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Guest Blog

by Greta McLachlan, Fellow at the Strategic planning and development cell, NHS England and Improvement, part of the Change Challenge Collaborative.

The change challenge collaborative is a group of professionals who have come together to work across the MSK, orthopaedic and rheumatology specialties to try and capture beneficial changes that have occurred within the NHS during COVID- 19. The aim being to try and capture these changes and ideas to ensure that these innovations are not lost when the NHS comes out of its pandemic measures.

Healthcare provision and delivery has changed greatly during COVID-19. Some changes have been detrimental to patients but not all. In fact there has been a whole host of innovations and different ways of delivering care across the NHS that have occurred in several weeks rather than the usual NHS pace of years.

We asked the communities of MSK, rheumatology and orthopaedics to tell us about the changes they had seen or instigated on a platform called Crowdicity.

Crowdicity is an online platform that allows collaboration of ideas and engagement through comments and discussion around each post. It was the ideal platform for us as it had been previously been used by NHS Horizons, but allowed our project to reach far further than a few emails for feedback might do.

In total over the four weeks that the platform was open for submissions, we had over 180 change ideas posted to the website, over 400 users registered, over 800 comments and some 10,000 plus page views. Our hashtag #nhschangechallenge got over 3 million impressions on twitter.

Once all submissions were closed, each change idea was discussed for its impact and feasibility and was assigned ‘themes’ so that we could see what commonalities there were between change ideas. The discussion that took place around each change idea took a co-productive, collaborative approach. For example, the group that discussed the rheumatology change ideas was made up of two consultant rheumatologists, one consultant physiotherapist, a patient with lived experience of MSK, a chair and secretary. The impact and feasibility were based on the premise that whilst some change ideas might be great during a pandemic and for a short period of time, they may not be feasible on a national scale or with the long term picture in mind. The same for impact. We wanted to be able to identify changes that would have greatest impact across the NHS, not just changes that have helped a small niche of patients or clinicians.

Now comes the hard part of this journey. Taking these change ideas forward and trying to work out how to champion them to the wider communities. ARMA has been a great supporter of this work, and helped us get to this point and I know will help us continue to make this project such a unique one as we look to next stage of this collaborative process. ​

Guest blog by Nina Davies, Project Lead: Integrating Long Term Condition Training and Development, Leeds Community Healthcare NHS Trust; Co-Chair Children’s Podiatry Special Advisory Group, The College of Podiatry

Person-centred care (‘person first’ or ‘child and family centred care’) is a term to reflect treating the whole person, encompassing physical, mental and social wellness, environment and personal circumstances. It is an approach which looks beyond the symptoms of a disease and aims to meet the person’s needs and priorities before those of the system or a professional. It forms a basis for goal based care. Everyone working in health and social care organisations has a responsibility to help ensure services are as person-centred as possible.

When delivered, person-centred care results in a meaningful outcome for the person. In the context of podiatry, children’s podiatrists help children and families overcome concerns that affect the lower limb, so all can stay active, happy and included. Yet, we see so little of these goals mentioned in our referrals. It is frustrating because what the child wants or how they may benefit is omitted. Referrals can also place an expectation on the practitioner that the presentation can be resolved independent of the person.

Not seeing the ‘person first’ can also appear in conversations, for example, why did I ‘choose feet’ as a profession? It’s interesting how it is framed – about the body and without connectivity. I chose to work with people and podiatry care was the quickest way to produce the biggest smiles. For those who’ve experienced foot pain, they will recognise that your feet and good lower limb health contributes to how you feel, move and interact. And for children this is so important; and to be able to help them get back to their everyday activities and achieve their goals is rewarding. It all starts by asking what matters to the child (and family).

What matters varies between children and families. Not all conditions affect people in the same way, either physically, mentally or socially. Therefore we must seek to understand personal impact on the child and family, so we can tailor care. Understanding the value of the referral ensures the right care is given at the right time, by the right person.

Too often, I see multi-agency referrals being made ‘just to give a full check’. We must always be aware of the pressures on families and where families rank an issue in comparison to professionals. Person-centred approaches attempt to engage and support people to make decisions and to be as in control as possible, this includes offering choice – even at point of referral. Sharing decisions at the point of referral places the family in control of their care.

One pressure is appointment burden – missed education, lost employment and siblings too can become affected as they are passed to other care givers. Where possible, we should seek to find solutions such as sharing patient experience, integrating practice so common knowledge and values are held; holding awareness of evidence base and treatment effectiveness; setting realistic expectations; resisting paternalism and promoting self-management.

