FLS Implementation Update

Hilary Arden, Head of Service Delivery

5th February 2016

National Osteoporosis SocietyPriorities and Plans for 2016Aim 1: Every person aged over 50 who breaks a bone is assessed for osteoporosis and managed appropriately.Priority 1:

Extend coverage of Fracture Liaison ServicesPriority 2:

Improve quality of Fracture Liaison Services and osteoporosis services

New for 2016…Develop and implement best

practice for identification and management of vertebral fractures

• FLS Implementation Group• FLS Implementation Toolkit• FLS Implementation Workshops• UK FLS Clinical Standards• Fracture Prevention Practitioner (FPP) Training• Peer Review• Service Delivery Team support

A National Approach to FLS

Service Delivery Team

Sonya StephensonService Development

Project Manager

Will CarrService Development

Project Manager

Hilary ArdenHead of

Service Delivery

Tim Jones Commissioning

Advisor

Mayrine FraserService Development

Project Manager

Debbie StoneService Development

Project Manager

Fiona GardnerOperation Projects

Officer

Henry MaceProfessional

Development Lead

Jo SayerService Development

Project Manager

• Facilitate stakeholder engagement• Help establish patient/care pathway• Project manage commissioning/funding:

o The economic and business caseo Service specificationo Resource and capacity planning

• Work with commissioners to ensure services are sustained.

How We Help

www.nos.org.uk/to

olkit

http://benefits.nos.org.uk/

FLS Cost & Workforce Calculator• Additional resource within the FLS-IT• Designed for use by clinicians and Health

Boards to help develop an FLS• Provides the ‘cost’ side of a cost/benefit table

for the FLS business case • Uses estimates of fracture numbers either

from local audit or from using the FLS Benefits Calculator

• Outputs: the numbers of staff, DXA, follow-ups etc. required, bespoke to the service.

FLS Implementation Workshops2 workshops planned for 2016: South Central & NE London

Rebecca Gear, Osteoporosis specialist nurse practitioner, Care UK: “I feel confident in going forward and have a plan in mind. A must have workshop when wanting to start an FLS.”

Dr Madhavi Vindlacheruvu, Consultant Orthogeriatrician, Cambridge University Hospitals: “Excellent to be able to present 1st draft of business case. Great expertise and support, really well organised.”

• Provide input to support the development of an FLS to meet the Clinical Standards

• Identify gaps in service provision, put in place improvement plans and monitor against agreed actions

• Help establish data collection, analysis, evaluation and reporting

• Peer review.

How We Help

UK FLS Clinical Standards Summary of Standards

CRITERIA RATIONALE MEASURES OUTCOMES Identification

1 All patients aged 50 years and over with a new fragility fracture or a newly reported vertebral fracture, whether managed as inpatients or outpatients, will be systematically and proactively identified.

Patients who have sustained a fracture are at higher relative risk of fracture than those who have not. Targeted interventions in this population will have most impact on reducing future fracture burden.

Proportion of fracture patients aged over 50 years identified by the FLS.

Denominator for all fragility fractures can be best estimated by multiplying total hip fractures in over 50 year olds by 5 (1).

Systematic identification of at risk patient population who would benefit from investigation.

Investigation

2 Patients will have a bone health assessment and their need for a comprehensive falls risk assessment will be evaluated within 3 months of the incident fracture.

Assessments need to be conducted promptly as the risk of having a further fracture is increased in the first year.

% of identified patients who have a bone health assessment within 3 months of incident fracture.

% of identified patients who have their need for a falls risk assessment evaluated within 3 months of incident fracture.

Improved identification of the population who will benefit from interventions leading to appropriate targeting of resources.

Information

3 All patients identified will be offered written information about bone health, lifestyle, nutrition and bone-protection treatments.

Anyone aged over 50 years who has had a fracture needs to be aware of the steps they can take to maintain healthy bones.

% of identified patients given information.

Improved patient understanding leading to confident self-management and engagement with recommended interventions.

Intervention

4 Patients at risk of further fracture will be offered appropriate bone-protection treatments.

Appropriately targeted interventions reduce future fracture risk.

% of assessed patients offered bone-protection treatment.

The right people receive the right interventions for bone health and falls leading to reduced fracture risk and fewer fractures.

Patient mobility and independence is maintained.

5 Patients at risk of further falls will be offered appropriate assessment or interventions to reduce future falls.

Evidence-based falls interventions are effective at reducing falls risk.

% of assessed patients offered referral for assessment or an intervention.

Gap Analysis

Fracture Prevention Practitioner (FPP) Training• Officially launched April 2015 @ BSR• 420 healthcare professionals registered• 98 accredited FPPs• Accessed by 91 different hospital trusts and

GP practices • Endorsed by 10 leading educational and

professional bodies • Accessed from across 15 different countries

(US, AUS, NZ, SA, CA, ROI, FR)

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Peer Review • A means of assessing clinical care against agreed

standards• Addresses agendas of clinical governance, practitioner

revalidation, and service development• Facilitates a quality assured level of care for patients

with osteoporosis and metabolic bone diseases. 

www.nos.org.uk/peer-review

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FLS Coverage England NI/IOM Scotland  Wales  UK 

2015FLS Coverage

47/141 (33%)

4/6 (80%)

7/14 (50%)

6/11 (55%)

64/171 (37%)

Supporting new service

development

38 0 2 4 44

Supporting quality

improvement

40 6 12 6 64

Number of additional sites

in contact

31 3 2 6 42

Total/Potential number of FLS

109/141(77%)

9/9 (100%)

16/16(100%)

16/16(100%)

150/182(82%)

No. of services commissioned

7 0 0 0 7

FLS ImplementationTo Date

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FLS Mapping

FLS BenefitsArea Population Cohort

(50+)Hip fractures prevented*

Total benefits (of hip fractures prevented)*

Bradford 459,142 129,011 119 £1,960,644East Sussex 374,801 167,905 188 £3,097,488Epsom 405,456 119,974 115 £1,894,740Rotherham 258,751 96,591 66 £1,111,902Salisbury 144,835 59,786 59 £972,084Stoke-on-Trent 214,991 88,334 88 £1,449,888Vale of York 348,363 131,411 128 £2,108,928Total 2,206,339 793,012 763 £12,595,674*Over a 5 year period

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