the role of administration and digital systems

Executive Summary

This case study shares learning from the Portsmouth Fracture Liaison Service (FLS) on how effective administrative leadership and purposeful use of a digital FLS system can enable a high-volume service to function safely and efficiently.

A key message is that digital systems do not replace administration; they work together to service effectiveness. In Portsmouth, a clearly defined, embedded administrator role provides pathway oversight, patient tracking, data quality assurance, and coordination across teams, allowing clinicians to focus on assessment and treatment.

Administrative ownership of workflows and the digital system has improved referral capture, reduced missed patients, strengthened collaboration, and increased confidence in national reporting. The case study also highlights common challenges shared by many FLS teams, including capturing refracture rates and identifying vertebral fractures, and demonstrates the value of collective working between services to influence digital system development. The learning is intended to support other FLS teams in designing, protecting, and strengthening administrative roles as a core component of sustainable FLS delivery.

Background and Service Set-Up

The Portsmouth Fracture Liaison Service (FLS) was established in 2014 following a successful business case led by a consultant clinician. Initially funded for two years, the service began with one consultant and one nurse, focusing primarily on bone health referrals from rheumatology.

Administrative support was introduced early, recognising that patient tracking and coordination would be essential as the service expanded. Over time, the FLS evolved into a comprehensive secondary fracture prevention service, identifying patients through fracture clinics, wards, and outpatient pathways.

Amy Jacobs joined the service as a full-time administrator in 2022, building on early admin systems developed by a predecessor. The current team includes:

• 2 consultants

• 5 nurses

• 1 full-time administrator

• 2 part-time administrators (18 and 16 hours per week)

Strengths of the FLS: Collaboration enabled by administration

A defining strength of the Portsmouth FLS is effective collaboration across multiple teams, including:

• DEXA services

• Orthogeriatric ward teams

• Fracture clinics and virtual fracture clinics

• Peripheral services such as St Mary’s, Gosport

This collaboration is not informal or ad hoc. It is enabled by clear administrative infrastructure: group mailboxes for ‘bone health admin’, orthogeriatric referral templates, agreed information standards, and defined routes into the service.

The administrator role has brought clarity and helped reduce missed referrals, incomplete information, and duplication of effort.

The Administrator Role: Operational Oversight and Clinical Enablement

The administrator role sits at the centre of the service, providing:

• Oversight of high referral volumes

• Daily worklist creation (e.g. allocating 10 new patients per day for nurse screening)

• Tracking patients through complex pathways

• Chasing DXA and blood test investigations and follow-ups

• Ensuring data completeness and audit readiness

This role allows clinicians to focus on assessment and treatment, rather than coordination and data management.

Colleagues describe the administrator as “the glue” of the service because:

• Patients are always visible within the pathway

• There is a system for managing uncertainty

• Risks of patients being missed are identified early

• Data quality issues are addressed proactively

Digital FLS: Administration as the Interface Between People and Systems

One of the most significant service changes was the introduction of the digital FLS module within e-Trauma in 2024. Originally designed for orthopaedics, the system focuses on national data capture rather than patient pathways.

Administrative leadership was essential to making the system clinically usable:

• Creating tags and filters to show where patients sit in the pathway

• Developing worklists for DEXA attendance, follow-ups, and treatment stages

• Manually reconciling data where systems do not integrate

• Ensuring data reported nationally accurately reflects clinical activity

Rather than reducing workload, the digital system expanded visibility and case capture, increasing referrals from:

• GPs

• Virtual fracture clinics

• Minor injury units

• Peripheral services previously unfamiliar with FLS

Data Quality, Refracture Measurement, and National Reporting

Improved administrative oversight has led to an approximately 20% increase in recorded activity since 2022. This increase reflects better data capture rather than a sudden rise in workload.

Amy highlights a critical distinction:

“The patients weren’t new — they just weren’t being recorded as well previously.”

The digital system has improved:

• Confidence that data is not being lost

• Consistency in reporting to the national FLS database

• Visibility of the true scale of FLS activity

However, limitations remain.

Refracture Rates

Currently, neither the digital system nor the national database adequately captures refracture rates for patients already under FLS care. This is widely recognised as a missed opportunity:

“Refracture data would be really useful for measuring the effectiveness of what’s gone on before.”

The Portsmouth team is actively collaborating with other FLS services - including teams in London - to collectively request system changes. These discussions aim to present a unified case to digital suppliers and IT teams.

Vertebral (Spinal) Fractures: Future Opportunity

Another identified gap is the systematic identification of vertebral fractures. At present:

• Vertebral fractures are not routinely captured by the service

• There is no dedicated pathway or system capacity to manage the volume

While this is not currently deliverable, it is seen as a clear opportunity for future service development if capacity and systems allow.

Service Improvements Driven by Administration

Examples of admin-led or admin-enabled improvements include:

• A central orthogeriatric referral mailbox

• Structured referral templates specifying infusion dates and fracture details

• Earlier follow-up and reduced delays to DEXA and treatment

• More accurate and timely national reporting

These changes reduced back-and-forth communication and ensured patients were not lost post-discharge.

Patient Experience and Outcomes

Patient feedback consistently highlights:

• Feeling listened to

• Having sufficient time with clinicians

• Easy access to advice via helplines and follow-up contact

This experience is directly linked to administrative preparation:

“Everything is prepared for the nurses before clinic — they can just be with the patient.”

Skills required for effective FLS administration

Key skills identified include:

• Proactivity and anticipation of problems

• Confidence in decision-making

• Strong cross-disciplinary communication

• Adaptability to different working styles

• Systems thinking and attention to detail

Being embedded within the clinical team — rather than operating peripherally — is critical.

Advice for new or developing FLS

• Do not underestimate the administrative workload

• Build systems around people, not just software

• Invest in admin roles early — they prevent downstream inefficiency

• Data quality and patient safety depend on administrative leadership

Future development

Looking ahead, anticipated developments include:

• Expansion of nursing and clinical capacity

• Corresponding expansion of administrative support

• Potential for admin leadership across multiple sites

• Further refinement of digital systems to support refracture and vertebral fracture identification

Key Learning Points

• The digital FLS system in Portsmouth did not replace administration — they rely on it.

• Administrative leadership underpins data quality, safety, and sustainability.

• Measuring refracture rates is a valuable next step for demonstrating impact.