Experience of working as a Primary Care Dietitian in a large Primary Care Network
Charlene Giovanelli-Nicolson, First Contact Dietitian and Non Medical Supplementary Prescriber
Worked across 22 practices. (2021-2023)
Main role: Nutrition Support Dietitian/Medicine Optimisation, Primary Care Dietitian
Contact with patients: telephonic, face to face at a few practices who requested dietitian clinics (on a rotation basis), System One Review
A comment from Charlene's colleague: ' I noticed that you have a very high (98%) use of guideline or best-value ONS (for standard ONS), and a very low use of 1.5kcal/ml RTD ONS and a high use of powder ONS – just shows how practices benefit from having a dietitian working with them'
Background of PCN:
22 GP practices, formed as one primary care network, managed by a holding company to provide primary care services.
The dietitian role was originally recruited to work with the pharmacy team, medicine optimisation team to help with nutrition support, and oral nutritional supplements queries and reviews. The dietitian was involved with the pharmacy quality scheme review to ensure the ICB formulary and costs were adhered to. Initially the job was a hybrid job. One of the conditions for the job was to become a prescribing supplementary dietitian, and therefore as part of the course, patients had to be seen face to face. A referral form was designed, focusing on the key nutrition areas as set out in the roadmap to practice for dietitians working in primary care, and patients were seen either via telephone or face to face. This period was during the COVID pandemic.
In total 7 GP practices across the 22 GP practices network, requested face to face Dietitian appointments on a rotational basis, and practices who did not have capacity to have a dietitian on premises, patients were spoken to remotely/ telephonic. Once the non- medical prescribing course was completed, the journey to become a first contact practitioner was started, and I was enrolled to the taught university training course. Additional face to face clinics was arranged at the 7 GP practices.
Care home reviews linked to 22 GP practices were conducted and a close working relationship was established with the care home team, the care home nurses and the care home pharmacy teams working at all the practices. A collaborative working with the community dietitian was established.
Unfortunately, the PCN holding company went into administration at the end of 2023, and the 22 GP practices formed smaller PCNs in the network. I accepted a position as a First Contact/ Primary Care Network Dietitian in one of the smaller PCNs in 2024.
The statistics below is a summary of the patients seen during the two-year period.
2021, 2022, 2023 Financial Year
|
Age group |
Number of clients seen |
Conditions referred |
Outcome |
|
0-12 |
62 |
26 CMPA, 13 Allergies, 20 Fussy Eating 13 Dietary Advice 4 Nutrition Support 1 Oral Nutritional supplement review 1 Obesity 1 Coeliac |
Discontinuation of specialised formula Dietary Advice Discharge Prescription for ONS
|
|
12-17 years |
25 |
4 Obesity 3 Picky Eating 2 Underweight 2 IBS 8 Healthy eating 1 Food Allergy/Intolerance |
|
|
18-24 years |
159 |
31 dietary advice 16 Gastro related conditions 55 IBS 9 Malnutrition/Frailty 34 Obesity 3 Oral Nutritional Supplements review and assessment 1 Type 2 Diabetes 7 Disordered Eating 2 Food Allergy/ Intolerance 4 Fussy Eating |
|
|
25-34 years |
156 |
26 Dietary Advice 10 Gastro related conditions 36 IBS 16 Malnutrition/Frailty 8 Obesity 7 Oral Nutritional supplements prescription 2 Breastfeeding 1 Type 2 Diabetes 2 Nutrition Support 1 Disordered Eating 37 Obesity 1 Picky Eating
|
|
|
35-44 years |
116 |
17 Dietary advice 7 Gastro related conditions 19 IBS 4 Malnutrition/frailty 48 Obese 20 Oral nutritional supplements review and assessment 6 Type 2 Diabetes 1 Disordered Eating 2 Food Allergy/Intolerance 1 Nutrition Support
|
|
|
45-54 years |
117 |
17 Dietary Advice 11 Gastro related conditions 11 IBS 14 Malnutrition/Frailty 37 Obesity 7 Oral Nutritional Supplements 8 Type 2 Diabetes
|
|
|
55- 64 years |
128 |
26 Dietary Advice 15 Gastro related condition 10 IBS 12 Malnutrition/Frailty 32 Obesity 12 Oral Nutritional supplements review and assessment 8 Diabetes 3 Cholesterol 2 Disordered Eating 2 Nutrition Support
|
|
|
65-74 years |
105 |
19 Dietary Advice 10 Gastro Related conditions 7 IBS 25 Malnutrition/Frailty 16 Obesity 20 Oral Nutritional Supplements review/assessments 3 Type 2 Diabetes 1 Food Allergy 2 Nutrition Support
|
|
|
75 years above |
356 |
29 Dietary Advice 2 Dysphagia 5 Gastro related disorder 6 IBS 123 Malnutrition/Frailty 4 Obesity 172 Oral Nutritional Supplements review and assessment 1 Diabetes 5 Nutrition Support |
|
Key Nutrition Focus Areas in Primary Care:
(Total patients seen: 1224 over two years/ 24 patients per week over 52 weeks average)
Paediatrics nutrition main conditions seen: 87 (7% of total patients seen in 2 years)
Frailty/Malnutrition 203 (16.6% of total patients seen in 2 years)
Obesity/Weight Management: 152 (12.4% of total patients seen in 2 years)
Diabetes: 28 (2.3% of total patients seen in 2 years)
Gastroenterology conditions: 75 (6% of total patient seen in 2 years)
IBS: 146 (12% of total patients seen in 2 years)
Oral nutritional supplements: 242 (19.8% of total patients seen in 2 years)