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Dietitians

Why Do We Need Dietitians Working in Primary Care?

According to studies from the British Dietary Association, Dietitians can often support the increase of capacity and resource in general practice. This is achieved through offering dietary management advice for short and long-term conditions, and at the front of pathways for patients presenting with gastroenterological conditions and food allergies. Studies show that:

  • 1 in 12 GP appointments are for patients presenting with Gastrointestinal conditions, with 46% of these being for Irritable bowel syndrome (IBS)
  • patients with undiagnosed IBS see GPs 10 times more frequently than matched patients
  • 30% of elderly patients are reported as malnourished, leading to frailty and associated complications, e.g. falls
  • dietitians can often support dietary needs in the management of patients with long term conditions, including; obesity, diabetes, heart disease, mental health conditions, hyperlipidaemia, stroke, and hypertension
  • dietary, lifestyle, and medication modification can often result in less medicine management for chronic conditions. Studies have found that food- related ill health is responsible for approximately 10% morbidity and mortality in the UK, and costs the NHS £6 billion annually

Benefits of Dietitians Working in Primary Care

Benefits for patients: 

  • Quick and easy access to expert nutritional advice
  • Prevention of symptom progression and exacerbation
  • Improved patient experience and ability to self-manage their condition

Benefits for GPs:

  • Release of GP time through reallocating appointments for patients with Nutritional needs, including; functional bowel disorders and coeliac disease, weight management, type 2 diabetes & frailty support
  • Reduced costs of nutritional borderline substances including oral nutrition supplements through specialist review of prescriptions. Reduce costs associated with appropriate prescribing of prescription only medicines (including deprescribing) for dietitians with supplementary prescribing rights.
  • Support to meet practice targets
  • Support to meet the ambitions to influence local population health improvements through early intervention and preventative work such as diabetes prevention programmes

Benefits for dietitians: 

  • Professionally stimulating and rewarding role and use of their professional knowledge and skills, including through stronger links with the multi-disciplinary team.
  • Opportunities to develop and make use of their scope of practice and skills, including supplementary prescribing, managing undifferentiated diagnosis and developing physical assessment skills
  • Opportunities to develop experience, learning and skills in service development, quality improvement and implementation science

 

Scope of Practice

  • Dietitians working in Primary Care see patients with (suspected or diagnosed) Nutritional or dietary conditions as the first point of contact, instead of a GP, and can be accessed directly by contacting the practice’s reception.
  • A typical appointment with a Dietitian involves assessment, diagnosis and first-line treatment. Dietitians working in Primary Care can also make referrals into secondary care services using the same pathways as GPs. Dietitians with additional training are also able to supplementary prescribe
  • As a person-centred service, dietitians employ a range of communication strategies to support a self-management approach. Dietitians also use digitally innovative approaches and support social prescribing.

Dietitians have the skills to deliver education programmes, for example, diabetes prevention programmes. They are also able to deliver training to multidisciplinary team members to build on nutrition and dietetic knowledge within the team.

Education Pathways

AHPs working as FCPs will need to be able to evidence that they are working at masters level (level 7) of the  clinical practice pillar in the Multi-professional Framework for Advanced Clinical Practice.

With further training, it is possible for AHPs to achieve Advanced Practice status – demonstrating level 7 practice across all four pillars of practice. This may be achieved through post-graduate clinical Masters training through formal academic routes, or through equivalent- level portfolio training submitted and signed off by the Health Education England Centre for Advancing Practice. Through this route, multi-disciplinary professions are able to achieve Advanced Practitioner status. This level of practice is commonly recognised through Agenda for Change banding of 8a or above in secondary care settings.

 

Please click here to find out more about Roadmaps to Practice from HEE.

Useful Resources

Please follow this link to access a recently published video discussing the new roles within primary Care, accessible here. The video is aimed at dietitians working, or considering working in primary care as well as dietetic managers being contacted by PCN and covers:

  • what we mean by first contact practitioners (FCPs)
  • what the FCP to advance practice roadmap is, and how the implementation of these roles will be supported by the roadmap
  • examples of FCP within dietetics
  • what the BDA is doing to support these roles.