Table 4 Recommendations for developing business cases for FLS

1. Using all available support. This includes national toolkits for FLS outlined by the IOF Capture the Fracture Initiative [41], the Fracture Liaison Implementation Programme (FLIP) [39], the Osteoporosis Service Development model [42] and training courses [22]. More general guidance issued by Clinical Commissioning Groups may also be used [43].

2. Using empirical evidence such as academic research to demonstrate the efficacy of FLS alongside clinical guidelines. Research identifying outcomes of the Glasgow FLS may be of use here [44]. Aligning the aims of the FLS with national priorities such as dementia could also be considered.

3. Using evidence such as outcomes data from the Hospital Episode Statistics [34], to make cost effectiveness calculations.

4. Benchmarking the service against local and national comparators using audit data.

5. Identifying a ‘Local Champion’ [22], generally the Lead Clinician within the Department, to work alongside the service manager. This clinician has an important role in providing clinical input and obtaining support from clinicians working both within and outside of the team.

6. Developing effective communication and cooperation with stakeholders working both inside and outside of the Department by establishing a multi-disciplinary working team [22]. Service managers have a responsibility to communicate with managers working in related areas.

7. Approaching managerial bodies and Commissioners early in the process to establish their priorities and working with them to develop the service if possible. Informal networking may be of use.