Home » Projects » Leading FLS improvement: Secondary fracture prevention in the NHS

Leading FLS improvement: Secondary fracture prevention in the NHS

Produced by:

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.

Key recommendations

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.

FLSs that participated in the report should:
  • prioritise reviewing their methods of identifying patients and their monitoring pathway as part of their service improvement programme develop a service improvement plan to address other key areas where they failed to meet adequate standards of performance
  • review their performance using their own live run charts, which are available on the FLS-DB webtool and share their data with their trust board / LHB and clinical commissioning group (CCG).
Chief executives and hospital trust boards that have an FLS should:
  • review their local findings and ask FLSs to provide evidence of how they are participating in this mandatory national audit, prioritising service improvement, and support their delivery of this.
Chief executives and hospital trust boards that do not have an FLS should:
  • recognise that secondary fracture prevention provides an opportunity to reduce activity in A&E and trauma units, and to reduce non-elective admissions and length of stay
  • use the opportunity of sustainability and transformation partnership (STP) planning to consider the coverage of secondary fracture prevention across the region, to ensure that all relevant patients have access to an FLS.
Commissioners and LHBs should:
  • review this report’s findings: CCGs that do not have an FLS should actively support a project plan so that they can implement a service in 2017/18
  • align the KPIs for their FLS(s) with the KPIs that are detailed in this report, to reduce duplication and improve transparency.


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.  


Please contact us by email at flsdb@rcplondon.ac.uk or by phone on +44 (0)20 3075 1619 if you have any questions about the report.