Commissioning a Malnutrition Service in Greenwich Rachel Oostra Dietetic Advisor NHS Greenwich CCG...
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Transcript of Commissioning a Malnutrition Service in Greenwich Rachel Oostra Dietetic Advisor NHS Greenwich CCG...
Commissioning a Malnutrition Service in Greenwich
Rachel Oostra
Dietetic Advisor NHS Greenwich CCG
30.09.2015
Situation
• In 2013/2014 Greenwich CCG spent £700k on sip feeds in the
community
• There was only a skeleton Community Dietetic Service to
address malnutrition
• Greenwich did not have a Home Enteral Feeding Team which was
identified as both a clinical and financial risk
• There was no training or support in primary care to address
malnutrition for mobile patients
Task
• To develop a high quality,cost effective service to address malnutrition
for the population of Greenwich
• To develop innovative ways of integrated working with the
local authority to identify malnutrition early
• To gather data and evidence to demonstrate how this service could
meet Greenwich CCG’s QIPP agenda
• To reduce the spend on sip feeds by addressing the variables in
prescribing trends among general practices
Actions
• Meeting with stakeholders and identifying the gaps in nutritional
services in Greenwich
• Through networking with dietetic colleagues and sharing
models of good practice
• Collecting evidence from dietetic colleagues to calculate a
projected saving that could be achieved by introducing a new
service
• Successful QIPP proposal
• Developing funding streams through the Better Care Fund
Nutrition Support/ Food First Team
Food first Project in nursing homes training all nursing home staff on MUST and Food First to address QIPP
• Providing nutrition support for housebound patients with a MUST score ≥2
• LA and community based training for early identification to increase awareness and address malnutrition in the community
• Team consisting of 1.5 dietitians and 1 nutrition assistant .
Deliver practice nurse / HCA training for care pathway referral.
GP clinics to review :- • Mobile malnourished patients
on sip feed: stroke, dementia• Gastroenterology patients –
Coeliac, IBS plus others• Weight management clinic for
patients with a BMI ≥40 or ≥35 with a comorbidity
• Team comprising of 3.5 dietitians and a nutrition assistant
Home Enteral Nutrition Team (HEN)
Multidisciplinary service to review all adult patients receiving enteral nutrition via a tube.
• All HEN patients including housebound and nursing / care homes
• Team comprising of nutrition nurse. speech and language therapist, dietitian, admin
• Support of nasogastric fed patients in the community
MMMMMalnutrition Service
Primary Care Team
Results
Costs
The projected additional budget for the service was £417 000 with
an estimated annual saving of £262 000
Benefit Realisation Plan
1.1 Key Outcome / Benefit 1 – Reduction in spend on HEN feed and equipment
1.2 Key Outcome / Benefit 2 – Reduction in spend on SIP Feeds
1.3 Key Outcome / Benefit 3 – Reduction in avoidable admissions
1.4 Key Outcome / Benefit 4 – Reduction in total unscheduled bed days
1.5 Key Outcome / Benefit 5 – Reduction in preventing non – red flag referrals
Outcomes
Quality
• Develop an integrated
Malnutrition Service
• Provide easy access to a
dietitian
• Provide early intervention
and treatment across all areas
• Increase awareness of
malnutrition and dehydration in
the community
Innovation
• Involve professionals from
health and social care
• Work with catering teams to
introduce ‘Food First‘ in care
homes
• Support domiciliary care
workers to identify the early
signs of malnutrition
• Deliver specialised dietetic
service at local GP practices
Outcomes
Productivity
• Equip staff to identify
causes of malnutrition and
dehydration early
• Deliver safe nutritional care
across all areas
• Reduce hospital admission,
length of stay and
inappropriate investigations
• Avoid waste of nutritional
products
Prevention
• Reduce the risk of infection and
complications
• Improve wound care in
those patients with pressure
sores
• Tackle malnutrition to improve
nutritional status, clinical
outcomes and
reduce healthcare use