How we carry out consultations also needs to progress, and the pandemic has certainly accelerated this. To provide patient-centred care, we should also seek alternative ways of working to benefit children and families such as providing flexible referral criteria, telephone or online consultations, co-locating services and appointments, working together to expand skills of practitioners to enable seamless care and also utilising a practitioner’s full skill set. The opportunities are wide.

To end, always better together.

Find out more about person-centred care via The Health Foundation publications.

Guest blog by

Cormac Kelly, Consultant Upper Limb Surgeon at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

and

Peter Kay, National Orthopaedic Alliance (NOA) Lead Clinician and Consultant Orthopaedic Surgeon at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

The COVID-19 crisis has changed the delivery of planned orthopaedic surgery drastically. As the pandemic continues to subside, the NHS, with various guidance from Public Health England, Medical and Surgical Colleges, the British Orthopaedic Association, and others, is working on a plan to get surgery back on track.

The information on the risks to patients and staff when operating during this crisis continues to emerge. In light of research from around the world indicating an increase in complication rates and mortality if patients contract COVID-19 around the time of surgical intervention, we are taking every precaution possible to develop processes to reduce the risk to our patients. These have included the appropriate use of PPE (personal protective equipment), routine testing and using a “clean” area for surgery away from COVID-19 positive patients. Despite this, it is clear that the risk to patients is likely to be higher than normal. How much higher, we do not know. Thus, we are progressing slowly and carefully to restore the delivery of non-urgent orthopaedic surgery. Through organisations such as the National Orthopaedic Alliance (NOA), providers of orthopaedic care are working together to ensure the restoration of planned orthopaedic surgery is safe for both patients and staff.

We are aware that some patients are at home – possibly in self-isolation suffering joint and soft tissue pain. Some are in high risk categories because of lung diseases, diabetes and other medical conditions, and may wish to wait several months and see how the pandemic recovery unfolds before moving forward with planned orthopaedic surgery. Others are living with progressive pain and may be reluctant to let us know that they need help for fear of ‘disturbing’ an already stretched NHS. We ask these patients to please not suffer in silence.

Recovery planning and restarting planned orthopaedic surgery is complicated as we have to consider joint issues along with other conditions such as cancer treatments and progressive sight loss. The volume of work we can do as we restart will be reduced because of factors including the availability of staff, PPE and resources such as theatres as these facilities are still being used to treat sick COVID-19 patients.

We all now know how to socially distance but this also needs to be considered when bringing elective orthopaedic patients back into hospital. Many patients have admitted to us that they are frightened of this new world and thoughts of visiting hospital. We understand that and have been investigating ways to help. Many patients are now able to take advantage of virtual clinics and are receiving telephone and video calls which we hope helps.

We continue to work to make sure patients have all the information, tricks and tips they need to help with pain as our therapists and nurses are constantly looking at new ways to deliver care. The ARMA website has some useful information on managing pain during the crisis. Although we strive, for patient’s protection, to avoid unnecessary face to face contact, this can be made possible after we discuss the risks and possible benefits. We are redesigning outpatients so that if patients do have to attend in person, it is as safe as possible.

Remember that we are still here for patients and we encourage them to let their orthopaedic care provider know if they are in trouble and are dealing with uncontrolled pain. Providers can work with them on a short-term solution while we work to restore elective and planned orthopaedic surgery post COVID-19.

——-

About Cormac Kelly

Cormac is a Consultant Upper Limb surgeon at The Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire. He assists with the facilitation of the National Orthopaedic Alliance (NOA) COVID-19 webinar series.

 

About Peter Kay

Peter is a Consultant Orthopaedic Surgeon at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust and Honorary Clinical Professor of Orthopaedic Surgery at Manchester University. He is the current Clinical Lead for the National Orthopaedic Alliance.

 

About The National Orthopaedic Alliance

The National Orthopaedic Alliance (NOA) brings together orthopaedic centres around the UK to share best practice and address shared challenges. The alliance is based on a quality standards membership model founded on evidence-based descriptors of ‘what good looks like’ in orthopaedic care. For more information visit www.nationalorthopaedicalliance.co.uk or email info.noa@nhs.net

MSK First Contact Practitioner roles; are they fit for the future for Primary Care?

by
Amanda Hensman-Crook FCSP, HEE AHP National Clinical Fellow, Consultant MSK Physiotherapist
Neil Langridge FCSP, Consultant MSK Physiotherapist
Laura Finucane FCSP, MSK Consultant MSK Physiotherapist
Chris Mercer FCSP, MSK Consultant MSK Physiotherapist

MSK First Contact Practitioner roles and the advancing practice agenda is moving at pace and as a result, there has been some anxiety around the MSK First Contact workforce. This has been expressed about several aspects of the roles, including:

  • numbers needed to ensure sustainability without wider destabilisation of the MSK workforce
  • where the workforce will come from with the requisite capability
  • concern about governance of the roles
  • who provides the supervision and support
  • a general need to understand the offer of the role to primary care
  • concern from other MSK professions that they are not included in the GP contract reimbursement scheme (DES) and where they might fit in the bigger picture.

