REMEDY : BNSSG referral pathways & Joint Formulary

Home > Formulary : Adult > Chapters > 9. Nutrition and Blood >

BNSSG Adult Joint Formulary

9.5 Nutrition

Last edited: 02-05-2024

9.5.1 Nutrition (intravenous)

First line drugs Second line drugs Specialist drugs Secondary care drugs

Plasma-Lyte® 148 (TLS Red)

  • Intravenous Fluid replacement

Millimoles per litre

  Na+ K+ Acet- Cl- Mg2+
Plasma-Lyte® 148 140 5 27 98 1.5


All intravenous nutrition (TLS Red)

NBT: Please contact the Dietetic Department regarding parenteral nutrition

UHB: Please contact the Nutrition Team regarding parenteral nutrition. Nutrition nurses: ext 23088 and bleep 2659

NHSE SCC 2344 Managing national compounding capacity for Home Parenteral Nutrition for adults, children and infants of all ages


9.5.2 Nutrition (oral)

Initiating Oral Nutritional Supplements (ONS) in Primary Care: 

Please see the Remedy Malnutrition & Oral Nutritional Supplements page for information about Food First advice and when to consider prescribing ONS.

For patients with disease-related malnutrition, please refer to the Pathway for prescribing Oral Nutritional Supplements (ONS) in BNSSG for disease-related malnutrition (DRM) for further information prior to commencing ONS. 

Please note, a dietitian may recommend alternative oral nutritional supplement products not specifically listed on the formulary and this will be documented in the patient letter where applicable. A dietetic management plan recommendation overrides any MUST screening because a full nutritional assessment will have been completed. A dietitian review is more detailed than the use of a screening tool and uses clinical judgement of the individual's circumstances. 

Patients with complex medical conditions (e.g. advanced renal disease, malabsorption, diabetes mellitus and dysphagia) should be referred to a Dietitian before ONS are prescribed.


GF= Gluten free

LF= Lactose free


First Choice ONS in Community Settings:

Sip feeds appear in the tables below according to category and maximum calories content for cost. Please ensure a lower acquisition cost ONS is prescribed.

Note that 1kcal/mL sip feeds are not recommended (Ensure®, Fortimel® and Fresubin® Original)

Standard powdered shake. Requires the patient or carer to make up using 200mL whole milk.

Supplement 'Free from' status Size (g) Kcal per sachet Protein (g) Available flavours
Aymes® Shake GF



19 Banana, Chocolate, Neutral, Strawberry, Vanilla, 
Foodlink Complete® GF



19 Banana, Chocolate, Natural, Strawberry, Vanilla
Aymes® Actasolve Savoury (make with 200mL warm water) GF



9.2 Chicken, Vegetable, Potato and Leek


Standard Milkshake style. Ready to drink. 



'Free from' status Size (mL) Kcal per bottle Protein (g) Available flavours
Altraplen® Energy GF 200 300 12 Banana, Chocolate, Strawberry
Aymes® Complete GF, LF 200 300 12 Chocolate, strawberry, vanilla, banana, 
Fortisip® GF, LF 200 300 12 Neutral, vanilla, chocolate, toffee, banana, orange, strawberry, tropical fruits


Low volume (Compact) powdered shake-  requires the patient or carer to make up using 100mL whole milk

Supplement 'Free from' status Size (g) Kcal per bottle Protein (g) Available flavours
Foodlink Complete® Compact GF 57 318 15 Strawberry, Chocolate, Banana, Natural, Vanilla
Aymes® Shake Compact GF 57 321 15-15.4 Banana, Chocolate, Neutral, Strawberry, Vanilla, Ginger



Low Volume (Compact) Milkshake style. Ready to drink dose delivered in 1 bottle per day. Patient or carer needs to be able to split one 250mL bottle into two 125mL doses and store in fridge after opening.

Supplement 'Free from' status Kcal per bottle Protein (g) Available flavours
Aymes ActaGain® 600 GF 600 24 Strawberry, Vanilla, Banana
Altraplen® Compact Daily GF 600 24 Banana, Chocolate, Hazelnut, Strawberry, Vanilla


Low Volume (Compact) Milkshake Style. Ready to drink 

Supplement 'Free from' status Size (mL) Kcal per bottle Protein (g) Available flavours
Altraplen® Compact GF, LF 125 300 12 Strawberry, Vanilla
Ensure® Compact GF 125 300 12.8 Banana, Coffee, Mocha, Strawberry, Vanilla
Fortisip® Compact GF 125 300 12 Apricot, Banana, Chocolate, Forest Fruits, Mocha, Strawberry, Vanilla


Juice style. Use in caution in patients with Diabetes Mellitus. 

