Group sessions
10% of respondents delivered group education sessions. The number of sessions per month varied, with 60% delivering once a month and the remainder between twice and nine times per month.
Group size varied from one attendee up to 20 individuals. 47% respondents reported an average of 4 – 6 patients per group.
The assessment of complexity for group education sessions came out slightly different from inpatient and outpatient individual contacts, with fewer high/very high complexity numbers (29% vs 48%), more medium complexity (42% vs 34%) and more low complexity (29% vs 15%). See appendix 6.1 and 6.2 for more details.
Patient Complexity
433 responded to the question requesting their views regarding the complexity tool. Respondents were very positive when asking about their views of the complexity tool.
The majority of responders strongly agreed or agreed that the tool was relevant for their area of clinical practice, that it would be useful to help with calculations for safe staffing and they would incorporate it into day-to-day work. Only 8% agreed that they already had a complexity tool that they used. See appendix 7.1.
Results regarding percentage patient complexity: estimates by dietitians
There were 410 responses to the question: “Considering the new patients you see each week, what percentage of new patients would you estimate are high/very high, medium or low complexity, according to the definitions from the complexity tool?”
The same question was also asked of patient reviews (413 responses) and of those attending group sessions (91 responses). For individual patients, most respondents stated that they had a high proportion of individuals who had a high or very high complexity (48% for new and 47% reviews), a moderate number with medium complexity (37% for new and 39% reviews) with very few having a low complexity level (15% for new and 14% for reviews).
Group sessions
With regard to group sessions, 29% of patients were deemed to have a high or very high complexity level, 42% medium complexity and 29% low complexity.
Complexity in different workplace settings
A separate question was asked regarding the length of time spent per individual patient seen and the complexity of these patients for three different workplace settings: inpatients, outpatients and home visits.
For new patients:
Home visits
For new patients, 66% were estimated to have a high or very high complexity level, and 34% medium complexity. For review patients, 51% were estimated to have a high or very high complexity level, 43% medium complexity and 6% low complexity.
Out patients
For new patients, 50% were estimated to have a high or very high complexity, 46% medium complexity and 4% low complexity. For review patients, 49% were estimated to have a high or very high complexity level, 48% medium complexity and 3% low complexity.
Inpatients
For new patients, 72% were estimated to have high or very high complexity, 27% medium complexity and 1% low complexity. For review patients, 53% high or very high complexity level, 44% medium complexity and 3% low complexity.
Across all three workplace settings, the percentage of new patients with a high or very high complexity was 50% or more. The percentage of review patients with a high or very high complexity level was lower for home visits and inpatients but there was little change in the outpatient setting.
Discussion
The results from the complexity tool[1] can only be used as a preliminary guide as the tool is currently undergoing a validation study. It is worth noting that we recognise the NHS is under considerable financial strain and some departments might only be able to see the higher complexity patients due to staffing levels.
Once validated, if the tool is used, all dietitians must rate the patients only on what appears in the domains to produce the overall score of complexity. It is worth remembering that patient complexity is not defined by the dietitian’s personal interpretation but is based upon an assessment using the validated complexity tool.
Home based and remote working, online working and consultations
- This section of questions was to ascertain the following:
- the percentage of contracted hours worked from home
- the percentage of individual consultations that took place when they worked from home (online or phone consultations)
A separate question was asked to ascertain the following: “What proportion of patients received either an online or phone consultation rather than a face-to-face consultation?”
There were 525 responses to the questions on home-based working, of which 72% spent at least some of their time working from home. Of these, 35% spent between 1 and 10% of their contracted hours working from home, 19% spent between and 11 and 20% and 12% between 21 and 30% of their contracted hours. Interestingly, 20% of respondents spent more than half of their time working from home.
It is important to consider the following when interpreting the results:
- time spent working from home included both patient consultation time (DCC) as well as all other SPA or ANR activities
- the questionnaire did not ask if respondents contractual employment was to work from home or whether working from home was a casual agreement. From the responses, only a small minority (4%) indicated that they–undertook 91 - 100% of their work from home; these respondents are most likely to be Dietitians with a contractual agreement to work from home. See appendix 8.1 for more details.
64% of all respondents to this section had at least some individual patient consultations working from home; though for nearly half of these respondents, this was for between 1 and 10% of their consultations; a very small proportion. For those who had some patient consultations when working from home, only 20%, had at least half of all consultations when working from home, see appendix 8.2 for more details.
Proportion of online and phone consultations
This section of questions asked where individual patients were seen; the choices were inpatient, outpatient, home visit or online or phone consultation
Note that 335 respondents had some individual consultations when working from home, though for about half of these, this was 10% of all their consultations.
There were a further 190 responses to the question regarding the location which indicated that most of these consultations were not held at home.
Most of these online or phone consultations were likely to have taken place in an NHS setting e.g. clinic room or dietetic office.
Overall, 20% of new and 22% of review patient consultations were held either online or by phone, though most of these did not take place from home but in other workplace settings.
Only 5% of new patients and 4% of review patients received a home visit. See appendix 8.3 and 8.4 for more details.
Perceptions of Workload Safety
Dietitians’ perceptions of their working environments produced interesting data. The following points highlight some of the principal findings:
- 55% felt their current workload to be unsafe
- 48% felt there were insufficient staff members in their teams
- 48% felt the skill mix in their teams was not correct
- 42% stated they felt unable to provide the quality of care they felt that they should deliver
- 21% did not have sufficient time to provide the level of service that they would like to deliver77% felt that their workload was excessive with only 23% who felt that it was not excessive
It was interesting to note that a greater percentage of staff felt that their workload was excessive than those who felt it was unsafe. However, if you include those who were “undecided” then only 25% of respondents felt that their workload was safe, a similar percentage to those who said that they did not have an excessive workload. Though these questions are very similar; the term “excessive workload” is used with greater frequency to describe the workload of NHS staff compared with the term “unsafe workload”, see appendix 9.1 and 9.2 for more details.
[1] Please note: this complexity tool should not be used in its current form until approved by the BDA and uploaded to the BDA website as both the content and complexity total score limits could change following the validation study.