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A Pioneering Partnership in Nutrition Prescribing for Rotherham

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Presentation on theme: "A Pioneering Partnership in Nutrition Prescribing for Rotherham"— Presentation transcript:

1 A Pioneering Partnership in Nutrition Prescribing for Rotherham
Jill Ward Clinical Director Nutrition and Dietetics The Rotherham NHS Foundation Trust

2 4 Strategic Themes AHP Strategy 2012-2017
Promoting person –centred practice and care Delivering safe and effective practice and care Maximising resource for success Supporting and developing the AHP workforce

3 NHS Rotherham Population 254, Practices (Size range 1,505 – 20,819 patients) 1 Secondary Care Provider located in the Borough 63 Community Pharmacists Spearhead PCT

4 GP opinion (2004) We are constantly being requested by dietitians and nurses to provide prescriptions for items that we are unable to assess whether they are appropriate for the patient We are only the mechanism of supply we rarely initiate or make any alterations to these prescriptions. We feel we are being bullied into prescribing

5 Solution = Prescribing and Financial responsibility should reside with the health care professional that is recommending the intervention. Nutrition = Dietitians Wound Care = Tissue Viability Nurses Continence = Continence Adviser Stoma = Stoma Nurses

6 Getting the evidence Audits confirmed
50% of patients not known to the dietitians Of those not know in excess of 90% had not received a review in the past 6 months Majority would not have received supplements if initially assessed by the dietitian. GPs Unhappy about prescribing Cost Growth Exceeded overall prescribing inflation.


8 Agenda 2004-2006 Audit/Information
April Took responsibility for budget Development of Contract April Contract Tender Discussion with Companies April Contract (FRESENIUS) April New Contract

9 Commissioner Involvement
NHS Rotherham is a stake holder in the nutrition contract and Community wide Maximising the benefit of that contract.

10 Advantages to the PCT Improved patient management
Increased dietetics service Improved control of the prescribing and supply of supplements Ownership of the budget Compliance with NICE guidance PCT now a stakeholder in the nutrition contract

11 But what's the Carrot

12 Project development Jan 2006-development of 2 posts:-
Band 7 Oncology post Band 4(25hrs) Clerical post Pump primed Paid for out of project

13 Hand over of patients Medicines Management identified patients on ONS/Feeds List developed per practice Current Workload (In excess of 1000 patients) Funny antidotes

14 What did we Find? Patients were receiving supplements for:-
Loose teeth Meal replacement (low income) Bereavement Didn’t like, but giving to pets Put on weight, so son using for body building

15 Dietitians “Assess, diagnose and treat diet and nutrition problems at an individual and wider public health level Dietitians translate public health and scientific research on food, health and disease into practical guidance to enable people to make appropriate lifestyle and food choices”

16 Process Patients were notified of changes in practice-to contact N& D services Phone call monthly-hand written script Each practice checked by myself and clerical post for compliance - Pt stopped (letter) - Pt continued-follow up arranged - Pt visit to assess

17 All Supplements are initiated & “Prescribed” by the Dietitian*
Dietitian completes attached order form which is sent directly to the patient or a pharmacy nominated by the patient for nutrition contract provider 2 copies forwarded to the pharmacy Letter sent to GP for Information only re Patient care 1 copy is retained by the Dietetic Department Return one copy to the Dietetic department for payment 1 copy retained by the pharmacy

18 Challenges to Practice
Internally within our service we had to change! PATHWAYS AND PROCESSES

19 Raising awareness Local Pharmacy Committee meetings-Pharmacy staff
TARGET events-GPs/HCP NO SAMPLES Meetings-Local Dietetic services

20 Nutrition Project Demand Management
Prior to April 06 xs 1000 patients were receiving a nutritional supplement April 06 = 856 Patients April 07 = 651 Patients April 08 = 506 Patients April 09 = 543 Patients (↓ 36.6%) April 10 = 583 Patients (↓ 31.8%) April 11 = 452 Patients (↓47%)


22 Funding freed up from the project
Pump primed initial posts Quality for patients Reinvestment in the N&D Services Dietetic staff Clerical staff Data base Prescription charges Postage/Stationery Exact budget is known

23 4.4 WTE Community Dietitains have been appointed from budget ( money not spent on sip feeds) 1 WTE band 7 Oncology Dietitian 3 WTE band 6 Dietitians –Community Paediatric Mental Health Oncology 0.4 Band 7 Diabetes Dietitian 2x P/T Admin and Clerical posts-Band 4(25hrs) Band 2 (15hrs)

24 Clerical Essential Increased hours to accommodate increase in work
Administrative Function Data capture/Information Contract /budget information

25 External Relationships with colleagues in other hospitals
Presentations Information Challenging( Act like GP) Contract products Feedback on patient care

26 Internal relationships
NHSR part of Contract Better Communication Better information High profile-FT/NHSR HSJ Efficiency Awards (Sept 2011/12) Highly Commended

27 Benefits to Dietetics Partnership working NHSR/GPs/Local Pharmacies
Dietetic responsibility Budget problem solved for NHSR Increase in Dietetics staffing-quality of patient care/changes occur No rep influence over prescribing Control of Care homes/Community staff Compliance with NICE

28 Audit Enteral Feed Company Contract Audit Patient feedback-Phone
Letters Complaints Patient Satisfaction Survey Patient Opinion

29 Project outcomes Patient opinion Data base-patient care
Continuous seamless pathway Screening for patients Regular Follow up Financial management Ordering control-no abuse


31 NHS Rotherham’s nutritional costs if the had followed national cost growth trends would in 09/10 = £858,991 Actual costs 09/10 = £452,027 Potential saving = 90.0%

32 Further expansion to the model Board approval in September 2010 to transfer GF + PKU products & specialist baby milks to the dietitians (With funding for 0.6 WTE Band 7 Dietitian and P/T clerical support at band 3 funded from current budget.

33 Challenges for Dietetics
QIPP Agenda Quality Innovation Productivity Prevention Follow the themes of your strategy


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