This section sets out the steps needed to build an evidence-based case for establishing or improving an FLS. You will assess the current position, define what needs to change and gather evidence of the benefits for your local population.
By the end of this stage, you should have a clear and compelling case for change, supported by data, patient insight, stakeholder engagement and recognised clinical standards.
1. Collect the evidence
Map your current services
Understand how patients currently move through the system from first fracture to assessment, treatment and follow up.
Identify gaps, delays, variations and missed opportunities.
Define your future service
Use the ROS Clinical Standards for FLS to inform what a high quality pathway should look like.
Begin outlining the benefits that a well designed FLS will bring to your local population.
Use national and local evidence
Use the Evidence for FLS document in our useful resources on this page to access research and outcomes data demonstrating the value of FLS models.
Contact the ROS for an FLS cost benefit calculation to strengthen the financial and operational case for an FLS.
2. Engage stakeholders early
Engagement events
Consider holding an engagement event to:
Raise awareness of the case for change
Build support across clinical, managerial and commissioning teams
Test early ideas and gather insight from across the system
Agree next steps, named owners and timescales following the event.
You can also connect with the ROS regional FLS forums to learn from other areas and share best practice.
Include people with lived experience
Speak to patients and patient representatives to understand their experience, priorities and unmet needs. Their insight is central to designing a service that improves outcomes and supports person centred care.
How the ROS can support your engagement
The Royal Osteoporosis Society can raise service gaps with health-system leaders and use its national voice to communicate the value and impact of high-quality FLS provision. This can reinforce the local case for change and align it with wider system priorities.
3. Understand your current patient pathway
To make a strong case for change, build a clear baseline understanding of:
The current patient pathway
Problems, delays and inefficiencies
Variations across sites or specialities
Local data on fracture incidence, activity or waiting times
Referral sources
Eligible patient groups
Case-finding processes
Waiting times
Treatment Initiation
Follow-up and monitoring
Data collection responsibilities
This baseline will help you quantify unmet need, define the future pathway and measure improvement.
4. Cost-benefit tool
Contact the ROS for a locally tailored FLS cost-benefit calculation. This can estimate fractures prevented, bed days saved, potential cost savings and the workforce required for a fully resourced FLS. Contact us at: FLS@theros.org.uk
5. Start developing your PID (Project Initiation Document)
Not all health systems will require a PID, but it is a good step to complete before working on your business case. Begin shaping the foundations of your PID, including:
The problem you are seeking to address
Aims and objectives for the project
Scope and boundaries of the service redesign
Governance and key stakeholders
Expected benefits for patients, staff and the wider system
Deliverables and milestones
Risks and dependencies
Decision-making arrangements
Resource assumptions
Patient Identification routes
Measures of success
Your PID will evolve as further data and insight are gathered.
Outcomes of this stage
By completing this stage, you should have:
A clear understanding of the current patient pathway
A defined future pathway aligned with the ROS Clinical Standards
A set of project objectives and a clear case for change
An outline service model
A list of information gaps to address as you move into planning
