Prescribing nutritional items on the NHS is a topic that often draws contrasting views and frequent media attention. Whilst there are clear arguments for supporting the nutritional needs of vulnerable patients, we must ensure that nutritional prescribing is appropriate and fair. The NHS landscape going forward is one of maintained budgets and increased financial accountability. Reducing both waste and inappropriate prescribing offers significant Quality and Productivity savings for Clinical Commissioners.
B145: ONS guidelines
These guidelines update the previous ONS guidelines and set out the steps for prescribing ONS and provide useful advice on monitoring progress as well as for prescribing in malnutrition associated with special conditions such as palliative care or drug misuse. Advice on self care, reducing inappropriate prescribing and waste is also included.
Fabulous Fortified Feasts
One of the resources developed for the Nutrition Toolkit was Fabulous Fortified Feasts, a collation of
useful recipes, advice and ideas for increasing the calorie and protein intake of people with weight loss, small appetite or people with or at risk of malnutrition. It contains recipes for food fortification, homemade sip feeds and snacks. It was developed to be used by both patients and carers, as preparation of the recipes is designed to be relatively simple:
B146: Infant Feeds
Breast-feeding is promoted and encouraged, but when the decision to move to formula in infants with special requirements has been made, this guideline provides primary care prescribers with advice on which formulas to use in particular clinical circumstances such as cow's milk protein allergy and secondary lactose intolerance.
B69: Gluten Free Prescribing
By prescribing only long life bread and flour, patients will receive a supply of staple foods on the NHS that are considered to be cost effective to contribute to the increased cost of maintaining a gluten free diet.
B188: Assisting people with swallowing difficulties
Although the use of thickeners is not just associated with care homes, there are particular concerns around the use of these products in care homes. These resources provide guidance on safe and appropriate use and encourage regular review and ensuring training of staff involved in administering thickeners. The resources are based on the current dysphagia diet food texture descriptors, however both the British Dietetic Association and the Royal College of Speech and Language Therapists have just agreed to adopt the IDDSI framework in the UK (International Dysphagia Diet Standardisation Initiative). This adoption will happen over the next 18 months and the bulletin will be updated in due course to reflect this change when it is common practice.
Other resources, projects and links
Foods on Prescription Webinar
The PrescQIPP team hosted a webinar entitled ‘Foods on Prescription’ presented by Judith Harding, Prescribing Support Dietitian at NHS South Essex and Melitta Mudaly from PrescQIPP.
Based on a successful training session for non-clinical staff, e.g. prescription clerks and practice managers, that Judith regularly gives locally, the webinar outlined nutrition prescribing (what's appropriate, what's not & common pitfalls) for staff handling repeat prescriptions. It also looked at outcomes from training in SW Essex. Melitta also went through the recently released Nutrition Toolkit.
View the Foods on Prescription Webinar here.
Infant FeedsA selection of guidance on infant feeds work from around the country is now online:
We will endeavour to keep adding new best practice as soon as we become aware of it!
Gluten Free ServiceBedfordshire PCT set up a Gluten Free Service in 2011 in order to create a manageable way of efficiently prescribing gluten free products via community pharmacies. The service has been very successful with patients and Bedfordshire CCG has produced an evaluation report. This report and the updated supporting documentation for the service, kindly provided by Belinda Ekuban, Chiltern Vale Locality Pharmaceutical Lead, can be found below. A selection of guidance from elsewhere in the country is also available.
Food FirstIn September 2009, the Bedfordshire Community Health Servcies project: Food First, was initiated to provide a sustainable approach to tackling malnutrition within the local area. Instead of adopting the common approach of switching to a cheaper alternative, the project aimed to address the root of the problems. The key findings were:
- Aiming for a long term solution, rather than quick fix
- Proactive project, focus on 'doing' rather than audit
- Project has been marketed with a logo to create brand awareness and certificate awards to encourage participation
- Project is a combination of training, resources and patient reviews
For more information on Food First:
- You can visit the eatforlife website
- Contact the team at firstname.lastname@example.org or Tel 01582 707629
There are also a number of documents available on our own website at:
NHS Bedfordshire Food First
Standard Communication Letters
The PrescQIPP team have been engaged with local dieticians to inform prescribing of sip feeds. One of the critical points in the prescribing pathway identified is the handover process between secondary care to primary care, i.e. when patients are discharged from hospital on sip feeds. The key to ensuring that prescribing after this point remains appropriate is effective communication between initiator of the sip feed (preferably a dietician) and the GP.
A recently identified goal of local dieticians is the development of standard communication letters from dieticians to GPs to inform prescribing of sip feeds when care is transferred from acute to community settings. During this process, communication letters already in use will be collected and uploaded to the PrescQIPP website as examples of best practice. They can be viewed using the link below;