This section helps you design a Fracture Liaison Service (FLS) based on local needs, stakeholder priorities and best practice.
Work with clinical teams, managers, commissioners and people with lived experience to develop a practical service model.
A facilitated workshop can help map pathways, explore options and create a shared service specification for implementation.
1. Set objectives
Clarify the objectives your new or improved FLS will work towards. These should reflect:
The gaps and needs identified in earlier stages
Expected improvements for patients and the health system
Alignment with the ROS Clinical Standards for FLS
Wherever possible, define objectives that are specific, measurable, achievable, relevant and time-bound.
2. Agree the service model
Work with your stakeholders to define the overall shape of the service, including:
Scope and core functions
How patients will be identified, assessed, treated and followed up
Multidisciplinary roles and responsibilities
Integration with orthopaedics, radiology, primary care and community services
Inclusions and exclusion criteria
Referral and case-finding routes
Interfaces with falls services and pharmacy
Treatment initiation and monitoring
Escalation and clinical-governance processes
The service model forms the foundation for your detailed specification.
3. Estimate capacity required
Begin to quantify the resources your service will need, such as:
Staffing levels
Diagnostic capacity (e.g., DXA)
Administrative and IT support
In addition to the ROS Cost Benefit Tool, you can use our staffing table tool, which allows you to adjust capacity estimates to reflect your local activity, workforce mix and service design.
4. Draft the service specification
Bring all elements together into a clear, shared document outlining how your service will operate. This could include:
Clinical pathway
The full journey from fracture to assessment, treatment and follow up
Key processes, quality standards and timelines
How the service will meet the ROS Clinical Standards for FLS, the 11 FLS-DB key performance indicators and relevant NICE guidance.
Service delivery
Who will deliver the service
Roles and responsibilities across the team
Any required training, equipment or systems
Operating hours and locations
Referral acceptance
Documentation and communication requirements
Data collection and reporting
Clinical governance and review arrangements
The specification should give stakeholders a shared understanding of how the service will operate, what it will deliver and how performance will be measured.
Outcomes from this stage
By the end of this stage, you should have:
A clear set of objectives for your new FLS (aligned with the FLS-DB)
An agreed service model shaped by stakeholders
An estimate of the capacity and staffing required
A detailed service specification describing standards, pathways and delivery
Plans in place to move towards implementation and pilot activity
