Demographics
A total of 783 BDA members responded to the survey, although not all answered every question. Members from all regions across the four home nations of the UK participated and a wide range of areas of work were represented. The NHS is the largest employer of Dietitians in the UK.
97% of respondents worked directly for the NHS, including 15 dietetic support workers, and the remaining 3% worked for a private company or freelance delivering NHS services.
75% of the HCPC registered Dietitians in 2023 work for NHS England. Historically around 90% of HCPC registered Dietitians have been BDA members.
73% of respondents worked wholly or partially in acute hospitals and 38% worked wholly or partially in community settings.15% worked in mental health services, 13% in primary care, 9% in public health and 10% were freelance all or part of the time. 58% worked in more than one place setting e.g. acute and community.
72% worked with adults, 20% with paediatrics and 8% covered both age ranges.
32 respondents worked as Advanced Clinical Practitioners and 3 as consultants (4.5% in total of the respondents).
Most respondents were Band 6 and above (median – Band 7). 5% were Band 5 and 2% were Dietetic Support Workers. (See appendix 2.1)
55% had worked for more than 10 years; only 8% were 0 – 2 years. (See appendix 2.2)
94% of respondents were in permanent posts, with 57% working full time. 13% had two posts.
Dietitians from all the BDA specialist groups were represented with the largest single group being Parenteral and Enteral Nutrition, followed by Paediatrics, Gastroenterology, Diabetes, Oncology, Critical Care, Older people, Mental health and then the remaining groups.
Most dietitians were Band 6 or above, with 5% working as a Band 5 and only 1% being Dietetic Support Workers (Band 3 or 4, n=15).
The majority of dietitians had been practising for more than 3 years, with only 8% of respondents (n=65) having worked for 0-2 years.
57% of dietitians were employed full time.
Most respondents (94%) were in a permanent post.
100 respondents (13%) also had a secondary post e.g. teaching and freelance
Workplace Activities and Job Plans
The NHS document published in July 2019 ‘Job Planning the clinical workforce – Allied Health Professionals; A best practice guide’ 1 defines this as a prospective, professional agreement describing each employee’s duties, responsibilities, accountabilities and objectives. It describes how an employee’s working time will be used according to the specific categories of direct clinical care (DCC), specified supporting professional activities (SPA) and other activities such as additional NHS responsibilities (ANR) and externally funded duties (EFD).
All NHS employees should have a job plan which needs to be reviewed on a regular basis, e.g., annually, to reflect changes in working practice.
871 respondents replied to the question on job planning. 37% reported having an up-to-date job plan, 30% had an out dated one, and 33% did not have a job plan at all.
The breakdown of the data shows that the greatest amount of time spent by all bands up to and including 8a was DCC. As banding levels increase clinical service management, clinical governance and trust wide roles take up more of the individual’s time as DCC reduces. Of interest, those with current Job plans spent an average of 70% of their time in DCC, those with out-of-date job plans spent 75% and those with no job plan spent 69% DCC time.
All bands up to and including 8b were involved with student training, CPD time ranged from around 4 – 6% of work time, and admin time varied from 4 – 12%,(band 3 and 4 being the highest). The majority of supplementary prescribers were in band 8a roles.
See appendix and 3.1 and 3.2 for charts
Direct Clinical Care
Worktime spent on DCC increased for unqualified staff as their pay band increased, and peaked at band 5 level at the qualified dietetic entry point. Thereafter, DCC decreased as the proportion of supporting professional activities (SPA) increased.
The BDA Workload Management Toolkit (2017) recommended the following amounts of time for bandings as guidance:
Band 5 = 85%, Band 6 = 75%, Band 7 = 65%, Band 8a= 40%, Band 8b suggested 25% and Bands 8c and above up to 10%.
Note; the BDA’s figures are between 5 and 15% lower than the example provided in the NHS Job Planning the clinical workforce: allied health professionals best practice guide (2019) (1) which covers guidance for all the AHP professions as a group. Generally, the recommended percentage DCC is lower for dietitians in view of the wide range of other activities within their job plans.
From the data in this survey, the actual percentage DCC currently being delivered by bands 5 to 8b is similar to the guidance of 2017, though the mean percentage DCC for band 6,7 and 8a was higher than this recommendation.
The survey results indicate DCC as a percentage of workload being, on average, 72% for bands 3 and 4, 84% for band 5, 79% for band 6, 70% for band 7, 46% for band 8a, 26% for band 8b and 9% for bands 8c to 9.
Note: For those band 8as working in more clinical roles, we would expect a higher % DCC than those who have mainly management roles and would be expected to have between 20-25% DCC. The expected range for DCC for the more clinical roles would be expected to be between 30-50%. Note: those 8as who felt their workloads were excessive had a mean percentage DCC of 56%, see appendix 3.3 for more.
When looking at the mean percentage DCC in the different workplace settings (and the proportion that is individual patient attributable and that which is not it is interesting to note that the percentage of non-IPA DCC is broadly similar across all settings (between 10 and 15% of all workplace activities). However, the mean total percentage DCC was highest in both the acute setting and freelance (over 80%).
When looking at the mean percentage DCC in the different workplace settings, it is interesting to note that the percentage of non-IPA DCC is broadly similar across all settings (between 10 and 15% of all workplace activities). However, the mean total percentage DCC was highest in both the acute setting and freelance (over 80%).
Note: due to changes in the definitions for patient activities compared with the 2015 survey, only IPA DCC is counted for patient contacts. However, non-IPA DCC time is extremely valuable as this is required for MDT meetings, ward or board rounds as well as other non- clinical activities. See appendix 3.4 for more.
Individual patient contacts
Respondents answered questions regarding the mean number of new and review individual patient attributable contacts that they had in a typical working week. This was further analysed in relation to their responses to questions regarding whether their workloads were deemed to be safe or excessive and if they had suffered from work related stress causing ill health in the last 12 months.
The total number of respondents “to these questions was 308. Most respondents worked in the acute sector with a significant number working in the community. The greatest proportion of respondents were specialist dietitians, working at band 6 or band 7 level, see appendix 4.1 and 4.2 for more details.
Time spent with individual patients
When asked how much time would be required to see a new patient including all aspects of a dietetic consultation, respondents could choose from the following blocks of time 0-15 minutes, 16-30 minutes, 31-45 minutes, 46-60 minutes, 61-75 minutes, 76-90 minutes and free text for any other time periods
The most frequent choice for time spent for new contacts was 76 – 90 mins for Home Visits, and 46 – 60 minutes for both Inpatients and Outpatients. For review contacts the figures were 46-60 mins for Home Visits and 31 – 45 minutes both for Outpatients and for Inpatients, see appendix 5.1 and 5.2 for more details
Mean number of contacts per month per FTE and time spent per contact.
The number of responses to this question was 396.
67% of new consultations fell within the 3 brackets from 16 – 60 mins and 65% of the reviews fell within the 3 brackets from 16 – 60 mins.
Unsurprisingly, more patients were seen when the time spent per contact was lower. For example, when patients only required between 16 and 45 minutes, the total number of contacts was approximately 120 per month. When the time spent was between 61 and 90 minutes, the number of patients seen was approximately 90-95 per month, see appendix 5.3 for more details.