Dietitians are establishing themselves as a vital part of patient care in the community, providing GPs with a valuable skillset, which in turn reduces the patient load for general practice. Following the introduction of the Additional Roles Reimbursement Scheme (ARRS) in 2019, dietetics within primary care is becoming more common. To recognise this, we spoke to Lisa Ledger, Lead Dietitian for RCHT and CFT, during Dietitian’s Week 2022 to find out more.
Lisa covered a lot of ground in our interview, including the clinical conditions dietitians are so well placed to treat in primary care, the type of training dietitians complete – and how it is changing – as well as a frailty study she undertook last year with encouraging results. You can watch the series of videos on our YouTube channel HERE.
The NHS long term plan places primary care at the centre and Lisa recognises how her profession needs to move in this direction too: “Dietitians traditionally work in secondary care. That's where we tend to sit, or we'll go into freelance. So primary care is a new career option for us. And those doors have just opened up in the last couple of years with the introduction of the ARRS roles.”
“So obviously the idea of the scheme was to take the workload off GP's. There aren't enough GP's. And obviously the pressures on the NHS with the amount of numbers that are seeking health care are really high. So, the idea is what other professions can be drafted in to really take the toll off the GP's,” Lisa continued. Despite this initiative, Lisa recognises that there is a lot of work to do, “because dietetics is
something that is not well understood by GP's and nurses”, she added.
There are many patients who could be triaged by dietitians in primary care and these patients could be taken through their entire treatment journey without the need for a GP appointment. Lisa names a number of conditions that could benefit from early dietetic input, including coeliac, diabetes – type 1 and 2, weight management, colic, milk protein allergy, reflux, selective eating among many more.
In 2020 Lisa was involved in a study with Plymouth University called ‘Dietitians in Primary Care Report’, where she evaluated how frail patients could benefit from early input from a dietitian – and there were some impressive results. The research – completed over a six-month period – saw Lisa working as a first contact practitioner in five practices across Cornwall. Speaking about the study, Lisa explained: “There was a proactive reaching out to patients. So, we did a search on System One and we pulled out anybody who had a BMI of less than 20. I then phoned those patients and I asked if they would be happy for my involvement.”
Lisa found that a lot of elderly, frail patients thought that getting more frail was part of normal ageing, “and that certainly doesn't need to be the case for a very long time,” she insisted. Patients experiencing unintentional weight loss or perhaps in the clinically underweight bracket were invited into their practise and given a consultation by Lisa. “So I did a lot of measurements on them. I measured their arm strength, their leg strength, how quickly they could walk four metres. I would talk to them about what their food and drink intake was. I would do their weight and then we would discuss what dietary changes they could do that were very practical to try and make themselves stronger, along with also just basic exercise advice to make sure that what they are taking in dietary wise was also supported by muscle growth.”
Those patients were then invited back two to three months later and Lisa repeated all the same measurements and found there was a nearly 30% improvement in arm and leg muscle strength. “That means that we're going to have patients that are not falling as much, that they are more robust and able to carry on with daily living activities at home,” Lisa explained. “So, it's really important that we are treating patients before they go to hospital … while they're living in their own homes, where the majority of patients want to be.”
So what does the future for dietetics look like as we enter a new era of Integrated Care Areas?
“I would really hope with our Integrated Care Areas that we are getting a full multi-disciplinary team of allied health professionals throughout those areas”, Lisa concluded. “So, it's really important to look at occupational therapy, physiotherapy, speech and language therapy podiatry, dietetics, how we can a link with national initiatives like Ageing Well to make sure that we are all working as an Integrated Care System - closer to patients in their own homes, so patients are getting timely care in a place-based way.”