Job planning
Make sure job plans are in place and up to date. This will help to ensure that the job role reflects what is required of the post and make adjustments where needed in response to changing service demands. It also ensures all dietetic workplace activities are timetabled, as well as Direct Clinical Care (DCC).
Referral rates
Monitor referrals and track changes in service demands. Many departments, particularly in acute settings, are reporting large increases in referral rates with staff struggling to cope, hampered by resistance from the organisation to accept the need for increased staffing.
Process implementation
Establish protocols and utilise screening tools for referrals. These processes should be reviewed on a regular basis as they may require modifications depending on demand so that skilled Dietitians are using their expertise efficiently in dealing with the more complex cases.
Range of competencies
Regularly review the skill mix of the department so that the correct level of expertise is in place to meet the demands of the service. Include dietetic support workers within the department; their contribution to the service can be highly beneficial and cost effective.
Complexity and caseloads
The complexity of patients and time required per consultation has increased over the years. This needs to be factored in during job planning to ensure sufficient time is allocated for each dietetic episode of care. In addition, the safe caseload /number of patients that can be seen by a dietitian varies according to a wide range of factors including speciality (which is outside the remit of this survey). Consideration must be given to individual requirements of the post and calculations must be realistic, allowing for planned absences.
Service delivery
Utilise technology and use video consultations, phone calls and emails where appropriate along with conventional face to face consultations. Group education sessions, where appropriate, are an effective use of clinical time.
Be aware that there can be a negative impact of moving to a service relying on remote working as the department may lose ‘visibility’ to senior management within the organisation. This could result in a struggle to make its presence felt, have clinic rooms and office accommodation removed, not be prioritised for investment etc.
Practice supervision
Ensure that staff members have regular practice supervision and annual appraisals. This contributes to the development of the team members (which aids retention), can be an opportunity to identify any issues (and put them right) and support the staff members with any health issues, including work related stress, by putting in plans to mitigate this. The HCPC states “Our Standards support the case that registrants should be participating in supervision as part of their practise where possible” and their standards of proficiency require registrants to understand the importance of participation in training, supervision and mentoring 17
Appropriate banding
Ensure that staff of all bands can feel confident to raise concerns with senior members of the department and that they are working within their scope of practice.
Staff recruitment and retention
Work on the recruitment and retention of staff within a department to help minimise vacancy rates as these are contributing to staff feeling overworked, undertaking considerable amounts of overtime and for some, work related stress results in ill health and can lead to burnout. There is shortage of AHP workers both in the UK and internationally, and the NHS is putting in place plans to increase workforce training to ease the situation.
Be aware that readvertising jobs at a higher banding, rather than offering a preceptorship route, in order to try and recruit to positions whilst not conforming to the necessary requirements for knowledge, skills and experience expected of the higher band, can put the individual registered dietitians and dietetic service in danger should there be a clinical incident as a result of this action.
Contact time
Aim to minimise the amount of overtime worked by team members as the workload should normally be achievable within the contracted hours of the post. Overtime worked should be repaid either financially or as time in lieu. Ensure breaks are taken and holiday entitlement is utilised. Consider requests to alterations to working hours/practice if this helps the post holder’s work life balance and productivity.
Triangulating methods for assessing safe workload
As the survey results have shown, excessive and unsafe workloads have contributed to episodic and chronic work-related stress and subsequent sickness among dietetic staff.
“Burnout is a widespread reality in today’s NHS and has negative consequences for the mental health of individual staff, impacting on their colleagues and the patients and service users they care for. There are many causes of burnout, but chronic excessive workload is a key driver and must be tackled as a priority. This will not happen until the service has the right number of people, with the right mix of skills across both the NHS and care system.7 Workforce burnout and resilience in the NHS and social care 2021 government report.
This report states that “It is imperative staff have the opportunity and the confidence to speak up. However, this needs to be matched with a culture in which organisations demonstrate that they are not just listening to, but also acting on, staff feedback.
Improvements to workplace culture have been made, but equally, there is more work to be done. Embedding and facilitating cultures which support compassionate leadership must be at the heart of that work.”
Below screenshot from 2017 safe staffing, safe workload document Taken From NICE (2014) 19
In 2018, NHSI stated that “Trusts must ensure the three components (see Figure X below) are used in their safe staffing processes”
Principles of safe staffing
Developing workforce safeguards Supporting providers to deliver high quality care through safe and effective staffing NHS Improvement October 2018
They also recommended the use of the NQB’s triangulated approach to staffing decisions
“From now on we will assess trusts’ compliance with the ‘triangulated approach’ to deciding staffing requirements described in NQB’s guidance. This combines evidence-based tools, professional judgement and outcomes to ensure the right staff with the right skills are in the right place at the right time (see Appendix 1). It is based on patients’ needs, acuity, dependency and risks, and trusts should monitor it from ward to board”
Developing workforce safeguards Supporting providers to deliver high quality care through safe and effective staffing NHS Improvement October 2018 (6)