Fracture care needs urgent overhaul, says GPSI

GP commissioners must improve access to specialist osteoporosis clinics to tackle the growing burden of fractures on the NHS, a GPSI has warned.

Just 24% of NHS trusts have established Fracture Liaison Services, the gold standard in osteoporosis care, according to West Sussex GPSI Dr Alun Cooper. This leaves many patients liable to fracture again.

A new report shows the number and cost of fractures in women over 55 has risen 13% in the past five years. The cost of hip fractures alone is £2bn and rising.

Dr Cooper, who co-authored the report, said GPs could reverse this trend. ‘This is an opportunity for GP commissioning,’ he said. ‘GPs are ideally placed to see those who have just fractured. If a patient has a fracture, they have double the risk of doing so again.’

There are more than 300,000 fragility fractures in the UK each year and hip fractures are the highest in the EU.

A Royal College of Physicians review in 2009 found just 23% of NHS trusts have a written local commissioning strategy for bone health.

The report, ‘Breaking Point’, says reducing the osteoporosis-related care bill could save a substantial part of the NHS’s £20bn efficiency target.

A recent survey found most GPs only assess fracture patients when prompted by orthopaedic surgeons. In turn, surgeons will often discharge hospitalised fracture patients without investigation.

This means many patients are undiagnosed and opportunities to prevent further fractures are missed, the report argues.

Dr Cooper hopes that new QOF indicators will break this vicious cycle. NICE is piloting indicators to hold a register of fractures and co-prescribing of calcium and vitamin D supplements. Preliminary results are due later this year.

He said: ‘The importance of QOF is not just that points win prizes, but in highlighting importance of disease areas.’

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