Work is being done collaboratively with Health Education England (HEE), NHS England (NHSE) and NHS England Improvement (NHSEI) to address all of the above to ensure that the education, governance, supervision, strategy and infrastructure is in place to ensure a sustainable model of MSK care at the front of the care pathway.

Standards

Quality and governance are key to first contact roles. To ensure this, the right capabilities at the right level need to be credentialed and accredited. The minimum requirement for a first contact role is to be working at an advanced level clinically i.e. at level 7 (masters level). It is desirable that the clinician who meets that criteria is also on the Advanced Clinical Practice pathway (ACP) to fulfil level 7 across all four pillars – clinical, education, research and leadership.

In physiotherapy, an important step has been taken with an agreement on a national UK standard across all MSK speciality groups. A piece of work was undertaken by Birmingham University that has led to this agreement, funded by HEE, which cross referenced the International Federation of Orthopaedic and Manipulative Physiotherapists (IFOMPT)* standards against the multi-professional advanced practice framework and the MSK core capabilities framework (Rushton, Hindle, Noblet and Heneghan 2020 in press).

The outcome of this exercise demonstrated that the two frameworks aligned with the IFOMPT standards. These findings are significant as the IFOMPT standards are already used in Higher Education Institutions (HEIs) leading to Musculoskeletal Association of Chartered Physiotherapists (MACP) membership, along with the HCPC standards to examine clinicians against a level 7 framework. This agreement is central to an educational roadmap from graduate to level 7 to credential a portfolio route in the workplace to Advanced Clinical Practice.

For physiotherapy this standard is now set, but the vision is to create a common MSK standard across all MSK professions that will assure the system of advanced practice in the UK.

This will be achieved by cross referencing other MSK professional standards against the updated IFOMPT standards and making any changes, if needed, to accommodate any gaps. The outcome will be that education in MSK to advanced practice in the UK will be standardised, and all professions will be able to sit on the MSK educational roadmap to develop their career pathway.

Education

Educational Roadmap

To create an MSK pathway from graduation to level 7 Advanced Clinical Practice, a roadmap is being developed. This will provide educational support that will aid clinicians in identifying learning opportunities in the workplace, gaining advanced skills and knowledge, and generating knowledge from reflective practice. It will give clear guidance of what competencies need to be achieved at each level, and ways on how to evidence this. Ultimately this will support different routes including an equivalence (portfolio) route to Advanced Clinical Practice from graduation over an expected minimum of 5 years.

Portfolio sign off to clinical level 7 in the workplace

FCP roles have a minimum requirement of advanced (level 7) sign off in the clinical pillar of ACP. Outside the HEIs, the development of a portfolio supported by HEE to advanced clinical practice incorporating mandatory primary care learning is underway which will be held by the APPN. This can be adopted by all MSK professions. Capability sign off will be carried out by both the clinical supervisor in the workplace and the clinician who will sign against a declaration to their professional registration.

Higher Education Institutions (HEIs) and professional special interest groups

There is a lot of work going on in the development of courses in universities (HEIs) across England and within MSK special interest groups linked to HEIs to develop level 7 FCP standalone modules and ACP Master’s degrees.

To make the ACP Masters easier to develop and to tailor to a specific profession or speciality, the overarching core generic capabilities are being mapped by HEE from the multi professional ACP framework. The capabilities specific to primary care for FCP modules on top of the already defined core, are also being identified. This will give a central minimum requirement for HEIs to build advanced practice Master’s degree courses from and enable them to pull stand-alone level 7 modules such as a First Contact Practice module or MSK module into an ACP course to tailor to the specific need of the clinician.

The taught level 7 First Contact stand-alone modules teach the nuances of working in primary care, largely modelled around the eight CPD modules in the Health Education England’s MSK primary care e-learning. The e-learning modules cover: What is primary care, identification of the ill and at risk, mental health in primary care, complex decision making, public heath, persistent pain, overview of medicines and prescribing and serious pathology of the spine.

