Good performance is possible within existing resources
In England, the quiet work of protecting the elderly from falls — one of the most preventable causes of death among those over 65 — is going undone, not from indifference but from a system stretched past its own capacity to care. A parliamentary committee has found that only 17 percent of frail older patients received the fall risk assessments their GPs are contractually obliged to provide, a failure rooted in competing policy demands that have consumed the very time preventive care requires. The cost is measured not only in £4.4 billion annually, but in the lives of older people left more vulnerable than they need to be. What the variation across NHS regions reveals is that this is not an impossible task — it is an unevenly carried one.
- Falls are the leading cause of injury-related death among over-65s in the UK, yet fewer than one in five frail elderly patients received the risk assessments they are owed in 2024/25.
- A government mandate expanding online GP access has quietly cannibalized the time doctors need for preventive care, creating a collision between digital modernisation and the needs of the most vulnerable.
- The failure is not uniform — some NHS areas assess 90 percent of their elderly population while others assess fewer than 10 percent, exposing a system of misaligned priorities rather than an impossible task.
- Age UK warns that nearly a decade after frailty identification became a contractual priority, older people living with frailty remain at steep and largely unaddressed risk of devastating or fatal falls.
- NHS England is now looking to pharmacists and other health professionals to absorb frailty and medication reviews, racing to close a care gap before it widens further.
A parliamentary committee has confirmed what many NHS leaders already know: the system is failing the people it should protect most. Across England, GPs are so overstretched that they cannot fulfil a core contractual duty — assessing older people at risk of falling. In 2024/25, only 17 percent of patients over 65 with moderate or severe frailty received that assessment. Among the 226,000 people with severe frailty, just 18 percent were evaluated for fall risk, and only 16 percent had their medications reviewed — despite certain drug combinations significantly increasing fall likelihood. The annual cost of falls to the UK runs to approximately £4.4 billion.
The House of Commons public accounts committee traced the failure to a specific policy choice: the government's mandate for expanded online patient access to GP services. Well-intentioned as it was, the rollout consumed the limited time GPs already had, leaving preventive care for vulnerable older people undone. Victoria Tzortziou Brown of the Royal College of GPs said the findings confirmed longstanding warnings — that pushing digital access without protecting continuity of care creates serious unintended consequences.
What makes the failure harder to accept is that it is not inevitable. Some NHS areas assess 90 percent of their elderly population; others assess fewer than 10 percent. The committee noted plainly that good performance is achievable within existing resources. Caroline Abrahams of Age UK observed that nearly a decade has passed since frailty identification became a contractual priority, with little improvement in actual care. A serious fall, she noted, can be devastating — sometimes essentially terminal.
NHS England is now exploring whether pharmacists and other health professionals could take on frailty assessments and medication reviews, since polypharmacy is itself a significant fall risk. The question is whether the system can reorganise quickly enough — or whether the gap between what is promised and what is delivered will keep growing.
A parliamentary committee has concluded what NHS leaders themselves now acknowledge: the system is broken in a way that harms the people it should protect most. General practitioners across England are so stretched that they cannot perform one of their core contractual duties—identifying and assessing older people at risk of falling—despite falls being the single leading cause of injury-related death among those over 65.
The numbers tell a stark story. In the 2024/25 financial year, only 17 percent of patients over 65 with moderate or severe frailty received the assessment they are entitled to under their GP's contract. Among the 226,000 people diagnosed with severe frailty that same year, just 18 percent were evaluated for fall risk. Even fewer—16 percent—had their medications reviewed, despite the fact that certain drug combinations and individual medications substantially increase the likelihood of a fall. The annual cost to the UK of falls and their consequences runs to approximately £4.4 billion.
The House of Commons' public accounts committee, a cross-party group with real investigative teeth, traced the root of this failure to a specific policy choice. The government mandated that patients be given online access to GP services. This expansion of digital access, while intended to improve care availability, has instead consumed the limited time GPs already have. The committee found that NHS England has essentially overloaded family doctors with competing priorities while giving them no additional capacity to meet them. One consequence appears elsewhere in the system: the preventive care that keeps vulnerable older people safe.
What makes this failure particularly striking is that it is not universal. Some local NHS areas assess at least 90 percent of their over-65 population for frailty and fall risk. Others assess fewer than 10 percent. The committee's observation was pointed: good performance is possible within existing resources. The variation suggests the problem is not that the task is impossible, but that resources are distributed unevenly and priorities are misaligned.
Victoria Tzortziou Brown, president of the Royal College of GPs, said the report confirmed what her organization has been warning for some time. Pushing online access without maintaining focus on continuity of care and proactive support for vulnerable patients creates unintended consequences. GP practices want to give older patients the time they need, she said, but the intensity of workload and workforce shortages make this increasingly difficult against rising demand and policy requirements.
Caroline Abrahams, director of the charity Age UK, placed the failure in longer perspective. Nearly a decade has passed since frailty identification became a contractual priority for GPs. Yet older people have seen little improvement in their actual care. Those living with frailty face steep risk of deterioration after even minor health shocks. A serious fall can be devastating, sometimes essentially terminal. At minimum, it adds pressure to an NHS already stretched beyond capacity.
NHS England is now exploring whether other professionals might absorb some of this work. Pharmacists, for instance, could conduct medication reviews for frail older people, since polypharmacy—taking multiple drugs simultaneously—is itself a significant fall risk factor. The question now is whether the system can reorganize itself quickly enough to prevent further harm, or whether the gap between what is promised and what is delivered will continue to widen.
Citas Notables
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.— Prof Victoria Tzortziou Brown, president of the Royal College of GPs
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.— Caroline Abrahams, director of Age UK
La Conversación del Hearth Otra perspectiva de la historia
Why does online access to GPs create this particular problem? Couldn't they just do both?
The issue is time. A GP has a fixed number of hours in a day. If those hours are now consumed by managing online requests and appointments, the time available for preventive work—the kind that requires sitting with an older patient, assessing their home, checking their medications—simply vanishes. It's not that GPs don't want to do it.
But the report says some areas manage 90 percent assessment rates. What are they doing differently?
That's the uncomfortable part. It suggests the constraint isn't actually the task itself, but how resources are allocated and how priorities are weighted locally. Some areas have made frailty assessment a real priority despite the same pressures. Others haven't.
Is this just about GP numbers, then? Hire more doctors?
Partly. But the committee's point is sharper than that. They're saying NHS England made a policy choice—prioritize digital access—without accounting for the cost elsewhere. More GPs would help, but the real issue is that nobody weighed the trade-off.
What happens to an older person who falls and breaks a hip because they were never assessed?
They go to hospital. They may never fully recover. They may lose independence. And the NHS then spends far more treating the fracture and its complications than it would have spent on prevention. The £4.4 billion annual cost reflects that.
So pharmacists reviewing medications could actually solve this?
It could help. But it's also a workaround, not a solution. It means accepting that GPs can't do their job and asking someone else to do part of it. The real solution would be giving GPs the capacity to do what they're contracted to do.