Food First Initiative — Bedfordshire

The malnutrition universal screening tool "MUST" can give an indication of malnutrition risk. This can be downloaded on SystmOne or accessed via The first line approach to managing malnutrition is "Food First". This means offering advice on food fortification to increase calories and protein in everyday foods. Additional snacks will be needed to meet requirements for those with a small appetite. Oral nutritional supplements (ONS) should not be used as first line treatment.

Care homes should be able to provide adequately fortified foods and snacks and prepare homemade milkshakes and smoothies, which should negate the need to prescribe ONS in the majority of cases. In addition, for patients in care homes, food fortifying care plans can be inserted into the individual's care plan to instruct staff regarding food fortification.

If a Food First approach alone does not meet nutritional goals and ACBS criteria are met then an ONS can be prescribed. See "Considering Prescribing Oral Nutritional Supplements" Formulary. Where possible a patient should be referred to the dietitian for full nutritional assessment and individualised advice prior to commencing ONS. Where ACBS prescribing criteria are not met then patients should be encouraged to follow a Food First approach and can purchase over the counter products such as Complan® milkshakes or soups, Build-Up® milkshakes or soups, or Nurishment® milkshakes.

The Food First Programme is delivered by two teams across Bedfordshire:

  1. Bedford Hospital Trust Nutrition and Dietetic team provide support for patients in Bedford and Ivel Valley Localities
  2. SEPT Dietetic team provide support for patients in West Mid Beds, Chiltern Vale and Leighton Buzzard.

Services provided by the Food First teams include:

  • Training and support on the identification and management of malnutrition and dehydration in the community to all health and social care staff
  • Talks to patient and carer groups on managing malnutrition and dehydrationAssistance in making cost effective and appropriate prescribing choices for patients at risk of malnutrition
  • Reviews of prescribing practice of oral nutritional supplements and infant formula at individual GP surgeries with production of a clear action plan and short term dietetic input to patients as required
  • Regular meetings to support care homes with 10 or more residents

Inform the team if

  • Any social care provider appears to be failing to take a Food First approach to managing malnutrition or dehydration
  • You receive inappropriate requests to prescribe nutritional supplements from patients and other healthcare professionals
  • You or your team would like further support or training
  • You would like the Food First team to review your current prescriptions of nutritional supplements and /or infant formula to provide an action plan
  • You would like any advice when supporting patients at risk of malnutrition or dehydration

The Food First teams work as part of the wider clinical dietetic teams.  When referring a patient please complete the appropriate referral form for your local team.

Please note that as part of the extended Food First service:

  • In Leighton Buzzard and Chiltern Valecare homes (nursing and residential)with more than 10 beds can refer directly to their visiting dietitian and are encouraged to use this route
  • In West Mid Beds, Ivel Valley and Bedfordnursing homestaff can refer patients directly. GPs should make referrals for at-risk patients in residential homes.

Patients within Bedford, Ivel Valley and West Mid Beds Localities will be seen by the clinical dietetic service at Bedford Hospital NHS Trust. A copy of the referral form can be found here.

Patients within Chiltern Vale and Leighton Buzzard localities will be seen by the clinical dietetic service at SEPT Community Health Services. A copy of the referral form can be found here.

Managing oral nutritional supplement prescribing in primary care

There is a guideline for GPs to support the detection and management of malnutrition - ONS Formulary. Laminated copies are available to display in consulting rooms and an electronic version is available here.

Fabulous Fortified Feasts (PrescQIPP) Recipe book

Information for HCP and carers

18 Providing assistance at mealtimes v.2014

BHT - Referral form to Dietetic team (FOOD FIRST ONLY) 

Infant Formula Prescribing Guidelines JUNE 2015

ONS Formulary

SEPT - Referral Form to the Community Dietetic Service

MUST tools

Alternative measures - instructions and tables

MUST flow chart


Step 1 - BMI chart 100-170kg weight

Step 1 - BMI chart up to 100kg weight

Step 2b - weight loss tables using previous weight

Factsheets for patients

1 100 Calorie Boosters v.2014

2 Constipation v.2014

3 Diarrhoea v.2014

4 Eat Well to Heal Well v.2014

5 Finger Foods v.2014

6 Hydration Boosters v.2014

7 Increasing Your Calorie Intake v.2014

8 Keeping Healthy on A High Calorie Diet v.2014

9 Keeping Hydrated v.2014

10 Making Every Mouthful Count v.2014

11 Making Mealtimes Manageable v.2014

12 Mouth Problems v.2014

13 Nourishing drinks v.2014

14 ONS without pictures v.2013

15 Puree Diet v.2014

16 Savoury Shakes

17 Fortified Soft & Pureed diet v.2014

18 Super Shakes paeds

19 Supershakes v.2013

Factsheets for paediatrics

Feeding The Preterm Baby Aug 15

GOR & Regurgitation Aug 15

Guide To Prescribed Formulas Aug 15

Help your child gain weight Aug 15

Infant Soya Formula Aug 15

Lactose Free Formula Aug 15

Lactose Free Weaning Aug 15

Last updated: 24/04/2018

Update due: 24/04/2019