Peter Selby North Western 12 October 2010 Fracture Liaison Service Provision in the North West

Fracture Liaison Service Provision What does Audit data tell us about Fracture Liaison Services in the region? What models are being used? How do they work for in-patients and out- patients?

RCP-CEEU national organisational audit 2009 Reported by SHA, NHS Trust and PCT FLN

RCP-CEEU national organisational audit 2009 Reported by SHA, NHS Trust and PCT FLN

RCP-CEEU national organisational audit 2009 Reported by SHA, NHS Trust and PCT FLN

RCP-CEEU national organisational audit 2009 Do you have a fracture liaison nurse or similar post? Organisations answering “Yes”: –North West SHA: 9/52 6/25 Acute Trusts 3/27 PCTs

RCP-CEEU national organisational audit 2009 Do you have a fracture liaison nurse or similar post?

Remember Having a FLN does not guarantee and effective fracture liaison service Not having an FLN may not necessarily mean that post fracture care is poor

FLS in the North West What you told us 31 respondents For Inpatients: –11 delegates have a funded service that provides routine post fracture assessment of future fracture risk in inpatients –4 have a nurse-led service –These services look at men and women, mainly over the age of 50 –Reasons for no service: lack of funding or delegates are community-based.

FLS in the North West What you told us For outpatients: –7 delegates have a funded service that provides routine post fracture assessment of future fracture risk in outpatients –Nurses and consultants take responsibility for assessment in these services –Again, men and women are assessed, either all adults or over 50 year olds. –Reasons for no service: lack of funding or delegates are community-based

FLS in the North West What you told us The majority of respondents said that responsibility for identifying low trauma fractures lay in fracture clinic or on orthopaedic wards 11/16 have consultant orthogeriatricians 14/16 have access to DXA 2/16 have an auditable database for fracture care (other than NHFD) 6/16 have agreed protocols between primary and secondary care

Manchester and Salford “It was the best of times, it was the worst of times…”

Central Manchester Early adopters Numerous obstacles Outpatient service still not functional Good inpatient provision with specific nurses and ortho- geriatrician

Issues for Outpatients Orthopaedic involvement –Small clinic area –No room for FLS to be based there –Feeling FLS is “in the way” Funding –Even using NICE requirements –All service from Medical Division whilst fractures in Surgical

Salford Joint community/hospital working System is effective

How it used to work Community nurses in fracture clinic Identify at risk patients DXA if neededTreatment according to NICE

Audit Doctor referral 1.6% Doctor + patient referral 63% FLN 77%  Purchased FITOS

How it works now Fracture Telephone triage DXA if indicated Nurse Clinic Seen with results Treatment as indicated Rehabilitation Bone boosters courses Works with falls team

Conclusion Fracture liaison is patchy in our region There are services that do work To achieve this we need: –Dedicated staff with a vision –Collaboration between stakeholders