Electronic Frailty Index

Identifying people with frailty who could benefit from preventative interventions to enable them to live well for longer in their communities.

The electronic frailty index (eFI) is a tool that can be used to identify people as they progress through different levels of frailty, and is based upon a person’s needs, rather than their service use. 

The eFI uses a cumulative deficit model to identify and score frailty based on routine interactions with their GP. As individuals interact with GPs, their GP records accumulate a list of read codes and community prescriptions. The eFI uses a subset of these read codes to interpret any number of up to 36 potential deficits. The number of deficits that an individual is considered to have is then divided by the total (36) to produce a score. This score determines whether a person is considered fit, mildly frail, moderately frail, or severely frail and nearing the end of their life. This can be calculated for an individual or for a whole GP practice population over 65 years of age.

Using eFI to identify people with lower levels of frailty, before they have significant unplanned service use, means these individuals can be targeted with appropriate preventative interventions.

The film below provides information on how to access the eFI report in Scottish Primary Care Information Resource (SPIRE), and this information is also available in the guide below.

The Scottish Primary Care Information resource (SPIRE) was decommissioned on 31 August 2023. Future access to the electronic frailty index (eFI) for GP practices will now be through Albasoft’s EScro software. This is currently in development and our resources will be updated as soon as possible. Any queries about accessing the eFI in the meantime please email his.frailty@nhs.scot 

Tools and resources

  • Frailty and the Electronic Frailty Index - This guide provides health and social care organisations with information on frailty and the electronic frailty index.
  • Scaling up a proactive approach to frailty identification - the electronic frailty index: This poster explains how we tested the eFI and made it available through existing IT infrastructure.
  • eFI read codes guide: This document highlights a selection of read codes to support GP practices to code some of the deficits that contribute to the eFI which may not be routinely recorded. This is not intended to be a definitive list, rather a guide to a selection of read codes GP practices may wish to use.
  • Testing a proactive approach to frailty identification: the electronic frailty index: This article describes how we tested the electronic frailty index with GP practices in three health and social care partnerships.


Examples and case studies

  • Severe frailty: In this case case study Paul Baughan, GP and National Clinical Lead for Palliative and End of Life Care, shares how his practice used the eFI to identify a person with escalating frailty and the subsequent support provided by the multidisciplinary team.  
  • Frailty progression: This story provides snapshots of an individual as they progress through different levels of frailty and highlights the support that can be offered at each stage.
  • Midlothian HSCP Case Study: This case study describes the approach taken by Midlothian HSCP to using data to improve the care of people with frailty.
  • Dalhousie Medical Practice Case Study: This case study describes a project undertaken by a GP to improve the continuity of care for people with frailty.
  • Midlothian HSCP video: In this video Jamie Megaw, Strategic Programme Manager for Midlothian HSCP, shares the experiences and benefits of using the eFI to identify people with frailty in GP practices across Midlothian HSCP.
  • Using the eFI: In this short video Paul Baughan, GP and National Clinical Lead for Palliative and End of Life Care, talks about using the electronic frailty index (eFI) to identify people with frailty in a semi-rural GP practice.