AimTo describe current practice across England regarding paediatric fracture management where national guidelines, published or emerging evidence indicate limited or no follow-up may be required. These include clavicle, forearm, elbow, tibia/fibula and toe fractures.MethodsAll children 16 years and under who attended an English emergency care centre April 2022 - April 2023 with a SNOMED code for the index fractures were analysed within the Emergency Care dataset. These were linked with subsequent fracture related activity within the Outpatient and Admitted Patient Care Episode datasets in the 3 months post-emergency care attendance. The percentage of virtual or face to face follow-up appointment (FUA) for each fracture type was calculated per hospital Trust and ranked, similar to Get It Right First Time (GIRFT) methodology.ResultsA total of 137,147 patients were identified with 90,394 FUA. Marked variance exists across Trusts in the proportion (6-100%) and mode of follow-up attendance (Virtual 25-50%) for different fractures. If FUA were reduced to the lowest quartile of Trusts (Elbow 62%, tibia/fibula 60%, Forearm 46%, Clavicle 31%, and toe 21%) 1/3rd (approximately 30,000) could be saved annually across England. This is likely an under estimation due to poor diagnostic coding by some Trusts. Of note, whilst paediatric clavicle fractures are generally accepted to heal without intervention many have two or more appointments when none are generally required.ConclusionsOur analysis sets a potential path for future GIRFT targets, to facilitate transformative change and substantial savings for the benefit of both patients and the NHS.