Step 3 GP to assess frailty level using clinical judgement and add Read code to patient record: Mild frailty: XabdY Moderate: Xabdb Severe: Xabdd Frailty pathway Phase 1 severe frailty Patients unknown to MDT Step 1. All patients aged 65 and over identified with severe frailty by eFI Step 2 Identification and filtering of unknown & existing patients Patients with severe frailty confirmed Step 4 LICT MDT meeting Medication review by GP Medication review done: Read Code XaF8d De-prescribing review: Read Code Y06af Informed consent to activate SCR (if not already done) Holistic assessment including falls risk Clinically relevant interventions Version 6 Oct 17 LICT Community Services steps Primary Care steps

Step 3 GP to assess frailty level using clinical judgement and add Read code to patient record: Mild frailty: XabdY Moderate: Xabdb Severe: Xabdd Frailty pathway Phase 2 moderate frailty Patients unknown to MDT Step 1. All patients aged 65 and over identified with moderate frailty by eFI Step 2 Identification and filtering of unknown & existing patients Patients with moderate frailty who would benefit from MDT assessment Step 4 LICT MDT meeting Informed consent to activate SCR (if not already done) Medication review by GP Medication review done: Read Code XaF8d De-prescribing review: Read Code Y06af Holistic assessment including falls risk Clinically relevant interventions Version 6 Oct 17 Primary Care steps LICT Community Services steps