1. QIPP – Sip feeds Waltham Forest PCT

2. S UMMARY Spend and potential savings Plan implemented in WF Barriers Progress so far Savings for east of England

3. T REND IN SPENDING ON ONS IN WF 2005/62006/72007/82008/92009/10Total ONS Spend £ % Increase 294,764341,041 (16%) 362,892 (6%) 443,022 (22%) 532,005 (20%) 1,973,723 (64%)

4. ONS EXPENDITURE IN WF

5. S AVINGS IN W ALTHAM F OREST Reduce inappropriate prescribing ONS policy Scriptswitch Increase GP awareness (newsletter & meetings) Complan switch First line where apporpriate Starter packs Educate care homes

6. POAPOA Alter policy to promote Complan before other nutritional on hospital discharge and in community Scriptswitch messages Complan starter packs in hospital Dietician to review all patients discharged from hospital on ONS if not referred while in hospital Audit current practice Dietician to review patients Recommendations to GP GP informs own practice Better referral levels to dieticians in future

7. B ARRIERS GP – relationship with PSPs, defensive of current practice Access to practices – time and computer facilities Need for dietician to carry out reviews Insufficient medicines management team support to carry out audit

8. A UDIT Top ten spending practices in WF Patient ID & age, recent BMI, indication, sip feed prescribed and duration, goals recorded, food first advice given, involvement of dietician Contact details of patients for dietician Confidential treatment of information

9. D IETICIAN SUPPORT Dietician seconded for a year Sits with dieticians but under MMT Reviews by telephone, face-to-face or at a clinic Recommendations to GP Patient and MMT copied into communications Weekly excel progress update

10. P ROGRESS SO FAR Early days but encouraging Discontinued or switched Informs other dieticians to be vigilant and use Complan first-line Appointments with patients set-up initially

11. P OTENTIAL FOR SAVINGS ACROSS EAST OF E NGLAND PCT2009 Spend Savings using Complan Shake Suffolk £753,664 £401,040 Norfolk £734,238 £390,957 Cambridgeshire £719,621 £384,756 West Hertfordshire £701,356 £363,687 East and North Hertfordshire £651,934£338,606 South West Essex £512,532 £270,752 North East Essex £506,843£261,996 Bedfordshire £495,700£235,441 South East Essex £471,104 £244,867 West Essex £375,590 £200,132 Luton Teaching £329,341 £173,415 Mid Essex £317,738 £164,999 Great Yarmouth and Waveney £271,461 £144,682 Peterborough £225,225 £119,539 TOTALS£7,066,347£3,694,869

12. T HANK YOU FOR YOUR TIME