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Re-categorisation of Nutritional Borderline Substance (NBS) products – development and maintenance process

The NHS Business Services Authority (NHSBSA) has worked closely with the Department of Health and Social Care (DHSC) to improve the categorisation of NBS products. It is part of a system-wide move towards interoperability.

The work has been supported by:

  • NHS London Procurement Partnership
  • NHSE Commercial Medicines Unit
  • PrescQIPP
  • the Advisory Committee on Borderline Substances ACBS
  • the British Dietetic Association Optimising Nutrition Prescribing Specialist Group.

This project is supported by other national projects that are being carried out to make sure there is consistency across the NHS, such as work on SNOMED codes.

Aims, objectives and scope

The key aims include but are not limited to:

  • collaborating to improve categorisation and understanding of NBS
  • improving the quality of information on similar and diverse products
  • improving appropriate prescribing of NBS 
  • improving data analysis of NBS (including metrics and dashboards) to improve population health
  • increasing efficiency by reducing duplication of effort in analysis of NBS
  • improving use of best value NBS

The objectives centre around simplifying and standardising categorisation of NBS products. This is to help people better understand who NBS products are prescribed for (both ACBS listed and non ACBS listed). In some patient groups this will also enable better understanding of needs, from individual to population level. Adoption of the categories across the NHS also has the potential to improve safety of prescribing in the event of product recalls and shortages.

The NHS Long Term Plan details enabling productive working as a priority. This work aims to deliver this by making sure all healthcare professionals can identify appropriate or equivalent nutritional products.

Getting the most out of taxpayers’ investment in the NHS is also identified. This re-categorisation will enable a reduction in duplication of medicines optimisation analysis, whilst improving validity of data and helping to promote cost effective product use.

The re-categorisation is intended to enable any clinician with ePACT2 access to compare similar products based on practical characteristics which mean that they are broadly the same nutritionally. This enables appropriate, alternative product choices to be identified if required (for example, due to unavailability or intolerance) and also supports formulary management and easy price comparison of nutritionally similar products.

Out of scope

  • ACBS listed products that are not NBS.
  • Review of ACBS indications.
  • Evidence base for ACBS listing of NBS.

Development process

New categories were developed and all products re-categorised. The coding of every NBS product has been simplified and standardised to reflect how products are commonly used in Primary Care. The changes affect all NBS listed by the NHSBSA, regardless of whether listed within the Drug Tariff or not.  No NBS products have been removed from those listed by the NHSBSA and the Drug Tariff.

All NBS products have been categorised by:

  • section description -- whether product is intended for enteral (tube) feeding or for oral administration
  • paragraph - broad product type (for example Standard ONS; Thickener; Condition specific infant formula; Paediatric protein source for inherited metabolic disorder; Low protein food)
  • sub paragraph - main conditions the product is intended to manage (for example, Unable to meet nutritional needs using food alone; Dysphagia; Cow’s milk protein allergy; PKU; Inherited metabolic disorder (protein))
  • chemical substance - physical presentation of product (for example, Ready to serve; Powder; Specialist food replacer)
  • product - specific product type (for example, 1.5kcal/ml milkshake; Gum based thickener; Extensively hydrolysed formula; 10g protein equivalent; Meat/fish replacer)
  • presentation - product name

Maintenance process

When a new NBS is added to the Dictionary of Medicines and Devices (dm+d) it will be categorised following this process.