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The benefits of this project
Benefits for Your Patients
- Reduced reliance on prescriptions
- Empowers families to self-care
Benefits for Your Practice
- £85644/year per 100 patients whose formula stopped* *Cost savings calculated based on Aptamil Pepti 1 400g tin price Feb 2025. Assumes stopping a prescription of 6x 400g tins issued every 28 days.
- Reduced prescribing leading to decreased administration for prescriptions
Benefits for The Planet
- Reduced manufacture and waste from unnecessary prescriptions
Opportunity for improvement
- Most well infants with Cow’s Milk Protein Allergy (CMPA), with an otherwise varied diet, can be moved from prescription formula onto widely available dairy free milks at the age of 1yr. Children over 6 months old with CMPA should be considered for referrals as per local guidance, including referring to dietician to be introduced to the milk ladder and advised about switching to supermarket milk at 1yr of age.
- It is important to remember that children under 5yrs should not be given rice milk and replacement milks should be fortified with 120mg calcium: parents should be encouraged to check this when buying from the supermarket.
- This project outlines how to put these recommendations into practice (see disclaimers), ensuring that formula milks are not prescribed when they are no longer needed. This is important to reduce unnecessary prescribing, and all the waste it involves.
- You might like to create a SMART goal for this project e.g. to review the notes of all patients over 1yr prescribed formula milk and stop the prescription unless a Paediatrician or Dietician has advised it to continue. This should be completed within 1 month.
How to carry out this project
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Identify patients
Search for all patients with formula milk on repeat prescription.
We hope to provide downloadable IT searches for EMIS & System 1 soon. In the meantime, you could use our EMIS and SystmOne search guides to create your own. Open Prescribing and EPACT2 track prescribing data and may be another way to track the impact of your project.
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Training for prescribers
Educate prescribers on current CMPA guidance, when, what & how much to prescribe and when to refer. Advise them to ensure the repeat prescription end date is the child’s 1st birthday and to include the stop date in dosage directions. This training could be via an online training session and email communications.
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Communicate with local pharmacists
Communicate with your local community pharmacists so they are aware of the change and can support with consistent messaging to patients. Your practice pharmacist will likely know how best to get in touch with the community pharmacists.
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Stop the formula milk prescription for any patients who have not had their milk issued in the last 12 months.
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Review the notes of all patients over 1yr who have had their milk issued in the last 12 months
Stop the prescription unless a Paediatrician or Dietician has advised it to continue. Record how many patients with an active prescription had it stopped. Send the parents this text:
Resource: Formula milk >1yr
For children with Cow’s Milk Protein Allergy over 1yr of age, we advise swapping from prescribed formula milk to a plant-based milk bought at the supermarket. Please be aware that replacement milks should be fortified with 120mg calcium and that under 5s should not be given rice milk as it may contain too much arsenic. https://www.nhs.uk/conditions/baby/weaning-and-feeding/drinks-and-cups-for-babies-and-young-children/ We have removed the prescribed milk from your repeat list. Please contact us if you have any questions
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Continue the formula milk prescription for patients under 1yr of age
Send them this text to invite them for a discussion with a GP or Pharmacist:
Resource: Formula Milk <1yr
Your child is due a review of their milk prescription to ensure they are on the ideal milk for them. We would also like to review if the child has been assessed by a dietician and if this is needed or wanted. Please book in for a review with a GP or pharmacist.
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During the review appointment
Check that the type and amount of formula milk is appropriate for their age. Ensure the repeat prescription end date is the child’s 1st birthday and include the stop date in dosage directions. Explain about switching to plant-based milk from supermarkets once 1yr old. Consider referral to dieticians.
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Study
Review the results, summarise learning, share with practice team + decide if any changes are needed to improve the process.
Decide when to re-audit again to ensure the change has lasted e.g. 3-6 months and use the Project Monitoring form to keep track.
Many practices run automatic searches at regular intervals – speak to your practice team about including this project in those searches.
How to scale this project up or down
| Please note - Use of this project requires NetworkPLUS membership. If you would like to share this project with others, please invite them to purchase their own membership—access must not be shared with non-members. |
You could upscale this project by working with your local ICB (England), Health Board (Scotland & Wales) or SPPG Pharmacy Advisor (Northern Ireland) to ensure local formularies are in line with national recommendations on formula milk prescribing.
You could take it to your Primary Care Network or Cluster to implement across all practices in your area.
Case study
This project was done at a GP practice with 7900 patients. They identified 24 patients for the project. They found that many of these patients were on the incorrect milk for their age and were being prescribed over the recommended maximum amount each month.
The project helped improve patient care by ensuring patients continuing formula were on the right formula for them and also made financial and waste savings.
Green Cross Group Practice, Sheffield
Have you completed this QIP?
Tell us a little about your project and enter your data in order to generate a certificate showing the probable cost savings and other benefits. This project may help with CQC evidence submission (see disclaimers).
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