Table 3 Best ways of making a business case for a FLS

You can use other [services as] comparators and the USA seems to be quite a good thing to beat doctors with at the moment so if you look at outcome in the best centres compared to the average centres, which is quite a good… we do this but [another Trust] do this, what’s the difference? Well they’ve got 15 Fracture Liaison Nurses and everyone doing this… [the Trust] tend to benchmark things across local groups but if you’ve got national comparators those are quite good. [Participant ID: 021]

I think patients’ voice can have more power, especially if we are looking at situations where we feel that patients may be at risk and I think that obviously helps to drive the changes as well. [Participant ID: 012]

You also need to get allies on side who will help you and support you… people who are key, for example, [a GP], she wasn’t involved in commissioning or anything but she is very well respected in her field [Participant ID: 004]

I think the managers are too separate and it should be more embedded and integrated so that we work together and we come up with clinical designs and models, they tell us we’re stupid anspending too much money, and then we work it out and come up with a compromise for it. [Participant ID: 009]

It’s through no fault of anyone’s but these are human organisations and you’ve got to engage with these things on a human level… It’s much easier to say no to someone who you’ve been saying no repeatedly to for the last five years and where you’re not regularly seeing them. [Participant ID: 024]