These e-learning modules are a minimum requirement for a clinician who is already working at clinical level 7 outside primary care to prepare for an FCP role and are free CPD to all in the NHS and can be bought outside the NHS to complete.

To support upskilling MSK clinical capabilities for all MSK professions to clinical level 7 (advanced level) the Society of Orthopaedic Medicine has now opened all their courses out to all MSK clinicians, and the Musculoskeletal Association of Chartered Physiotherapists are developing their course curriculum further to be a vehicle for advanced practice educational sign off as well as signing off at level 7 via the equivalence (portfolio) route, and in-house FCP modules.

The diagram below provides a visual diagram of where FCP sits and the routes to ACP. CAP is the Centre of Advanced Practice that sits in HEE.

FCP ACP routes diagram

Supervision

To support clinicians, there is a need for supervision for both clinical work and CPD. In primary care day to day clinical supervision is to be provided by a named supervisor at the GP practice. CPD supervision is to be provided by the Trust or private provider with the exception of an individual directly employed by a Primary Care Network (PCN) who needs to be supervised by the PCN.

There is an Advanced Practice supervision framework coming out soon to support this.

Further information

For further information with links to a timeline and FCP papers and resources, please refer to this paper: ‘A retrospective review of the influences, milestones, policies and practice developments in the First Contact MSK model’, Langridge, Hensman-Crook 2020, http://arma.uk.net/wp-content/uploads/2020/05/FCP-MSK-review-with-authors_v3.pdf

*(IFOMPT is an international body of 22 national groups who are clinical experts in MSK)

By Dr Helen Branthwaite, MSK Project Lead, College of Podiatry.

The rapid changes in shoe design and the increasing number of choices that occur in the footwear market might make a consumer with painful feet quiver at the thought of buying any new shoes. Yet, humans have been wearing shoes on their feet for thousands of years as protection against the environment. Problems have only been recorded in the last 600 years when shoes have been used more as a fashion statement as well as a status symbol. In fact, it was only considered normal for a western culture to wear shoes as standard after the first world war. However, it is well established that incorrect shoe choice can cause pain or injury yet the advice available about which shoes to purchase can be inconsistent. Within ARMAs campaign to heighten the awareness of the amount of pain that people suffer with MSK complaints, it is vital that the choice of shoes selected for painful feet are considered.

Currently, most people own many different pairs of shoes and choose what to wear based on the activity that they are planning to do. The choices are dominated by fashion and image with colour being considered before correct fit. Trends are set by celebrity endorsements and can often end up as a staple in everyone’s wardrobe. Think of the Ugg Boot®, designed in the first instance to be a slipper for surfers in Australia using surplus sheep’s wool. This boot initially rose to fame when Hollywood celebrities paired it up with the latest catwalk fashion but now Ugg® is a worldwide brand and the “boot” has many less than desirable imitations, all which have been correlated to causing pain. Footwear trends do come and go and sometimes the styling can help the wearer have more comfortable feet and other times they create a problem. The main complaint though from people who have painful feet, is working out what is best for them and what is the right choice.

Podiatrists frequently engage with patients about footwear choices and advise them on their selections. This can be as part of a treatment to prevent development of further complaints or can also be to improve the function of the foot to reduce pain. It is commonly thought that high heel shoes are really bad for users, but in some cases the use of a heel between 2-4cm can actually alter ankle movement reducing strain on the plantar fascia and Achilles tendon, two of the most common structures that cause pain in the heel and ankle. This is not the case for everyone though and for some people wearing a heeled shoe can increase the pressure on the front of the foot and cause problems with the digits and metatarsals. That’s why when issues like the equality act on high heel shoes for females was debated in parliament, the College of Podiatry presented the argument that heeled shoes should be the wearers choice and not a stipulation of uniform, as wearing high heeled shoes does alter mechanical function and is different for everyone.

The influence of marketing and trends can also be seen in the running community where scientific research and development aims to create a running shoe that can break world records, reduce injury, maximise efficiency and improve function. The rapid evolution of the running shoe leads to most active runners being in a state of bewilderment as to what is right for them. It also leads to governing bodies banning certain styles, as performance enhancement is considered.

With a drive to become more active in society to improve MSK health, where does this confusion leave the average park runner who is wanting to complete their 5k run in a quicker time, injury free?

