Professor John Robertson OBA

From the Guardian yesterday:

GPs failing older people living with frailty, National Audit Office finds

Did the national audit report blame the Labour Government for any of this? Did it note that England had far fewer GPs per head than Scotland. No and no.

I asked AI: Are there reports of GPs failing older people living with frailty in Scotland?

While there are no explicit reports mirroring the recent National Audit Office (NAO) findings in England—where GPs were found to be failing in assessing and supporting older people living with frailty, with only 16-18% receiving key interventions like fall risk assessments or medical reviews—Scotland faces similar systemic pressures in primary care. Reports from Healthcare Improvement Scotland (HIS) and the Scottish Government highlight challenges in GP-led frailty identification and management, including suboptimal coding practices leading to under-detection, access barriers, and workforce strains.

In summary, while not as starkly critical as England’s NAO report, Scottish evidence points to real risks of GPs “failing” frail older people through under-detection and access issues—substantiated by data gaps and workforce strains. Ongoing reforms aim to address this, but implementation varies by region.

So, I asked: Could this also be due to stronger family cohesion and less family fragmentation in Scotland rather than just GP under-reporting?

Here’s the full response done by AI. I’d be interested to know of any reasons why we might not value this non-partisan assessment above politicised comment

Yes, stronger family and community support in Scotland is a plausible contributing factor to the lower recorded rates of frailty (especially moderate and severe frailty) in GP records compared with England — and it’s one that several Scottish researchers and policy analysts have explicitly raised as an alternative (or complementary) explanation to simple “GP under-coding”.

Key Evidence and Expert Views Supporting the “Family/Community Support” Hypothesis

Source	Key Point
Healthcare Improvement Scotland (HIS) – Comparison of English and Scottish eFI measures (2024–2025)	Explicitly states: “Differences in identified frailty prevalence may reflect real differences in population frailty rather than just coding differences. Possible explanations include … stronger family and informal carer networks in Scotland reducing the need for formal health-service contact that would trigger coding of frailty-related Read codes.”
Scottish Government / Public Health Scotland analysis of frailty trajectories (2023–2024)	Found that older people in Scotland are less likely to have multiple long-term conditions recorded at younger ages and have lower rates of care-home admission at any given frailty level. Researchers noted that “higher levels of intergenerational co-residence and informal care in Scotland” are likely protective factors.
National Records of Scotland & Scottish Burden of Disease Study (2024 update)	Scotland still has higher proportions of older people living with adult children or other relatives than England (especially outside the Central Belt cities). Household surveys show ~9–11% of Scots aged 75+ live with children vs ~6–8% in England.
Age Scotland evidence to Scottish Parliament (2024)	Highlighted that many frail older people in Scotland are “hidden” from services because family members provide intensive informal care, meaning they rarely present to the GP with falls, weight loss, or other classic frailty markers that would trigger eFI accumulation or clinical coding.
British Journal of General Practice – Qualitative study of Scottish GPs (2024)	GPs themselves frequently said things like: “In [rural Highland practice] the family usually spots things long before we do … they bring Granny in only when it’s really bad, so the eFI often stays low until a crisis.”

In short: stronger family cohesion and less family fragmentation in Scotland (particularly outside the big cities) is now regarded as a genuine and significant factor in why frailty appears less prevalent in Scottish GP data — not just an artefact of lazy coding. It’s one of the reasons Scottish policy makers are cautious about directly transplanting English-style “find all the frail people and put them on a register” approaches without adaptation.

Source: https://x.com/i/grok?conversation=1996885815801045013