Nutrition update Medicine Optimisation GP Forum November 2016 a.cholet@nhs.net tina.cheung@hhft.nhs.uk

Total cost per 1000 population ONS YTD (Apr-Sep) 7% reduction from last YTD (aim for 12% for the year) 18K cost reduction predicted for 2016-2017 Overall all surgeries progressing well Treloars % non-preferred Total cost per 1000 population crèmes Odiham cover Treloars, all in hand

17K reduction predicted this year (Based on YTD Gluten Free 20% cost reduction (vs 8% predicted) 17K reduction predicted this year (Based on YTD Apr-Aug) Beggarwood (22%) Chawton Bramblys G (38-39%) Kingsclere (33%) Whitewater (50%) Clift (52%) Bentley (64%) % Non-Preferred league: 1 1 2 3

4.2% increase in IF cost YTD Infant Formula Guidelines almost finalised! Nber of babies on allergy formulae in NHCCG: 196 17 > 2years old (7%) 38% on AAF 77% ‘seen by paediatrician’ 28% ‘seen by dietitian’ 4.2% increase in IF cost YTD (aim for 7% reduction) For products available OTC Lactose free Reflux Soy Review Age: 3 children > 7! Promote breastfeeding Encourage OTC purchase Start Similac Alimentum early if CMPA suspected

Please code residence status (care home) ONS Key message Food First as first line (food first diet sheets / Care home pack) Encourage Care Homes to engage + elect nutrition and hydration champions Aymes shakes as much as possible (standard or compact dilution) ONS request form for care homes / community nurses Dietitian referral for MUST ≥ 1/At risk of malnutrition Tadley, Hackwood, Crown Heights, Kingsclere Please code residence status (care home)

GF Key message All surgeries to go over to restricted prescriptions New patient letter available from NHCCG website When is it appropriate to prescribe outside guidelines? Faltering growth / malnourished (MUST ≥ 1) If compliance likely to be compromised Learning Disabilities, Teenagers… Dealing with challenges: Offer step down approach Offer discussion on items on prescription, but within 60% limit

Gluten Free prescribing Prescriber Name Total 6m (mar-aug16) av/month Non Preferred Bread & flour only % NP BEGGARWOOD £876.45 £146.08 £192.80 £683.65 22% KINGSCLERE £1,346.69 £224.45 £445.73 £900.96 33% CHAWTON £2,996.20 £499.37 £1,131.13 £1,865.07 38% BRAMBLYS £3,985.63 £664.27 £1,556.84 £2,428.79 39% BOUNDARIES £1,222.79 £203.80 £492.72 £730.07 40% WILSON £2,556.58 £426.10 £1,050.24 £1,564.12 41% CAMROSE £3,578.83 £596.47 £1,475.01 £2,103.82 ROOKSDOWN £979.87 £163.31 £407.51 £572.36 42% GILLIES £3,726.27 £621.05 £1,559.46 £2,166.81 ODIHAM £1,769.61 £294.94 £753.48 £1,016.13 43% CHINEHAM £1,554.86 £259.14 £674.35 £880.51 TADLEY £6,159.09 £1,026.52 £2,703.83 44% HACKWOOD £2,063.62 £343.94 £909.76 £1,153.86 BERMUDA £965.46 £160.91 £428.52 £536.94 O&OVERTON £3,977.18 £662.86 £1,854.98 £2,122.20 47% CROWN HEIGHTS £6,805.17 £1,134.20 £3,318.06 £3,487.11 49% WHITEWATER £2,589.86 £431.64 £1,292.55 £1,297.31 50% CLIFT £1,407.70 £234.62 £727.62 £680.08 52% BENTLEY £532.56 £88.76 £340.16 £192.40 64% TOTALS £49,094.42 £430.65  

IF Key message Check age / review Prescribe powdered pre-term formula rather than liquid Soya, Lactose-free and Anti-reflux: advise OTC Try Similac as 1st line if CMPA suspected Code (Read/Snomed) for Diagnosis Secondary care involvement

ONS: In development Care Home Managers forum Nutrition & Hydration champion for care home network Nourish Pack resource HCC health and wellbeing strategy: training Southern Health Nutrition & Hydration strategy SHFT community malnutrition project (WAHSN sponsored) Discharge pack from HHFT Website updated EMIS template from 4 pilot surgeries Resource review in january

IF: in development Now officially approved by local and regional DPC and APC Wessex approval (november 2016), then PIER endorsement Training for secondary AND primary care Dietitians, Paediatricians, Nurses & Midwives, Medicine Managements Health visitors, Community Nurses, GPs and Commissioners, community Pharmacists Support sofware/website (EMIS, FourteenFish etc.) Wessex Healthier Together Website www.what0-18.nhs.uk Baselines data and audits, focusing on secondary care initially Infant feeding pathway with CCGs PIER = Paediatric Innovation Education and Research Network Huge influence of secondary care. DPC= District prescribing Committee APC= Area prescribing Committee