I guess some of the answers lie in getting a full footwear assessment tailored to your individual requirements and needs. This should be in conjunction with an assessment and diagnosis of any pain you are suffering from. Provision of footwear rules and advice from a podiatrist can certainly make the scenario of purchasing new shoes more bearable and could possibly improve pain and function too. Don’t forget, that just by simply wearing shoes there are many changes that occur to the way you move and how you use your feet.

by Clare Jacklin, Chief Executive, NRAS

I heard a good joke during the Christmas break –

Question: What do you think next year will bring?
Answer: How would I know…? I don’t have 2020 vision!

Albert Einstein is widely credited with saying, “The definition of insanity is doing the same thing over and over again but expecting different results.”

Now, I’m not for a moment saying we’re all going insane but I wonder how many of you reading this feel (as I do) a sense of déjà vu that we’ve heard the same thing over and over but little change has occurred. We hear so much rhetoric about ‘shared decision making’, ‘patient centricity’, ‘shared care’ etc. but still our NRAS helpline gets far too many calls from people who feel excluded from their own treatment and care! These are people without power to choose or influence or contribute to their own therapy.

NRAS has been leading the way since 2001 for the rights of those living with RA and JIA to have access to the right care, at the right time provided by the right people. This is a challenge that is still ongoing; despite so many promises and policies being made by various stakeholders over this last decade, there is still blatant evidence of the UK being victim to postcode lottery health care.

People living in the UK with inflammatory arthritis have access to the very best of medicines, the very best of multi-disciplinary team care but only if they happen to live in certain areas of the country. Too often we are hearing from people who not only struggle with the day to day issues of living with RA or their child with JIA, but are battling to get appointments, fighting to get onto particular treatments or being denied choice or input into their care. So, who or what is making these decisions? Not surprisingly in my opinion it is the loudest voice of all that calls the shots… money! That old adage ‘money talks’ has never been more evidently true than it is today. Short term gains are prioritised over long term improvements to individuals’ lives, the NHS as a whole and the UK economy.

Within the first half of 2020, NRAS will be launching our two new websites (one for NRAS and one for JIA at NRAS), as well as the first of our e-learning modules. All of which along with our informative resource booklets are aimed at giving people living NRAS logo with RA or JIA the knowledge, tools and confidence to keep on demanding what is rightfully theirs… the right to be part of their own care and treatment. The NRAS Right Start New2RA service (launched at BSR conference 2019) is also evidencing that giving individuals the right information at the very beginning of their journey with RA is making a significant difference to their prognosis and outcomes. Better outcomes for patients leads to less demand on NHS services, improved adherence to treatment which in turn reduces wastage of medicines, individuals who have the right care at the right time also are more likely to stay working hence contributing to the economy which in turn is reducing the strain on the welfare system but most importantly improving their quality of life and reducing the risk of developing depression and anxiety. So, if ‘money talks’ then surely all of this is currency for conversation!

This is why I was keen that NRAS re-joined ARMA so that collaboratively with all our fellow ARMA Members we can be bold and brave as we enter this new decade to bring about and support new initiatives that can contribute to efficiency savings and investment in projects such as the First Contact Practitioners initiative. I am hopeful that by engaging with and offering supportive training to practitioners in primary care that NRAS, along with other ARMA Members, can bring about earlier diagnosis for many with inflammatory arthritis which in turn can contribute to all of the above.

In summary, my 2020 vision is to banish those déjà vu moments of the last decade and see clear change for the better, living up to the NRAS strapline of Changing Minds, Changing Services and Changing Lives for all those living with RA and JIA.

Guest blog by William Pett – Senior Policy Advisor, NHS Confederation

As people grow older, health conditions often become both more complex and chronic. Evidence shows that rates of those living with multimorbidity rise significantly with age; a recent study revealed that 30% of adults aged 45 to 64 years report at least two chronic conditions, increasing to 65% of adults aged 65 to 84 years and more than 80% for those above 85 years old.

For older people living with multimorbidity, musculoskeletal conditions are common. Organisations such as Versus Arthritis have drawn attention to this in recent years, highlighting that among those over 45 who report living with a major long-term condition, more than 3 out of 10 also have a musculoskeletal condition.

Yet, as those who have lived with comorbidities may tell you, the NHS has not historically dealt well with patients with multiple conditions. The health system has traditionally been focused around episodic care – one provider contracted to treat for one condition, another contracted to treat for a second condition. This in turn has made care pathways somewhat arduous for patients, requiring them to go to different locations for different conditions – especially problematic, of course, if you are older and less mobile.

