1. Nutrition update Medicine Optimisation GP Forum
November 2016

2. 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
Overall all surgeries progressing well
Treloars
% non-preferred
Total cost per 1000 population
crèmes
Odiham cover Treloars, all in hand

3. 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. 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

5. 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)

6. 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

7. 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

8. 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

9. 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

10. 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
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