Developing a national Osteoporosis service model supporting NHS Customers and organisations in understanding their current service costs and to demonstrate a variety of scenarios to help support service redesign and development. A pharmaceutical company commissioned the development of this model as a service to medicine on behalf of the Osteoporosis service. The model was required to focus on the whole system and support the NHS in achieving its targets in line with its agenda.
The Fracture Liaison Tool was designed to comply and adhere to the NHS Commissioning Cycle and thus as a service development tool to support the commissioning and full implementation services within community settings.
“[the model] provides a flexible modelling tool for individual communities to develop a business case for a fracture liaison service, allowing them to include both local activity data and local costs to forecast the impact of such a service.” : National Osteoporosis Society website
The tool was required to reflect the impact of establishing a fracture liaison service to increase engagement with osteoporosis fracture sufferers, increasing adherence with the patient pathway and treatment completions, and reducing recurrent fractures.
Following feedback received from in-depth liaison with an Alliance Internal Stakeholder group and the development of a NHS Stakeholder Group we received feedback enabling the specification of a new tool for Osteoporosis including the following requirements:
- Demonstrate the clinical and economic burden associated with osteoporosis patients
- Identify and estimate the local impact of osteoporosis based on real data
- Run a variety of scenarios over varied time frames
- Display results simply and clearly for stakeholder to understand key relationships and impacts of changes in the service
- Incorporate available clinical data and demonstrate the clinical and economic burden associated with osteoporosis patients and the outputs
- Demonstrate how supporting more patients in primary care, using a fracture liaison service, may result in less cost to the organisation if the patients are treated appropriately.
As part of an overall Commissioning Support project, Benson Wintere developed a “Fracture Liaison Tool” meeting the requirements and specifications expressed. This was built using advanced Excel and employed proven development methodologies.
This tool enabled primary care trusts or other health areas to develop a model adapted to the local environment by pulling through current fracture data for the area (from the HES database) and by overriding national settings where applicable.
Costs of treating patients in hospital and with available medicinal treatments were also estimated and flexibility was built in to ensure these could be customised to the requirement of each health area.
This resulted in a tool that can forecast the outcomes and costs of Osteoporosis on two scenarios – the current and new service scenarios. The current scenario reflects a continuation of the existing service. The new scenario reflects the implementation of a Fracture Liaison service to increase the level of intervention and reduce recurring fractures. The costs of setting up this service can be offset over tiem by the cost savings associated with a reduction in recurrent fractures (which is established by a comparison with the current scenario). These outcomes are demonstrated on the Dashboard and other detailed reports.
The tool was delivered and received a positive response from the pharmaceutical company who then rolled it out to the NHS and the National Osteoporosis Society (NOS). The Fracture Liaison Tool was subsequently adopted as a national tool. This is now available on the NOS website: http://fracture-liaison-model.co.uk/