Fractures in Barnet

Healthwatch Barnet visited the Fracture Clinic at Barnet Hospital in November 2016 after receiving reports from patients about overcrowding and long waiting times. The review focused on understanding patient experiences and assessing the impact of a new Virtual Fracture Clinic (VFC) model introduced in January 2016. 

The report found that the Virtual Fracture Clinic had significantly improved the service. Previously, all patients attending Barnet A&E or Chase Farm Urgent Care Centre with musculoskeletal injuries were routinely referred to the fracture clinic, even when many required little or no follow-up treatment. Under the new model, referrals were first reviewed remotely by a consultant, physiotherapist and administrator using patients’ records and X-rays. Patients were then contacted by telephone and either discharged or given an appointment with the most appropriate specialist clinic if required. 

The Virtual Fracture Clinic reviewed between 100 and 150 patients each week and had reduced face-to-face fracture clinic attendances by around 40%. As a result, clinics that had previously been very overcrowded were now generally calmer and more manageable, with approximately 60 patients attending per day.

Inspectors observed three fracture clinics and found that they operated in a calm and orderly manner. The waiting area provided seating for 44 people and, during the visits, there was sufficient space and seating available for everyone. Staff reported that overcrowding was now uncommon and usually occurred only when referral numbers were unusually high. 

The patient journey typically involved several stages, including registration, nursing assessment, X-rays, plaster room treatment where necessary, and consultation with a doctor or consultant. Because of these multiple stages, some waiting was unavoidable. Patients were generally kept informed by staff, and inspectors observed nurses providing updates and apologies when delays occurred. 

Feedback from patients was largely positive. All patients surveyed had received appointments, most within one week of referral. However, many patients did not fully understand what the Virtual Fracture Clinic was or how the referral process worked. 

The main criticism related to waiting times within the clinic. Nearly 60% of patients reported waiting more than 45 minutes before seeing a consultant. Although Healthwatch recognised that part of this time reflected the multiple stages involved in fracture care, delays remained a source of dissatisfaction for some patients. 

Parking was identified as another issue affecting patients’ experience. Several people reported arriving much earlier than their appointment because they were concerned about finding a parking space. This sometimes led to patients occupying parking spaces for longer periods and potentially contributing further to parking pressures around the hospital. 

Overall, Healthwatch concluded that the introduction of the Virtual Fracture Clinic had been highly successful in reducing unnecessary appointments, improving patient flow and preventing overcrowding. The report recommended ensuring patients better understand the referral process and available sources of information, extending the Virtual Fracture Clinic model to include referrals from additional services such as GPs and walk-in centres, and improving communication with patients when clinic delays occur.