What are Oral Nutritional Supplements?
Oral Nutritional Supplements (ONS) are commercially produced medicinal products that you can buy over the counter from a community pharmacy or get on prescription. They are used in addition to a fortified diet (a diet where you add more of the same nutrients to your food and drinks) and give you more calories, protein, vitamins and minerals to improve your nutritional health if you are malnourished or have a reduced appetite.
Why are you focusing on food first now and reducing use of ONS/Why are ONS being taken off my prescription?
Where possible, we want patients to enjoy the benefits of food. National reviews and advice from the British Dietetic Association about ONS tell us that there is little benefit from ONS for most people, and that ONS does not provide anything more than food can provide. Local and national data has shown that ONS are often prescribed to people who do not actually need them, but they cost the NHS millions of pounds every year. In Staffordshire and Stoke-on-Trent, we spend the most on ONS across the country, and we know that lots of people don’t actually like them. Instead, we want to give you the right information and tips to fortify your own food and drinks at home. This will mean you can make small changes that will enable you to continue enjoying the foods and drinks that you love, whilst also improving your nutritional health. You will do this without the need for prescribed supplements that are often not as nice as the meals and drinks that people enjoy as part of normal life.
What does the new policy say and what does it mean for me?
From 27 January 2025, local clinicians are being asked to stop prescribing these supplements to adults aged 18 and over unless they meet certain criteria. This means that they can only prescribe them to you if they have spoken to a dietitian, and the dietitian thinks you really need them. If you don’t need them anymore, we will give you information and tips about some small swaps or additions that you can make to your everyday food to help boost how nutritious they are.
Who does the policy apply to?
The policy only applies to adults aged 18 and over and does not affect children and young people. It also only applies to those who take these supplements orally themselves, so any patients receiving food via a tube/peg will not be affected.
What about patients who are already prescribed ONS?
If you are already given ONS by the doctor on prescription, we will need to review you to see how your nutritional health is doing. There is a calculator that clinicians use to measure a person’s nutritional health, so the doctor will review your health with you. If we find that you no longer need to take these supplements, the doctor will talk you through the next steps. We will give you some information to take away with you which will help you make more nutritious food at home. If the doctor thinks that you might still need the supplements, we will refer you to the Dietetics Service for a more in-depth review and if they agree that you still need the supplements, we will continue prescribing these to you. We will then review your needs regularly.
What advice/information is available to patients who are not eligible for prescription of ONS?
A set of recipe cards, including handy hints and tips about how you can make your food and drinks more nutritious at home are available. These can be printed off for you to take home if needed, or we can send a link to you or your loved ones/carers, if you have access to the internet and would prefer to view the recipes on your phone, tablet or laptop. These also include links to handy videos on YouTube that show you how to make the recipes, if you’d prefer to watch a video.
What support is there for people who can’t afford extra food or over the counter supplements?
A lot of the hints and tips within the recipes are small changes, such as adding milk powder to your milk and using that as normal in your hot drinks and over cereal for example. Some other little swaps or additions included in the recipe sheets include things like adding full fat butter to your toast or vegetables and potatoes, or adding toppings like jams, honey or grated cheese to your meals. These additions and swaps can make a big difference to your nutritional health and don’t need to cost a lot. However, for anyone that needs more support for financial reasons, we can offer you further support via our social prescriber, who will be able to signpost to available services to support.
My consultant/care home/hospice/community nursing team/etc told me I need these supplements – will they still be stopped?
We know that a number of prescription requests come from different professionals outside the surgery. We are working with these professionals to make sure they are doing the correct assessments to make sure they only request these supplements if you really need it. If patient had initial request outside the practice and this has been continued, see question 5 for info about next steps re. reviews etc.
Is the advice different for palliative care and end of life patients?
Just like with any other patient, we want to make sure that those receiving palliative/end of life care are able to enjoy the foods and drinks they love if they can. Therefore, the guidance is the same for anyone receiving this type of care, and clinical professionals should be doing all they can to help with this.
Where has the decision been made?
The policy applies across the whole of Staffordshire and Stoke-on-Trent and was signed off at the Integrated Care System Clinical Senate in September 2024. The Clinical Senate is attended by senior medics and nursing leads from health and care organisations across Staffordshire and Stoke-on-Trent.
Patients with comments, queries or concerns can contact the Patient Advice and Liaison Service (PALS) on freephone: 0808 196 8861 or email PatientServices@staffsstoke.icb.nhs.uk.
Click on the link below to download the Food First advice leaflet –
Food First recipe sheets for print at home.pdf