Supplement 'Free from' status Size (mL) Kcal per bottle Protein (g) Available flavours
Aymes Actasolve Smoothie (powder based to make up with 150mL water) GF, LF 66G 297 10.7 Strawberry and Cranberry, Mango, Peach, Pineapple
Aymes ®ActaGain Juce GF, LF 200 300 11 Apple, Orange, Mango and Passionfruit, Cranberry and Strawberry
Altrajuce® (ready to drink) GF, LF 200 300 7.8 Apple, Blackcurrant, Orange, Strawberry


Supplement 'Free from' status Size (mL) Kcal per bottle Protein (g) Available flavours
Aymes ® ActaSolve Protein Compact (make up with 100mL of whole milk) GF 57 312-315 20.2-20.5 Vanilla, strawberry, banana, chocolate, neutral
Altraplen® Protein GF 200 300 20 Strawberry, Vanilla



Supplement 'Free from' status Size (mL) Kcal per bottle Protein (g) Available flavours
Foodlink® Complete Fibre (4.5g) (make up with 100mL of whole milk) GF 63 420 19.6 Vanilla, strawberry, banana, chocolate, neutral
Aymes® Shake Fibre (5g) GF 57 374 19 Vanilla, strawberry, banana, chocolate, neutral
Fortisip® Compact Fibre (4.5g) GF 125 300 11.8 Mocha, Strawberry, Vanilla



Pre-thickened ONS

Please note, International Dysphagia Diet Standardisation Initiative (IDDSI) levels are only a guide. The decision regarding the suitability of ONS for patients with dysphagia is a clinical decision and should be based on the prescribing clinician's judgement.

Supplement (g of fibre)

'Free from' status

Size (g)

Kcal per bottle

Protein (g)

Available flavours


Fresubin® Thickened IDDSI Level 2 (1.6g)





Vanilla, Wild strawberry


Thickened IDDSI Level 3 (1.6g)





Vanilla, Wild strawberry


Nutilis® Complete Drink Level 3 (4g)





Vanilla, Chocolate, Mango & Passion fruit, Lemon tea, Strawberry


Nutilis® Complete Creme Level 3 (4g)





Vanilla, strawberry, chocolate


Nutilis® Fruit Level 4 (3.9g)





Apple, strawberry


Aymes® ActaSolve Delight (make with 75mL whole milk)





Butterscotch, Lemon, Mixed Berries


Nutricrem® (ready to eat)





Chocolate, orange, strawberry, Vanilla, mint chocolate



Patients discharged from Secondary care on Oral Nutritional Supplements (ONS):

  • Refer to BNSSG Pathway for prescribing Oral Nutritional Supplements (ONS) for disease-related malnutrition (DRM) available on the 'Blood and Nutrition Guidelines' page


  • Please refer to the Dietetic Formulary (available to view on the intranet)


  • Please contact the dietetic department


Useful Links

Food First Ideas

Sirona Leaflet Library 


Pathway for prescribing Oral Nutritional Supplements (ONS) in BNSSG for disease-related malnutrition (DRM)

Online ‘MUST’ Calculator

‘MUST’ explanatory booklet

Malnutrition – NHS Choices


Malnutrition Task Force – Preventing Malnutrition in Later Life


9.5.3 Metabolic Supplements

Primary care are responsible for continuation of specialist dietary products for inherited metabolic disorders. Nutritional supplements not included on the formulary may be appropriate for less common metabolic conditions such as Tyrosinaemia, Homocysteinuria, Maple Syrup Urine Disorder requiring a low protein diet, specialist low protein foods and protein substitutes with specific amino acids omitted and should be supported by clinic letter. See link to British Inherited Metabolic Diseases Group formulary here

The Drug Tariff lists all products which are available for prescription on FP10.

Further information about prescribing for metabolic conditions is available on the PAEDIATRIC Joint Formulary page


9.5.4 Drink Thickeners for Adults with Dysphagia

Nutilis® Clear

Please note, the thickening of standard oral nutritional supplements is not recommended and patients with dysphagia requiring oral nutritional supplements should only have texture level specific supplements or pre-thickened supplements prescribed on the advice of a dietitian or SALT team.


9.5.5 Phenylketonuria

Patients with phenylketonuria (PKU) are managed with a low protein diet, including special low protein versions of common foods such as flour, bread and pasta which are not freely available other than on prescription.

ACBS indications for prescribing low protein foods include inherited metabolic disorders, renal or liver failure requiring a low protein diet. Thus prescribing low protein foods for individuals with PKU is in line with ACBS criteria. Once initiated by the specialist centre, it is the responsibility of the GP to continue prescribing these low protein foods.

Please see guidance on prescribing in PKU below:

Prescquipp PKU prescribing bulletin

PKU society guidance on quantities of prescribed low protein foods


Sapropterin dihydrochloride (TLS Red)


9.5.6 Coeliac Disease

Coeliac disease

Intolerance to gluten in coeliac disease is managed by completely eliminating gluten from the diet.

Following consultations by North Somerset and South Gloucestershire CCGs (Summer 2017) and Bristol CCG (early 2018) the newly formed Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group (BNSSG CCG) no longer prescribes gluten free foods to patients aged 18 and over. Prescriptions are still available for those patients aged under 18 from a limited choice of products. 

If you have further questions or feel you need further support in managing your condition, please contact the surgery to make an appointment.

Bristol, North Somerset and South Gloucestershire (BNSSG) CCG have developed guidance for prescribing within the area:

BNSSG Gluten free prescribing guidelines


Contact Us

Got a question or comment about the Joint Formulary? 

Please use the email address below to contact us and we will endeavour to respond within 2 working days.