First Contact Dietitian
First Contact Dietitian (FCD) is a Dietetic Led pilot working with
GP's in Primary Care as part of a multi-disciplinary Team to
enhance the patient journey, by providing timely access to
nutritional diagnosis and dietary treatment in the GP Practice. This
will be achieved by providing assessment and clinical dietetic treatment
plans with thresholds for intervention. Where a patient requires more intense dietary treatment
over a longer period of time following initial assessment and treatment, the FCD will refer the
patient on to the relevant dietitian in local Trust for ongoing review. This will ensure the FCD has
the capacity to pick up all newly identified patients in a timely manner.
FCDs can have a number of important impacts:
• Enable patients to self-manage their condition
• Reduce demand on GP time
• Make 'prevention' possible in community
• Manage medicines and ACBS products effectively and efficiently
• Reduce the need for referrals to secondary care and the need for hospitalisation
• Be part of the Multi-Disciplinary Primary Care Team.
The pilot ran from November 2019 to end February 2020. Staffing of the service comprised a
Band 7 Paediatric Specialist Dietitian (0.01wte) and a Band 7 Specialist Dietitian (0.3wte).
• There were 21 referrals to the First Contact Paediatric Dietitian over 5 clinics and
50 referrals to the First Contact Specialist Dietitian over 11 clinics.
For the paediatric referrals:
• 12 had service completed by first contact dietitian, no further follow up
• 3 required onward referral to acute for follow up
• 5 required referral to the cow's milk allergy clinic.
For the adult referrals:
• Of the 7 IBS patients, 1 was referred on to acute for follow-up
• All diabetes and pre diabetes patients met 100% outcomes set
• 12 other referrals had service completed by First Contact Dietitian with no dietetic follow-up.
It is clear that this dietetic post can provide a first contact for cow's milk allergies babies and
manage the onward referral releasing GP clinic time.
There is also a role to review prescriptions of specialist formulas and feeds and their
appropriateness for prescribing which will help towards reducing prescribing costs.
There is a potential to develop this role with the health visitors to include a public health aspect
in particular for addressing early nutrition and childhood obesity. Other pieces of work within
adults would include:
• Anticipatory management of nutritional conditions to help prevent admission to hospital
• Scoping exercise to review eg. patients on PERT to ensure compliance and correct
dose with view to improving symptoms
• Appropriate prescribing of ONS/ medications for long term condition management.
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