Published: 03/11/2005 Volume 115 No. 5980 Page 30

Norman Evans is former chief pharmacist at Wandsworth primary care trust; he is now the PCT's consultant in pharmaceutical public health.norman. evans@swlondon. nhs. uk

Malnutrition is a major problem in the UK and its treatment is a significant cost for primary care trusts. Appropriate nutritional and dietetic support improves patients' nutritional status and contributes to improvements in morbidity and mortality.

The NHS could save as much as£266m a year by better recognition and treatment of malnutrition.

Malnourished patients are more likely to have decreased mobility and may suffer from depression, apathy, fatigue, anorexia and anxiety.

They are predisposed to falls, infections, poor wound healing and slower recovery times. They are also more likely to consult their GP, need medication and be admitted to hospital.

Nutritional products are the seventh highest spend item on the prescribing analysis and cost data for Wandsworth PCT. A pilot study indicated that savings of more than£200,000 could be made through ensuring appropriate prescription of sip feeds. As a result of the study, the PCT last year employed a senior primary care dietician to visit practices, advise GPs, district nurses and practice nurses on prescribing and review clinical practice.

The dietician trains healthcare professionals to use the malnutrition universal screening tool (MUST) to identify those at risk of malnutrition and determine whether patients need nutritional supplementation.

In future, it will be recommended that only those trained to use the screening tool will be allowed to recommend sip feeds to ensure appropriate prescribing.

Some healthcare professionals feel there are patients who do not meet the MUST criteria who should receive supplements. However, training reduces inappropriate prescribing and ensures that people who could benefit from supplements are not missed.