Fracture care failings put spotlight on osteoporosis services
A drastic rethink of osteoporosis services is needed after a damming report cataloguing the failings of care received by fracture patients.
The national audit of fracture care, carried out by the Royal College of Physicians, concluded that the variation of care across the NHS was ‘unacceptable' and that the most local health services were providing an ‘inadequate service'.
Data from 157 of 173 hospital trusts found that the majority of patients returning home from A&E after a fracture were not offered a falls risk assessment and, shockingly, only 4% of patients admitted to hospital with fractures had had a DXA scan previously.
Amongst a raft of recommendations the authors said that fracture liaison services should be set up, possibly in hospitals, to target patients who are most at risk. The report also added to the growing calls to add osteoporosis to the QOF.
Dr Alun Cooper, a GP in Crawley, West Sussex, and one of the GPs who was consulted in the expert report submitted to the Department of Health to make osteoporosis part of the QOF, described fracture care as ‘a national disgrace.'
He said: ‘Fracture liaison services should be based in primary care not in secondary care. It's only GPs who have access to continuity of care. Osteoporosis should be regarded as a chronic disease of which the outcome is fractures.'
There is also concern about the lack of patients receiving DXA scans, with the report finding that only 19% of non-hip and 18% of hip fracture patients aged 65 to 74 were referred for one after their fracture.
Dr Jonathan Bayly, a former GP and scientific adviser to the Osteoporosis Society, said:
‘The Department of Health announced funding of £20 million for extra DXA funding, but £17 million was not ring fenced and we don't know what happened to it. The solution to the problem is not just more DXA scanners – it's making sure that there is a pathway so that the right people are referred.'
However, GPs feel that politics is standing in the way of making changes to the system in order to improve care.
Dr Peter Stott, a GP in Tadworth, Surrey, said: ‘There's no doubt that care would improve if osteoporosis was included. It's a very easy condition to manage, it's got very few markers. I think the problem is political.'
Dr Richard Vautrey, GP Negotiator, confirmed that no assurances could be made.
‘We are not underestimating the concerns in this area, but it's one amongst many competing priorities. Osteoporosis is just one that has strong evidence behind it,' he said.Dr Peter Stott: Care would improve if osteoporosis were included in the QOF Dr Peter Stott: Care would improve if osteoporosis were included in the QOF