Dietitians in General Practice – A Clinical Director view
Dr Joanne Price, Clinical Director Bay PCN (Lancashire)
I am always surprised when I speak to fellow Clinical Directors (CDs) and hear they haven’t considered the role of a Dietitian for their Primary Care Network (PCN) team. While I understand the barriers faced with integrating a new role into Primary Care, the breadth of knowledge and skills that a Dietitian can bring more than make up for the challenges in doing so.
My PCN is probably different than most. We are one large practice with 54,865 patients, based over 5 sites and are the sole Practice in Bay PCN. The PCN covers a mixed area, with large pockets of deprivation (40% of our patients fall into the Index of Multiple Deprivation (IMD) deciles 1 and 2), a significant number of care home beds (593) and above national average prevalence of Diabetes, Obesity, Hypertension and Depression.
We currently have two First Contact Practitioner (FCP) Adult Dietitians (0.8 and 0.88 WTE) and one FCP Paediatric Dietitian (0.2 WTE) as part of our large, multi-disciplinary team. All three Dietitians came to our PCN from secondary care with varied clinical backgrounds. They have a 70:30 split clinical to development as endorsed in the PCN Direct Enhanced Service (DES) contract. This has allowed protected time for the role to be introduced, embedded and flexed according to the needs of our service.
Suitable cohorts of patients for the FCP Dietitian team include gastrointestinal symptoms, those requiring weight loss support (including onward referral to tertiary services), oral nutritional supplement (ONS) monitoring, long term conditions care (Diabetes, lipid management and cardiovascular disease optimisation), infant feeding issues and more. Clinics are loaded up to 6 weeks in advance and quickly become fully booked, reflecting the demand for this service from both patients and other clinicians.
The benefits seen can be broadly grouped into three categories:
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Reducing GP workload – from project-based work to direct patient care, the scope of an FCP Dietitian is broad. Our PCN has developed pathways to allow Dietitians to review all requests for appointments without input from a GP. This reduces demand on GPs and ensures those who need a full Dietetic assessment are prioritised. Signposting and onward referral to local and national services can be done at the point of contact, avoiding long waiting times and unnecessary appointments for both the patient and clinician. Our Dietitians can refer directly into secondary care Dietetic services, further reducing the need for GP involvement.
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Increasing Practice income – Dietitians can play a key role in boosting QoF income for Diabetes, Hypertension and Cholesterol indicators. We have also seen an increase in our income from Weight Management Service referrals and there have been significant reductions to our prescribing budget, specifically for ONS, Orlistat and infant formulas.
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Improving Patient Experience – providing in depth nutritional support to our patients is difficult, not only due to our lack of training in this area, but also given the brevity of a GP appointment. Making dietary changes requires intensive support and ongoing monitoring, something which GPs are limited in offering. Having a Dietitian within your team gives your patients a skilled, knowledgeable clinician who can commit more time to supporting these transformative lifestyle changes. For patients who perhaps don’t need such in depth support, the benefits of having PCN Dietitians can be felt in the education which they deliver to the wider clinical team, allowing us all to feel that bit more comfortable in making a nutritional assessment and providing appropriate support and treatment.
With each new ARRS role comes change which we all know is hard. I don’t claim that our journey so far has been plain sailing, but I do firmly believe that the effort put in has paid off for both patients and staff alike. If you would like to chat about my experiences or speak with a member of the Bay PCN Dietetic team, please do get in touch via [email protected].
Dr Joanne Price, Clinical Director Bay PCN