NHS LPP team member’s project work features in British Medical Journal Nutrition, Prevention and Health

A member of the Medicines Optimisation and Pharmacy Procurement (MOPP) team at NHS London Procurement Partnership (NHS LPP) is a lead author in a British Medical Journal (BMJ) Nutrition, Prevention and Health article on improving the assessment of older adult’s nutrition in primary care.

Allied Health Professional Prescribing and Procurement Advisor, Rebecca Fisher, carried out this work to take a fresh look around issues relating to older adults’ nutritional status in primary care, and to ultimately identify approaches which could have a positive impact on care.
Find the full piece in the BMJ here.

We recently sat down with Rebecca to talk about her work in this area and how it can benefit patients and the wider NHS system.

• How does this relate to NHS LPP’s work as a procurement organisation?

Procurement of enteral nutrition is a notoriously difficult area with frequent challenges. A majority of contracts are loss leading (selling a product at a price that is not profitable), as Oral Nutritional Supplements are provided to hospitals for free (or penny pricing). This is despite the cost being picked up in primary care prescribing budgets, with no systematic approach to understanding potential benefits to patients.

Procurement specialists working with ICS-pooled budgets to re-contract should be aware of questions of value to patients and the whole health economy around ‘free’ products for acute settings. A rethink on specifications is vital, as well as considering the environmental sustainability of these drinks.

• Can you tell us a little more about why the project was carried out?

Despite England having an annual spend of £185 million on Oral Nutritional Supplements, the assessment of older adults’ nutritional status in primary care has received little scrutiny or research to date. Taking a look at this problem helps us to find underused approaches which can be easily implemented. This project work was carried out in collaboration with NNEdPro Global Institute for Food, Nutrition and Health.

• How will this work benefit patients?

The research is clear. Older adults (and many healthcare professionals) do not identify with the term ‘malnourished’ and all too often unintended weight loss is seen as an inevitable part of the ageing process – which isn’t the case. The British Dietetic Association have produced a helpful resource on prevention.

The approach we recommend has been co-developed with patients and helps to identify interventions that relate to the cause of weight loss, which we believe will make the most difference in adding to quality of life and meaningful outcomes for older adults.

• How will this work benefit the wider NHS community?

The work encourages a proactive approach, identifying issues early on to help prevent worsening health relating to deteriorating nutritional status in older adults with various negative consequences. This helps take pressure off GP appointments and admissions. Ageing well and early identification of unintentional weight loss with aetiology-based solutions is important to reduce demand on the NHS.

• What was it like for you being involved in this project?

My clinical role is in adolescent mental health, and I’ve been confused and frustrated for many years about why managing older adults’ nutritional status has been largely reduced to Oral Nutritional Supplements or food-based strategies.

This is a false dichotomy and disregards the role of both fundamental issues such as loneliness and bereavement, and practical challenges such as lost dentures. Our population is ageing and we need to work harder to support living well for longer.
I am so thrilled to have this work published in the British Medical Journal – Nutrition, Health and Prevention - it is a professional first for me and real achievement.

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If you’re interested in finding out more about this project, please get in touch with Rebecca via Rebecca.Fisher@lpp.nhs.uk.