Lucy Cassidy: Virtual Fracture Clinic

I would see the same injury handled in many different ways within the same hospital. Patients ended up seeing the wrong person at the wrong time, and nothing was done. Our objective was to put the patient at the centre of the model.


The NHS and what happens when you fracture a bone. In times of cutbacks, it’s more difficult than ever to innovate within the NHS or invest in new technology – one source said that the NHS is using yesterday’s technology tomorrow, but using tomorrow’s budget today. In 2016-2017, trauma and orthopaedics was the number one treatment with the highest number of attendances at 7,779,904. The NHS needs to reshape care delivery and harness technology. Lucy was an Advanced Practice Physiotherapist and is now a Digital Transformation Consultant leading this change.


Imagine you are playing football and you damage a bone in your foot. What happens next? Well, you go to A&E and they tell you that you have a fracture. You then have to go to the hospital and drive around for up to 90 minutes looking for a parking space (which is nowhere near the department), then walk up 80 steps to the fracture clinic, then wait an hour to be seen. That’s more or less what happens every day at the fracture clinic in Brighton. 45% of these patients will take time off work to attend the appointment, 44% will be discharged after the first appointment, and only 44% will be given any advice on rehabilitation exercise. After experiencing this for most of her career, Lucy decided there had to be a better way.

In other industries, private service providers automate everything from online shopping to buying car insurance and booking train tickets. However, the NHS hasn’t made significant changes to their systems in the last 20 years. If you have an appointment, then you are sent a letter by post, and if you want to change the date then you get put to the bottom of the list. Is this current model really the most patient-focused, cost-effective and evidence-based model possible? In the case of orthopaedics, as long as the bone isn’t pointing out of the skin or turned the wrong way then it will heal on its own. This gave Lucy the idea for developing a virtual fracture clinic that offers much more efficient care without the wasted time and money.


Based in Brighton, The Virtual Fracture Clinic aims to help reduce the NHS deficit, provide the right information in the right place at the right time, and reduce sickness. No more unnecessary time off work, variations in recommended treatment or waiting for a follow-up. Focusing on putting people back at the centre of the model, Lucy created a new process flow for the Virtual Fracture Clinic. The first thing was to use consistent Trauma and Orthopaedic guidelines based on knowledge from experts around the world to standardise the care at the front door. Users will then receive an outline of service and contact details for the Virtual Fracture Clinic before seeing a consultant and a physiotherapist. After this, the physiotherapist can offer rehabilitation advice and access to online resources.

Instead of excel spreadsheets and outdated technology, the Virtual Fracture Clinic uses a CRM (customer relationship management system) to manage workflows, bookings and schedules. They have also developed a bot called ‘Lucy’ (a virtual version of Lucy), that uses a rehabilitation app to guide users through different exercises and allows them to start rehab straight away. Users are also prompted to enter a pain score, with high ratings triggering a message to the NHS for someone to contact them. There is even a chat function for asking questions and video call functionality. The added benefit is that if a user is recovering more quickly than expected, the clinic can also learn from this experience.

The Virtual Fracture Clinic has now been running for a year and has received huge publicity in The Guardian and The Telegraph. The startup recently partnered with HBS to help recreate this success and roll out the new model for care to the rest of the NHS.


Lucy is now rolling The Virtual Fracture Clinic out to the rest of the NHS. The results have been incredible, with 85% of users reporting that they had a good understanding of their injury and planned rehabilitation (up from 44% in 2013). Replacing the clinic with virtual care has also directly saved the NHS an estimated £1m. But there are other benefits too – there is no secretary at the desk, no fuel emissions from wasted journeys to and from the clinic, a reduction in time off work, and a standardised practice for care. It’s a win for the NHS and a win for patients.