Leading FLS improvement: Secondary fracture prevention in the NHS contains data on the first 12 months of the FLS-DB (patients diagnosed with a fragility fracture between January and December 2016) and examines how the FLSs in the NHS have engaged with the audit and improved the quality of data collection and case finding.
All FLSs should submit data to the FLS-DB. NHS foundation trusts are required to participate in National Clinical Audit and Patient Outcomes Programme (NCAPOP) audits that are relevant to the services that they provide as part of their NHS contract. Those services that are not currently participating should implement an urgent action plan to address this.
In 2010, the RCP audited the quality of the clinical care delivered to patients who had fallen and fractured a bone and had been seen in a hospital emergency department (A&E). Only 32% of patients with a non-hip fracture received an adequate fracture risk assessment and just 28% were established on anti-osteoporosis medications within 12 weeks. Of these, the percentages were much lower for those who were not admitted to hospital.
The Department of Health (DH) subsequently incentivised primary care services to initiate these treatments for relevant patients, but by the end of the first year of this scheme, fewer than one in five patients were receiving the treatments. These results are consistent with others that suggest that good clinical practice for these patients requires a systematic approach that encompasses case finding, assessment, initiation and monitoring of treatment – in other words, an FLS.
... high-quality service delivery is achievable by FLSs but that the quality varied nationally.
In January 2016, the FLS-DB started to collect web-based continuous data on patients aged 50 and over who were diagnosed with a fragility fracture. In April 2017, the first FLS-DB report was published, examining data from the first 6 months of the FLS-DB (patients who suffered a fracture between January and June 2016). The key finding from that report was that high-quality service delivery is achievable by FLSs but that the quality varied nationally.