Objectives The objective of the National Osteoporosis Society (NOS) is to establish a Fracture Liaison Service (FLS) in every NHS Trust in the United Kingdom (UK). The Service Delivery Manager supports sites to establish, implement and develop a new FLS, as well as to improve the quality of existing services. The FLS model enables secondary fracture prevention through identification of fragility fractures in every person who breaks a bone aged over 50 using dedicated case-finding, with assessment and appropriate management of osteoporosis where necessary. The object of FLS is to prevent secondary fractures, in particular expensive hip and vertebral fractures, thereby providing both clinical and cost effectiveness for patients and payers. The NOS has developed a unique service to support FLS across the UK.
Developments A team of specialist development managers with clinical and commissioning experience support providers and payers in the process of establishing new FLS's by offering consultation and guidance at every step of the process from pathway development to successful funding of services. This model has been replicated across the UK since April 2015 with the support and expertise of the NOS. Once an FLS is established the NOS provides support with service improvement, whether through additional commissioning of funds, Peer review or Gap analysis.
Results Results from a range of analyses show that FLS has a positive impact on fracture rate and in particular hip fractures.
At the time of writing, the NOS is currently supporting 166 sites across the UK. 83 sites are improving the quality of their service; 58 sites are developing new services. 13 new services have been commissioned since commencement of the work programme, delivering new FLS provision to an additional 1.6 million people over 50, preventing 1,482 hip fractures over a 5-year period. Figures have been calculated from the NOS FLS Benefits Calculator https://benefits.nos.org.uk
Challenges The primary challenge in establishing an FLS is identifying a clinical champion - this maybe a nurse, an allied health professional, rheumatologist or ortho-geriatrician in the hospital, or a representative from Public Health or from a Clinical Commissioning Group (CCG). The champion can lead and take the FLS from an idea to implementation.
To support the establishment and implementation of FLS the NOS has developed the FLS Implementation Toolkit as well as the Clinical Standards for FLS. The Clinical Standards will shortly be supported with a supplementation - New Clinical Guidance on the identification of Vertebral Fractures.
Furthermore, the Charity has developed the Fracture Prevention Practitioner (FPP) training for those wishing to implement an FLS. This is backed by the Competency Framework for Nurses, allied health professional and doctors to ensure best practice in fracture prevention.
Conclusion The NOS service development model of support is successful in driving the establishment, implementation and improvement of FLS across the UK. This is tough in an economic climate where health budgets are constrained. However, there is strong evidence that investment in FLS improves the quality of care as well as illustrating financial savings in health and social care. NHS England recommends that every patient with/or at risk of osteoporosis and fragility fractures should have access to a commissioned service.
Disclosure of Interest None declared