Frailty Support
Coordinated frailty services, delivered online and F2F
One operational platform to co-ordinate referrals, triage, and appointment scheduling on behalf of one or more interdisciplinary team – delivering 1:1 or group rehabilitation at home, in care homes and across the community.
TRUSTED BY NHS SERVICES, RESEARCH TEAMS & ICBs
NHS England
NHS Scotland
NIHR
Lancshire & South Cumbria ICB
65+ health providers and Universities worldwide
THE CHALLENGE
Frailty care is fragmented.
Coordinated care delivery is our solution.
Frailty is one of the most significant challenges facing the NHS and social care system. Frail older adults are disproportionately high users of urgent and emergency care, hospital beds, and long-term care resources.
Frailty Rehabilitation (FR) services including community MDT reviews, falls prevention programmes, strength and balance classes, and hospital-to-home reablement are under significant pressure.
Identifying frail patients early, triaging accurately, assigning appropriate group or individual interventions, and monitoring outcomes remotely are all challenges which current paper-based and fragmented digital systems handle poorly.
Lack of co-ordination
Care is split across primary, community and social care, with duplicated assessment and no-one holding the whole picture.
Capacity-constrained teams
Falls, re-ablement and community rehab teams are stretched and carry long waiting lists.
Avoidable admissions
Frailty drives a large share of non-elective admissions and A&E attendances that proactive care can prevent.
Isolatation accelerates decline
Social isolation speeds decline – and 1:1 clinic models can’t reach enough people.
THE MODEL
One hub, coordinating multiple services
Set up a central operations hub as the single front door into multiple services across a region. Receive referrals, triage by need, build and co-ordinate therapy cohorts and schedules for multi-displinary staff across a region to deliver — so clinicians spend their time delivering care, not coordinating it.
Scale group therapy provision
One route in for services, professionals and self-referrals — the hub validates and prioritises every referral.
Cohort scheduling across a region
The hub groups patients and books the right team, so capacity flexes to demand without burdening clinicians.
Real-time oversight
Every patient and every team, visible on one dashboard — with outcomes shared across delivery teams.
From referral to recovery, coordinated end to end
01
Referral & intake
A single digital front door for services, professionals and self-referrals.
02
Frailty assessment
Comprehensive Geriatric Assessment validated PROMs, plus falls and nutrition screening.
03
Cohort scheduling
Operational teams triage, group patients and schedules appropriate clinical staff from regional teams.
04
Online group therapy
Interdisciplinary, multi-week programmes delivered to cohorts close to home.
05
Service reporting
Cohort-level exports, trend analysis, and clinical reports that flow into electronic health records.
06
Self-management library
Curate resources, signpost to local services, and support patients in-between appointments.
Value for the whole system
FOR COMMISSIONERS
A configurable remote monitoring platform for NHS teams
3.7X ROI shown at Lancashire & South Cumbria’s regional neurorehab service
A scalable, regionally-licensed service model
FOR CLINICIANS
Over 70% less admin
Coordinating rehab groups
Real-time oversight
Every patient and every team, on one dashboard
Standardised, interdisiplinary pathways
FOR PATIENTS & CARERS
Care closer to home
Group support that rebuilds confidence
Less carer strain, better quality of life
Family and carers can join sessions and stay involved.
Referral & Triage
Cohort assignment
Session scheduling
Automated reminders
Monitoring & review
Discharge & PIFU
Why choose autonom-e for group therapy?
01
Configurable to your pathway
Tailor group programme structures, eligibility criteria, PROM bundles, session formats, resources, and branding to match your service design – without expensive bespoke development.
02
Reduces administrative burden
Appointment scheduling, automated PROM capture eliminate paper, postage, and manual data entry. 1,250+ estimated clinical admin hours saved each year in Lancashire.
03
Reduces waiting times
Group therapy enables services to multiply appointment availability with the same staff time, allowing for waiting times to be cut and pre-appointment administrative tasks to be automated.
04
Scalable across organisationstions
Deploy autonom-e in a single-service or multi-site deployments across ICBs, NHS Trusts, community providers, and VCSE organisations – with each site maintaining its own configuration and branding.
05
Evidence ready
Capture group-level and individual outcomes data to evaluate service impact, demonstrate cost-effectiveness to commissioners, and support research bids or NICE submissions.
06
Improved health equity
Increased rehab provision and workforce utilisation enables patients to receive more intensive and multi-disciplinary care remotely from home, without the need for travel.
Contact Us
For general enquiries, sales and technical support, get in touch!
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