BNSSG Healthier Together

Frailty-ACE service supports elderly frail people at home


A new, integrated approach to supporting older people living with frailty has been launched in Bristol, North Somerset and South Gloucestershire.

Frailty-ACE (Assessment and Coordination for Emergency and Urgent Care) is a service for older people with multiple medical conditions or those living with frailty, who have urgent or emergency care needs. The goal of the service is to provide a multi-professional, multi-organisation, person-centred assessment and where possible, support them to be cared for in their own home. The team comprises clinicians and staff working in primary care, social care, mental health and community care, and works closely with hospital geriatricians.

It means paramedics who are called out to a frail older person can contact the Frailty-ACE team, who can then manage the person’s urgent care needs at home, or arrange a direct hospital admission instead of going to the emergency department. GPs who refer someone for a hospital admission are also offered the opportunity for F-ACE to help.

Dr Charlie Kenward, GP and Research Clinical Lead at Bristol, North Somerset and South Gloucestershire Integrated Care Board, who works in the Frailty-ACE team, said:

“The Frailty-ACE team coordinates community care for frail older people who have an emergency or urgent care need, who would traditionally have been admitted to hospital. Our team is set up to co-ordinate care options to help keep people be cared for at home, or arrange direct admission to a hospital ward or other service.”

A paramedic from South Western Ambulance Service added:

“I was grateful frailty could support us and our patient, including the patient’s daughter who was at crisis point trying to cope looking after her mum. When the ambulance was freed up, we were sent to a child who was sick.”

The service has run over winter and is funded until May 2024 but the team is currently seeking on-going funding.

Watch Dr Kenward’s video to find out more about Frailty-ACE.

Find out more about the service on the Frailty-ACE website.