Pre-heat oven to 350°F (180°C). In a saucepan on medium high heat melt the butter, then add the flour and cook while stirring for 2-3 minutes. Add just enough milk to cover the flour mixture, and continue stirring until mixture comes to a soft boil and thickens slightly, then repeat to add the remaining milk in two steps.
Add mustard, Worchester and hot sauce to the milk mixture, then add the cheese. Cook while stirring until all the cheese is melted. Season with the salt and pepper.
Cook the macaroni according to package instructions, then drain but do not rinse. Transfer the macaroni back to the pot, then add the cheese sauce and stir until evenly coated. Transfer mixture to a 9 x 13 casserole dish.
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