Virtually Fractured Clinic

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One of the first blogs I wrote was about the relative of a friend of mine attending fracture clinic. I called the blog “Wait, wait, wait…“. In it I detail the experience of attending the clinic, the inconvenience and wasting of time encountered. Imagine my delight, therefore, when I heard that our local orthopaedic surgeons were keen to introduce a ‘Virtual Fracture Clinic’. Let me tell you about it.

Currently, if you attend A&E and they suspect you have a fracture, then you are treated and sent home with an appointment to attend fracture clinic for follow up. With the Virtual Fracture Clinic, rather than having to return for the follow up, you get a phone call from the orthopaedic doctors, who review your X-rays, ask how you are, provide advice and can often avoid the need for further attendance. Some people will need to be called back for assessment, but many not. Brilliant. This makes things so much better for patients, avoiding unnecessary attendances while maintaining the quality of the service. 

This clinic is a win-win. It’s better for patients, and it’s cheaper for the NHS. As a commissioner of a cash-strapped CCG this is music to my ears. As far as I’m concerned this clinic should be put into place immediately. 

There is a problem though. It might be a win-win, but it’s not a win-win-win. Good for patients, good for the overall NHS budget, but not good for the hospital bank balance. The clinic loses the hospital money as their are fewer out patient attendances. The hospital are the ones who can put this clinic in place, and they have so far not done so. 

This is what happens when you have a system built around individual organisations in their silos all looking out for their own organisational needs rather than the needs of the larger system. The hospital are being instructed to ensure they achieve financial sustainability, and this has become a greater driver than the need for system sustainability. This is what is playing out with our local Virtual Fracture Clinic. It is resulting in fracture lines appearing between the clinicians at the hospital and their management who appear to be blocking the development of the clinic. It is also resulting in fracture lines building between commissioners and hospital managers. 

This is a wholly unsatisfactory and unacceptable. For there to be drivers in the system that prevent the development of something that would improve the long term stability of the local health economy and, many would say even more importantly, be better for patients, then what is going on here? How can this be right? 

We need to take action. We need to push, hard, for clinics and schemes like this to be implemented. Canterbury, New Zealand chose to implement and fund any scheme that saved patient’s time. They recognised that this was a key way in which to improve and integrate their system. Locally, in Central Cheshire we seem to be a way off this.

The system needs to change. The system needs to recognise it is a system. Organisations need to recognise they are just one part of the system, and that we can achieve so much more together, but only by collectively doing the right things for patients, and the system itself. 

We have an opportunity here to do the right thing. Let’s not lose it. Let’s put aside our individual needs and put the patient first.

Fracture clinics are there to ensure healing. Let’s make this project the start of making our local health economy better.

Dr Jonathan is a GP at Swanlow Practice in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group.

Follow Jonathan on Twitter @DrJonGriffiths

Image courtesy of stockdevil at


  1. Spot on Jonathan. An obvious improvement, dashed by the wrong financial incentives. As a commissioner you should be able to negotiate a tariff for the service, which shares the benefit reasonably fairly between you and the provider. Where there’s a will there’s usually a way.

    Liked by 1 person

  2. So your CCG patients are getting a service which is more convenient for all but you don’t want to pay for it?. Your blog sounds as though you are upset at the hospital not providing this for free.


  3. Hi,
    My name is Mieke,
    I work at East Sussex Healthcare NHS Trust as a Trauma and Orthopaedic Coordinator, I’m working with a team to redesign our current fracture clinic service, we are looking at a Virtual Fracture clinic model and have seen your Blogs, would you be able share your views you have on this, we would love to know any thoughts you have and any lessons learnt and how we can set ourselves up for success.

    Thanks for your time.

    Kind regards



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