Nutritional Borderline Substances - The case for change

The Issue

Nutritional Borderline Substances (NBS) are an essential part of clinical care for patients with a diverse range of long term conditions and nutritional disorders and are a vital part of a dietitian’s toolkit. They include enteral feeds, oral nutritional supplements, specialist infant formulas, gluten free products and products for patients with metabolic conditions. 

The BDA wants to ensure patients have quick and appropriate access to the NBS they need, while improving the efficiency and effectiveness of the systems used to provide them. As experts in the nutrition care pathway, we believe that placing dietitians at the heart of this process is the best way to ensure that patients receive the appropriate products for the right period of time and with maximum benefit.

Currently and in most cases, NBS are prescribed in the same way as all other products within the Drug Tariff, i.e. prescribed by a healthcare professional who is registered as an independent or supplementary prescriber. In the community setting, dietitians will request a prescription from the patient’s GP as appropriate. GPs may initiate and prescribe NBS themselves in the community or be requested to prescribe NBS by other healthcare professionals e.g. nurses or health visitors.

Across the country, in an attempt to cut prescribing cost, some local health services are choosing to restrict NBS. The BDA understands that it is essential that prescribing policies secure the right balance the between the cost-efficient use of NBS and effective delivery of improved patient outcomes. This means ensuring patients who require them can access them at the right time for the right duration to drive the right outcomes, whilst minimising inappropriate use and wastage. The BDA believes that, as the experts in the nutritional management of patients, dietitians play a critical role here to ensure nutritional assessment, review and follow up. 

What the BDA is doing

The BDA has been discussing this issue with NHS England, the Department of Health and industry partners to explore how we can improve the current system and protect access for vulnerable patients. We will continue to do so and push for an improved system. We will also be monitoring when changes occur to provision of NBS at a local level and make representations as appropriate. 

There are a number of possible models that could be used to improve the current situation and place dietitians at the heart of NBS management. We believe a form of "dietitian's formulary" which provides a pre-approved list of products that all dietitians could provide to patients, would be a good way of achieving this. 

What we need members to do to help

We want you to get in touch with your personal and patient stories regarding the provision of NBS products - either good or bad. Being able to draw on these real life stories is invaluable when we are making the case for change. 

If you know of changes to the provision of NBS being made in your area, please let us know (including Gluten Free and Infant Formulas, which are picked up elsewhere in our influencing themes)

Further information 

  • Read our full Case for Change document, which describes the current situation, and explores how we might improve it.
  • Visit the ACBS web pages to understand more about how NBS are approved for prescription in the NHS.