Gluten free
Review prescriptions of gluten-free products to ensure that:
- They are only issued to patients with a diagnosis for established gluten-sensitive enteropathies, including dermatitis herpetiformas and coeliac disease
- They are only for bread and flour mixes
- They follow the ‘National Prescribing Guidance (for England) on the Recommended number of Units of Bread and Flour Mixes per month According to Age and Gender’
Number of units of bread/flour mixes
| Age and sex | Number of units per month |
|---|---|
| Child under 10 years | 8 |
| Child 11-18 years | 12 |
| Female 19 years and older | 8 |
| Male 19 years and older | 12 |
Number of units from bread products
| Food item | Number of units |
|---|---|
| 400g bread/rolls/baguettes | 1 |
| 500g bread/flour mix | 2 |
Dorset patients are receiving gluten-free products that fall outside of best clinical guidance.
Use the SystmOne searches provided to identify patients who:
- Do not have a diagnosis of established gluten-sensitive enteropathies, including dermatitis herpetiformas and coeliac disease
- Are receiving items other than bread or flour mixes
- Are receiving excessive quantities each month
Communicate the changes to patients involved.
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F3 Low clinical value
Template patient text message – gluten free diagnosis:
NHS Dorset have asked all GP teams to review prescribing of gluten free prescribing bread and/or flour mixes. These can only be issued for patients diagnosed by their doctors as suffering from established gluten-sensitive enteropathies, including dermatitis herpetiformas and coeliac disease.
Your records do not show such diagnoses and hence your prescription for these items has been stopped. If you would like to continue with these products, NHS Dorset recommend that they are purchased. If you would like to discuss this change further, please contact the surgery.
Template patient text message – gluten free products:
NHS Dorset have asked all GP teams to review prescribing of gluten free products. As per NHS England guidance only bread and/or flour mixes can be prescribed. Your records show that you have previously received other gluten-free products which will no longer be supplied on prescription. If you would like to continue with these products, NHS Dorset recommend that they are purchased. If you would like to discuss this change further, please contact the surgery.
Template patient letter – gluten free diagnosis
Template patient letter – gluten free products
ONS (SIP feeds)
Dorset Pharmacy Network Meeting – Adult Oral Nutritional Pathway
Review prescribing of high protein Oral Nutritional Supplements (ONS) to ensure that:
- A recent dietetic assessment has been performed to confirm patients fit ACBS ‘criteria to prescribe’ and use the assessment date as a baseline for future reviews
- Patients are reviewed every three months as per the guideline
- Patients prescribed Oral Nutritional Supplements (ONS) have a MUST score >2 (MUST online calculator)
- High protein ONS should only be continued post hospital discharge where clinically indicated
- Add review date within directions on each prescription
NOTE: Hospital teams are reviewing their discharge processes in support of this measure.
There has been a significant rise in primary care ONS prescribing in Dorset and we are a national outlier for prescription of high-protein ONS.
High protein ONS should only be prescribed under the direction of a dietician, restricted to use in patients with increased protein requirement, as per the Dorset Formulary and ONS pathway.
Use the SystmOne search provided to identify patients prescribed repeat ONS, particularly high protein ONS, and review ongoing need.
Here is an example from a local frailty pharmacist on their process for reviewing nutritional supplements in a care home setting:
- Check under communication/letters to see if patient has any dietician input and plan
- Carry out Must Score (Step 1: calculate BMI score – obtain weight and height. Step 2: calculate weight loss score – ny unplanned weight loss in last 3-6 months?)
- Check patient’s Nutrition status: are they eating and drinking well?
- Follow local guidance
- If patient is not under dietician care, has a MUST Score under 2, eating and drinking, no weight loss or issues – Nutritional supplements are STOPPED.
- MUST score and Nutritional status usually checked in care homes as part of annual medication review
SystmOne search: Dorset SystmOne GPs/PQS Finance 24 25/F7 Oral Nutritional Sip Feeds
Dorset Formulary – ONS formulary 23/24
Dorset pathway for prescribing ONS
Dorset common questions about prescribing ONS
Patient advice: tips for taking ONS
Patient & carer advice: making the most of your food
Referral criteria/forms for Dorset dietitian teams:
Stoma Ancillaries
- Only issue formulary items unless clinical need dictates otherwise
- Have a process for checking the quantities and frequency of repeat supplies of these items:
- Contact the patient if there is a query
- Contact the stoma nurse for follow up if the patient is regularly over-ordering
- Issue stoma products on a separate FP10 prescription to the patient’s regular medication
- Send stoma FP10 prescriptions to the patients’ nominated dispensing organisation (this may be different from the patients’ regular dispensing organisation)
Dorset issues a high-volume of non-formulary ancillary items.
Stoma clinics and GP practices must not provide retrospective prescriptions when requested by appliance contractors, dispensing practices or community pharmacies.
Only prescribe items from the Dorset formulary.
If a patient has received non-formulary stoma ancillary items and/or large quantities and has not had a recent review, the patient should be referred to their local stoma clinic.
Dorset formulary – stoma ancillaries
Dorset Guidelines for the prescribing of stoma additional products preferred in primary care
Contact details for stoma nurses & clinics (GPs may refer patients or patients may self-refer).
| Dorset County Hospital NHS Foundation Trust
Lead Nurse – Kate March Telephone: 01305 255152 Ext: 5152 Email: stomacare@dchft.nhs.uk |
University Hospitals Dorset (Bournemouth Site)
Lead Nurse – Jane Wijeyekoon Telephone: 0300 018 4813 Email: stoma.care@uhd.nhs.uk |
University Hospital Dorset (Poole Site)
Lead Nurse – Tracy Lees Telephone: 0300 019 8199 Email: stoma.team@uhd.nhs.uk |
