Data-Driven Innovation multi-morbidity report for partner GPs

Frailty and multi-morbidity are terms used to describe people at risk of worsening health, increasing disability and death. These are often older people who have multiple health problems and frequently present to health and social care services at a point of crisis. However, identifying these vulnerable people earlier may allow extra support and assessment to prevent such crises. There are multiple ways of identifying multi-morbid people, but our current record systems for primary care (GP practices) and secondary care (hospitals) are not well connected. In this project, we aim to bring data together data from GP and hospital records to provide a combined view of patients’ health. We will provide reports of multimorbidity that may be used to test new approaches to the care of these patients. No individual level patient data will be shared as part of this project.