Osteoporosis Resources for Primary Care: Frameworks and guidance

• The FLS Clinical Standards and Competency Framework
  
  
• Guidelines for the provision of a clinical bone densitometry service
  
  
• Vitamin D and Bone Health: A Practical Clinical Guideline for Patient Management
  
  
• A practical guide to bone densitometry in children
  
  
• Quality Standards for Osteoporosis and Prevention of Fragility Fractures
  
  
• Vertebral Fractures Guidance
  
  

For more information and to download any of our standards and guidance, visit our health professionals' Tools and Resources page.

• NICE: Guidance on Osteoporosis
  
  
• The SACN vitamin D and health report 2016
  
  
• SIGN 142: Management of osteoporosis and the prevention of fragility fractures
  
  
• SIGN 111: Management of hip fracture in older people
  
  
• NOGG 2017: Clinical guideline for the prevention and treatment of osteoporosis
  
  
• GOV.UK: Falls and fractures: consensus statement and resources pack
  
• NICE: Quality Standard Hip fracture in adults
  
  
• Additional Information: Best Practice Tariff proposals, NHSE, 2016

Supporting routine frailty identification and frailty through the GP Contract 2017/2018

• This guidance provides GPs and Primary Care with a summary of the core contract requirements in relation to frailty within the contract and includes signposting to further support.

Osteoporosis indicators in the QOF and FLSs are complementary. Together they create an integrated systematic approach to secondary fracture prevention bridging Primary and Secondary Care. This is in the best interests of patient care and will save health and social care resources.

Key points:

• Osteoporosis indicators in the QOF present a real opportunity to improve secondary fracture prevention across the UK
• An FLS is a clinically and cost-effective service model for systematic secondary fracture prevention
• In areas where an FLS is in place, the service will support practices to achieve the quality of care required by QOF indicators
• In areas where there is no FLS, commissioning a service is recommended to improve the quality of provided care, support the implementation of QOF indicators and reduce the burden of fragility fractures on health and social care resources
• In areas where an FLS is not commissioned, implementation of the QOF indicators through other means by general practices is recommended

The QOF is the annual reward and incentive programme detailing GP practice achievement results. It rewards practices for the provision of quality care and helps standardise improvement in the delivery of primary medical services. It is a voluntary process for all surgeries in England and was introduced as part of the GP contract in 2004. The indicators for the QOF change annually, with new measures and indicators been retired.

W: http://content.digital.nhs.uk/qof

The following QOF standards are relevant to osteoporosis. They are available on the NICE website.

NHS England and the UK devolved administrations will use the NICE QOF menu to help decide which indicators are included in the QOF within their countries.

The contractor establishes and maintains a register of patients: 1. Aged ≥ 50 years and who have not attained the age of 75 with a record of a fragility fracture on or after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan, and 2. Aged ≥ 75 years with a record of a fragility fracture on or after 1 April 2014 and a diagnosis of osteoporosis

View indicator details NICE id code: NM29

The percentage of patients aged ≥ 50 years and who have not attained the age of 75, with a record of a fragility fracture on or after 1 April 2012, in whom osteoporosis is confirmed on DXA scan, who are currently treated with an appropriate bone-sparing agent

View indicator details NICE id code: NM30

The percentage of patients aged 75 or over with a fragility fracture on or after 1 April 2012, who are currently treated with an appropriate bone-sparing agent

View indicator details NICE id code: NM31

Good communication between Primary and Secondary Care practitioners is vital to the success of secondary fracture prevention. Find out if there is an FLS in your area and talk to the providers about how you can work together to effectively reduce fracture risk in your patients. An FLS will be able to identify fracture patients at risk of osteoporosis, but as a Primary Care professional you have a crucial role to play in long-tern disease management.

The 2017/2018 GP contract introduces routine frailty identification for patients who are aged ≥ 65 years from 1 July 2017. This guidance provides GPs and Primary Care with a summary of the core contract requirements in relation to frailty within the contract and includes signposting to further support.

The six step contact process asks GPs to:

1. Identify patients at risk of frailty using the Electronic Frailty Index (eFI) or other validated tool or clinical judgement
2. Undertake secondary check using Clinical Frailty Scale (CFS), clinical knowledge of patient or information available
3. Code the patient
4. Complete a Summary Care Record (SCR)
5. For those with severe frailty, undertake falls assessment and medications review
6. Use clinical judgement for other relevant and appropriate interventions

Read more on the NHS England website.

The Falls and Fragility Fractures Pathway defines the core components of an optimal service for people who have suffered a fall or are at risk of falls and fragility fractures. It has been developed in collaboration with the National Clinical Director for Musculoskeletal Services, Peter Kay, Public Health England (PHE), the NOS and a range of other stakeholders from across the health and care system.

The Pathway contains a number of key messages for commissioners who are responsible for Falls and Fragility Fractures for their population.

Local health economies, with support from their NHS RightCare Delivery Partner, can use the Falls and Fragility Fractures Pathway resource as a framework for their local improvement discussions.

W: https://www.england.nhs.uk/rightcare/products/pathways/falls-and-fragility-fractures-pathway/

The CCG indicators are designed to provide evidence-based area of practice to:

• measure against to demonstrate improvement;
• form the basis of payment tariffs.

NHS England and other organisations can use the NICE menu of indicators for national and local frameworks incentive schemes and they can be used to support measurement of the new Sustainability and Transformation Plans work programmes.

A full set of the indicators can be found on the NICE website via the 'Single menu of indicators' which can be filtered by indicator type and by subject.

Indicators relevant to osteoporosis and hip fracture as published in August 2017:

The proportion of people with hip fracture, who receive a formal hip fracture programme from admission.

VIEW INDICATOR DETAILS

NICE id code: CCG20CCG

The proportion of people with hip fracture, who receive surgery on the day of, or the day after, admission.

VIEW INDICATOR DETAILS

NICE id code: CCG21CCG

The proportion of people with hip fracture, who receive a multifactorial risk assessment of future falls risk.

VIEW INDICATOR DETAILS

NICE id code: CCG22CCG

The proportion of people in the national hip fracture database who have received all nine care processes performed.

VIEW INDICATOR DETAILS

NICE id code: CCG23CCG

The rate of people admitted with a primary diagnosis of hip fracture per 100,000 CCG population.

VIEW INDICATOR DETAILS

NICE id code: CCG24CCG

The FLS Implementation Toolkit has been developed by the NOS, with support from relevant professional bodies, to support health professionals and commissioners to set up or improve an FLS. It includes a template business case which you can adapt to put forward a case for the development of an FLS in your area. Use our FLS benefits calculator to support your business case and learn from case studies of existing FLS services across the UK. Our dedicated Service Delivery Team can also provide bespoke support to help you develop a new service or improve an existing service. More information is available in the FLS section of this website.