Limitations
At the time of preparing this document, the authors were unable to obtain exact figures for the number of RDs working within the NHS. The HCPC register has 11,006 registrants (September 2023) and the BDA membership for practising RDs is 8524 with an additional 55 working abroad. Therefore, 77% of HCPC registered RDs belong to the BDA. It is likely that registered dietitians working in the private healthcare sector, freelance, academia, industry, media and any other areas are almost certainly BDA members. By deduction, the gap between the HCPC figures and BDA ones (2482 people) is likely to be mostly staff employed within the NHS.
Job planning
A requirement for NHS positions; the survey indicated that 37% respondents had a current Job Plan, 30% had an out-of-date Plan and 30% had no Job Plan at all. Workload activity definitions have been updated to be in line with the NHS Job Planning Guidance (2019) 1.
Safe Caseloads
The data was analysed to produce guidance for safe caseloads, and safe number of individual patient contacts/month/FTE) for acute and community settings. The figures are provided on page X. The mean safe number of contacts decreased as banding increased due mainly to the increase in SPA activities among the higher bands.
There was a wide variety in the average length of time spent per individual patient, but the most frequent choices were 46-60 minutes for a new patient and 31-45 minutes for a review. The length of time spent per patient is considerably longer than the estimates from the 2015 survey and helps to explain the reduction in the estimated safe number of patient contacts.
Dietetic assessment and intervention
The mean safe number of contacts is lower than the 2015 figures. This is likely to be due to the increased complexity of patients seen, the increased time required to complete both dietetic assessment, intervention and associated documentation as well as a slight change in the definition of both direct clinical care and an individual patient attributable contact.
Practice supervision
Regarding practice supervision, 38% of respondents did not receive supervision on a regular basis.
Workload safety
There were a number of questions on workload safety with some concerning results. A high proportion reported that their workload was excessive (77%), with a further high proportion of respondents (61%) reporting work related stress, both episodic and chronic stress. 78% of respondents worked overtime, the majority delivering between 10% and 20% above their contracted hours. The large group of staff with all of these factors: an excessive workload, working overtime and feeling unwell due to work related stress was concerning as this was 44% of all the respondents to this section.
Workforce
Workforce concerns covered a range of issues. Of the 20 options provided, the most frequently cited were lack of CPD opportunity in work time on an individual theme, and for service-related issues, patients not seen in a timely manner, too much clinical work to manage properly, lack of opportunity for service development, reduced opportunity for MDT working and the national concern of high vacancy rates and lack of backfill. Some respondents cited their concerns over being asked to work outside their scope of practice.
Patient complexity
Initial findings on patient complexity are provided within this document, with a full guidance document expected in 2024 following validation studies within the UK
Home-based working
Home-based working is a relatively new change to dietetic practice, and supports the NHS Long Term Plan (2019) 10. 72% of respondents spent some of their time working from home. For a third of these, this was for less than 10% of their time.
64% of respondents had at least some individual patient consultations when working from home; though this was often less than 10% of their consultations. Only 20% had more than half of all consultations working from home. Vacancy rates were looked into as this has a detrimental impact on safe staffing, overtime working and stress levels within departments. The survey showed that vacancies on average were 3 per year within a department, and varied from 10% to 30% of the staffing establishment.
Advancing roles in dietetics
Over the last 10 years or so there has been an increase in advanced roles of practice in varied workplace settings, both in clinical and operational positions available for dietitians. advanced clinical practitioners, first contact practitioners and consultant dietitian positions have increased career opportunities for experienced dietitians, and this growth should continue in the future. This survey showed that numbers were still low, with only 12 FCPs and 4 Consultant dietitians who responded to the survey, though 37 ACPs responded. Not all FCPs and ACPs had completed the appropriate training.
Safe staffing levels
Guidance for dietitians is given within the document to help calculate safe staffing levels within a team/department with indicators highlighting potential safety issues.