ONS Service Level Agreement

Practice Details
Practice Name*
Clinical Lead for project and approval of pharmacist interventions*

Full NameNHS Email
Practice Manager for project*

Full NameNHS Email
Admin/IT lead for system access*

Full NameNHS Email
GP Clinical System*

SystmOneEMIS
Practice wishes to arrange a virtual meeting to discuss project*

YesNo
Clinical Review
Practice approves the service to be conducted remotely with the required data security assurance*

YesNo
Pharmacist GP system access provided with rights to conduct drug searches, update medication records and access clinical letters*

YesNo
Please add any further comments in relation to the scope of service or Pharmacist activity in relation to optimising ONS therapy at your Practice
Pharmacist Actions & Authorisation

GP approval for Pharmacist to implement approved interventions and update patient record*

	Authorisation (Y/N)
Change Compact (RTD) formula to cost-effective RTD of formulary choice - ALTRAPLEN ENERGY
Change Energy (RTD) formula to cost-effective RTD of formulary choice - ALTRAPLEN ENERGY
Change Fibre (RTD) formula to cost-effective RTD of formulary choice - ALTRAPLEN ENERGY
Change Low Energy (RTD) formula to cost-effective RTD of formulary choice - ALTRAPLEN ENERGY
Change Modules (RTD) to more cost-effective product - ALTRASHOT
Change Desserts (RTD) to more cost-effective product - NUTRICREM
Change Protein (RTD) formula to cost-effective RTD of formulary choice - ALTRAPLEN ENERGY
Change Juce (RTD) formula to cost-effective RTD of formulary choice - ALTRAJUCE
Stop ONS if appropriate - NO CLINICAL INDICATION

I agree to the Clinical Pharmacist implementing therapy changes in accordance with the Nutritional Support review protocol and criteria listed above.
GP Name*

Full NameDate (DD/MM/YY)
Signature*

Clear
*Remote working will only be conducted after sharing a Data Processing Agreement

This service has been financially supported by Nualtra Ltd.
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Practice Details