Fortunately, things are beginning to change. The NHS Long Term Plan, which builds on the principles of the Five Year Forward View, looks to break down silo working across the health system and sets out how integration of services will improve outcomes for patients. There are likely to be several beneficiaries of more integrated working – including not just patients but also clinicians and the tax-payer – but it may well be those with multiple conditions who benefit most.

For those with musculoskeletal conditions specifically, care pathways are being made easier and more direct for patients through direct access to First Contact Practitioners (FCPs). Recognising that musculoskeletal conditions account for 30% of GP consultations in England, FCPs will allow those with conditions such as arthritis to see a physiotherapist at a local surgery straight away, without the need to go through a GP.

More broadly, the old model of GPs referring patients out to different specialist and community services is being streamlined through Primary Care Networks (PCNs). These will bring together GP practices and community services in neighbourhoods across England, with the aim of achieving fully integrated community-based health care. A key feature of PCNs will be multidisciplinary teams, comprising a range of staff from pharmacists to district nurses to physiotherapists, as well as those from the social care and voluntary sectors. Someone living with multimorbidity will therefore be able to have a single comprehensive care plan that recognises the complexity of living with multiple conditions at community level.

We are, however, in the very early stages of the new integrated world. Clinical directors leading PCNs are still settling into roles that didn’t exist a year ago, within networks that didn’t exist a year ago. There are multiple expectations being placed on PCNs and many clinical directors are beginning to feel overwhelmed. This is where the NHS Confederation comes in. The Confederation has launched NHS Primary Care, which will act as the voice of PCNs as they develop and begin to deliver against new service specifications. Crucially, if the ambitions of the Long Term Plan are to be achieved – and if care is to improve for those living with comorbidities – then it is vital that new integrated care models are given the time and resources they need to succeed.

by Ellie Davies, Acting Project Manager, Falls and Fragility Fracture Audit Programme (FFFAP)

The challenge:

520,000 cases of fragility fracture occur every year amongst those (primarily over-50s) suffering with the bone-weakening disease known as osteoporosis. That is 520,000 broken bones caused by as little as slipping in the shower, stepping off a curb even. This is not only a huge economic burden on the NHS, approximately £5.25 billion, but an epidemic that has lasting physical and emotional repercussions for sufferers. It is upsetting to learn that 42% of older people say that osteoporosis has made them feel more socially isolated.

And it’s going to get worse. For as life expectancy steadily increases, it is estimated that there will be 25% more fragility fractures by 2030, and with that a 30% rise in healthcare costs that the NHS is simply not equipped to meet. A sobering prospect yes, but a crucial reminder nonetheless that now is the time to target improvement.

The solution:

Of course, eradicating the occurrence of fragility fractures altogether is the ultimate goal. However, given that any such fracture approximately doubles the risk of another, most likely within two years, focusing on secondary prevention is an effective starting point. Rapid assessment and timely treatment post index (first) fracture could avoid thousands of secondary cases.

Fracture Liaison Services (FLS): what are they and why are they so important?

A fracture liaison service (FLS) is an NHS service which aims to reduce the risk of subsequent fractures by systematically identifying, treating and referring all eligible patients aged 50 and over who have suffered a fragility fracture to appropriate services. A FLS is a proven approach, recommended by the Department of Health, for targeting these high-risk groups and improving secondary fracture prevention.

Fracture Liaison Service Database (FLS-DB): Our mission

According to the Fracture Liaison Service Database: Commissioner’s report 2019, there are significantly fewer fracture liaison services (FLSs) available for older patients in some parts of England and Wales than others. The Fracture Liaison Service Database (FLS-DB) is not only working towards improving the care provided by existing services but making these preventative services available more widely and avoid approximately 50,000 life-altering fractures in the process.

Dr Kassim Javaid, RCP clinical lead for the FLS-DB said “Those suffering broken bones are often the most vulnerable in society and it is unacceptable that such variation exists in service accessibility depending on where in the country they live. Fracture liaison services are proven to reduce the risk of experiencing further fractures, reducing the impact on older patients, and save the NHS millions of pounds. I implore all Clinical Commissioning Groups to ensure that FLSs are commissioned in their areas so that millions of older people receive the care they deserve.

What can you do?

  • Watch and share our short animation with information about fragility fractures and the care that should be provided
  • Read and share our guide to strong bones after 50 to help reduce the occurrence of fragility fractures
  • Find out about the data available for healthcare professionals and academic institutions for research and analysis
  • Follow us on twitter @RCP_FFFAP to find out more about the FLS-DB and other related audits.