Frailty Hub: Setting up and developing frailty services

BGS Clinical Quality Committee
British Geriatrics Society
Date Published:
23 June 2020
Last updated: 
22 March 2023

Useful information to help you set up a frailty service, with examples of best practice, service development, and business cases. 

Knowing where to start when setting up a new service can be overwhelming. The following publications provide an overview of the key principles underpinning effective healthcare for older persons.


  • Joining the dots: A blueprint for preventing and managing frailty in older people - BGS
    The report provides an overview of the core features needed to support system leaders and commissioners of health and social care services in the development of high-quality integrated care systems for older people. 
  • Making healthcare systems fit for an ageing population - Kings Fund
    This provides a useful start for local service leaders and practitioners wanting to understand the key components of improving care in an older persons healthcare journey. It outlines key standards of care, followed by the evidence based strategies to improve care and examples of effective local practice.

  • Front door frailty:  Advice on setting up services - BGS
    In this document, the BGS sets out five principles that should underpin front door frailty services. It provides tips on establishing services from those who have been through the process. 

  • Fit for Frailty Part 2 - BGS
    This publication is aimed at GPs, geriatricians, Health Service managers, Social Service managers and Commissioners of Services. As well as providing an overview of the political framework for the development of frailty services, it provides guidance on development, commissioning and management of services for people living with frailty in community settings.

  • HOW CGA Service level toolkit
    This toolkit is aimed at hospital staff within any discipline who want to improve the care for older people living with frailty in their service. It provides a step by step approach about how you can use quality improvement methodology to support both identifying and then addressing the problems within your service.

  • Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed methods study
    This mixed-methods study describes the development, implementation and evaluation of delivering a hospital-wide comprehensive geriatric assessment (HoW CGA toolkit).


The following resources highlight different successful local initiatives that have led to an improvement in the care of older people.

Europe-wide approaches

This report is part of Joint Action ‘724099 / ADVANTAGE’ which has received funding from the European Union’s Health Programme (2014-2020). The FPA provides guidance on how to strengthen national/regional capacities and accelerate national/regional efforts to set up or further develop a frailty prevention policy in any MS to enhance healthy ageing. It is a practical tool to combat the inequities that currently exist in Europe not only between countries but also within them. The FPA offers guidance on approaches to:
  • Identify national/regional areas of action on frailty and position these within the MS health priorities.
  • Set national/ regional objectives and deliverables for the specific areas of action.
  • Implement proven interventions to reduce risk factors for frailty.
  • Implement proven interventions to manage frailty at public health level.
  • Implement proven interventions to train the workforce.
  • Measure progress and results, considering proposed indicators.
  • Advance action beyond the health sector through multi-sector co-operation.
  • Promote international collaboration and cooperation across regions within participant MS to transfer and scale-up best practices.
The FPA document is a reference document for any region, country or MS facing challenges of ageing and frailty.

Feedback on this resource?

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.