of time is that GPs are being chained to their computers answering a never ending stream of online queries, sifting through the hay fever and sprained ankles to make sure that we don't miss exertional chest pain or meningitis."

However, it is misguided to rely solely on, and criticise, primary healthcare. GPs certainly have a key role to play in addressing the challenge of multiple long term conditions (MLTCs), the welcome new term for multimorbidity. However, people living with frailty need a much wider range of support because deprivation is both a major cause of frailty and a factor that complicates its management.

What is needed is stronger community support, with older people themselves becoming even more involved in supporting people living with frailty and dementia. For example, many could volunteer with Age UK, while those fortunate enough to live in one of the Centre for Ageing Better's Age-friendly Communities are already experiencing the benefits of community action.

This, in turn, requires resources. GPs could help release those resources by reducing the amount of unnecessary, and sometimes harmful, prescribing, as described in the Department of Health and Social Care report Good for You, Good for Us, Good for Everybody. If they were given the authority to shift funding from unnecessary prescribing to community support, more effective care could be delivered where it is most needed.

There is no drug for frailty, dementia or deprivation. The intervention is community action.

References

Public Accounts Committee. Support for people with dementia and their carers. https://committees.parliament.uk/publications/53342/documents/298401/default/

Helen Salisbury. BMJ (2026). https://www.bmj.com/content/bmj/393/bmj-2026-100048.full.pdf