Hilary Arden, Head of Service Delivery, National Osteoporosis Society presentation at the FLS Champions’ Summit, February 2016

1. FLS Implementation
Update
Hilary Arden, Head of Service Delivery
5th February 2016

2. National Osteoporosis Society
Priorities and Plans for 2016
Aim 1:
Every person aged over 50 who breaks a
bone is assessed for osteoporosis and
managed appropriately.
Priority 1:
Extend coverage of Fracture Liaison Services
Priority 2:
Improve quality of Fracture Liaison Services
and osteoporosis services

3. New for 2016…
Develop and implement best
practice for identification and
management of vertebral
fractures

4. • 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

5. Service Delivery Team
Sonya Stephenson
Service Development
Project Manager
Will Carr
Service Development
Project Manager
Hilary Arden
Head of
Service Delivery
Tim Jones
Commissioning
Advisor
Mayrine Fraser
Service Development
Project Manager
Debbie Stone
Service Development
Project Manager
Fiona Gardner
Operation Projects
Officer
Henry Mace
Professional
Development Lead
Jo Sayer
Service Development
Project Manager

6. • Facilitate stakeholder engagement
• Help establish patient/care pathway
• Project manage commissioning/funding:
o The economic and business case
o Service specification
o Resource and capacity planning
• Work with commissioners to ensure services
are sustained.
How We Help

9. 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.

10. FLS Implementation Workshops
2 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.”

11. • 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

12. 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.

13. Gap Analysis

14. 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)

15. 15
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.

16. 16
FLS Coverage England NI/IOM Scotland Wales UK
2015
FLS 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 Implementation
To Date

17. 17
FLS Mapping

18. FLS Benefits
Area Population Cohort
(50+)
Hip
fractures
prevented*
Total benefits
(of hip fractures
prevented)*
Bradford 459,142 129,011 119 £1,960,644
East Sussex 374,801 167,905 188 £3,097,488
Epsom 405,456 119,974 115 £1,894,740
Rotherham 258,751 96,591 66 £1,111,902
Salisbury 144,835 59,786 59 £972,084
Stoke-on-Trent 214,991 88,334 88 £1,449,888
Vale of York 348,363 131,411 128 £2,108,928
Total 2,206,339 793,012 763 £12,595,674
*Over a 5 year period

19. 19