Abstract
BackgroundTo develop services, healthcare professionals must make business cases to managerial bodies within Hospital Trusts and if approved, to commissioning bodies. Patients with hip fracture are at high risk of subsequent fracture. To prevent this, guidance recommends structuring fracture prevention services around coordinator based models. These are known as Fracture Liaison Services (FLS).Methods33 semi-structured qualitative interviews were conducted with healthcare professionals with experience of making business cases for FLS. Data was analysed thematically.ResultsChallenges in the development of business cases included collecting all the relevant data and negotiating compartmentalised budgets that impeded service development. Participants described communication and cooperation between providers and commissioners as variable. They felt financial considerations were the most important factor in funding decisions, while improved quality of care was less influential. Other factors included national guidelines and political priorities. The personalities of clinicians championing services, and the clinical interests of commissioners were seen to influence the decision-making process, suggesting that participants felt that decisions were not always made on the basis of evidence-based care. Effective strategies included ways of providing support, demonstrating potential cost effectiveness and improved quality of care. Using a range of sources including audit data collected on the successful Glasgow FLS, and improving cooperation between stakeholders was advocated. Participants felt that the work of commissioners and providers should be better integrated and suggested strategies for doing this.ConclusionsThis study provides information to healthcare professionals about how best to develop business cases for FLS. We conclude with recommendations on how to develop effective cases. These include using guidance such as toolkits, aligning the aims of FLS with national priorities and benchmarking services against comparators. Introducing a ‘Local Champion’ to work alongside the service manager and establishing a multi-disciplinary working team would facilitate communication between stakeholders. Involving commissioners in service design would help integrate the roles of purchasers and providers.
Highlights
To develop services, healthcare professionals must make business cases to managerial bodies within Hospital Trusts and if approved, to commissioning bodies
In April 2013, responsibility for the commissioning of services changed from the Department of Health and local Primary Care Trusts led by managers, to National Health Service (NHS) England, an organisation overseeing 211 GP led local Clinical Commissioning Groups [2]
They are contracted to deliver services commissioned by local Clinical Commissioning Groups and NHS England, and all NHS Trusts are in the process of becoming Foundation Trusts [3]
Summary
Healthcare professionals must make business cases to managerial bodies within Hospital Trusts and if approved, to commissioning bodies. Guidance recommends structuring fracture prevention services around coordinator based models These are known as Fracture Liaison Services (FLS). In April 2013, responsibility for the commissioning of services changed from the Department of Health and local Primary Care Trusts led by managers, to NHS England, an organisation overseeing 211 GP led local Clinical Commissioning Groups [2]. Foundation Trusts are independent organisations responsible for providing over half of NHS secondary care services operating in local regions. They are contracted to deliver services commissioned by local Clinical Commissioning Groups and NHS England, and all NHS Trusts are in the process of becoming Foundation Trusts [3]. Decisions should be made on the strength of the available evidence and the robustness of the business cases [2]
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