In 2015, Primary Care Workforce Commission identified a number of challenges facing primary care and the healthcare as a whole. These included:
- Increasing and rapidly ageing population
- Rising demand for care with increasing number of primary care visits per year
- Increasing numbers of complex patients with multiple long-term conditions
- A need for increased time with patients to support self-management
- Progressive move of health services from secondary to primary care
- Poor coordination between general practice, community health and hospitals
Declining number of GPs (problems with recruitment and retention and also retirement)
In England, The GP Forward View (NHS England 2016) builds on the Five Year Forward View with general practice in mind. It describes the extra money going into training more GPs but goes on to suggest the need to make better use of the wider primary care workforce and other measures, such as:
- MCPs should have a much stronger focus on population health, prevention and
- supporting communities.
- GPs should make better use of the talents of the wider workforce e.g. integrated
- teams including therapists (a term usually referring to the allied healthcare
- professionals that include dietitians).
- More should be done to support patients to manage their conditions themselves
Primary care is facing similar challenges across the UK, and the Welsh, Scottish and Northern Irish Governments have all identified Primary Care as a priority.
- In Wales, the Plan for Primary Care Services up to 2018 identifies the need to invest in the development of the wider primary care workforce, making use of a wide range of professions according to prudent healthcare principles.
- NHS Scotland and Healthcare Improvement Scotland identify the importance of using multidisciplinary teams in Primary Care to support GPs.
- The Northern Irish Government first approved its Primary Care Strategy in 2005, and it clearly indicates that a wider workforce, including dietitians, is critical to the delivery of effective primary care.
The BDA believes that dietitians have a critical role to play in supporting primary care services. Diet and obesity are the main factors or one of the main factors in the aetiology of many long-term conditions (LTCs) or Ambulatory Care Sensitive conditions (ACS) including diabetes, hyperlipidaemia, hypertension, stroke, heart disease and mental health conditions. This means that dietary treatment is key to the management of these conditions.
We also know that 96% of people living with malnutrition are in the community, and more needs to be done to prevent people ending up in the hospital with malnutrition. Food-related ill health is responsible for approximately 10% of all morbidity and mortality in the UK and this costs the NHS £6 billion annually.
We believe dietitians can have a number of important impacts:
- Enable patients to self-manage their conditions
- Reduce demand on GP time
- Make ‘prevention’ possible in primary care
- Manage medicines effectively and efficiently
- Manage ACBS products effectively and efficiently
- Reduce the need for expensive referrals to secondary care and the need for hospitalisation
- Utilise technology effectively
- Be part of the multidisciplinary primary care home team
The BDA has commissioned Plymouth University to undertake a research project to collect and evaluate data on the effectiveness of dietitians working in primary care. This will give us a firm evidence basis on which to base our calls for more dietetic posts in primary care.
This research will be carried out across the UK with dietitians working in key areas like diabetes, malnutrition and IBS. The research with Plymouth has been part funded by Health Education England, and we are continuing to work with HEE and NHSI to highlight case studies of dietitians in Primary Care, community and public health roles.
Dietitians in Primary Care Paper
As part of our work with HEE, the BDA has developed a paper which explores the idea of "expert generalist" dietitians working in primary care, the impact they can have, and how these roles might be developed. You can read the full document here. We are also working on guidelines for GPs to help them secure a dietitian or dietetic services in their practice.
We will continue working with partners such as HEE to look at developing the role of dietitians in primary care. This will include a number of elements, from training and commissioning posts to helping GPs to see the benefits of dietitians as a key part of their workforce. We will also need to build the evidence base of the impact that dietitians can have and the success stories that can be replicated.
We want dietitians already working in Primary Care to tell us what they are doing, how well it is working and what challenges they are facing. Building case studies and evidence is going to be critical when making our arguments. You can submit case studies directly to firstname.lastname@example.org.
If you need inspiration, take a look at the fantastic work of Somerset dietitian in using best practice to create a pathway to improve management of irritable bowel syndrome.
If you don't already work in a Primary Care of community setting, we want you to think about how your services might be delivered outside of the hospital setting. This is the direction of travel for the NHS as a whole, and we want our members to be at the forefront of this.
- Read and download our Dietitians in Primary Care flyer.
- Read the King's Fund's briefing on "Primary Care Networks" in England, part of the NHS England Long Term Plan
- Read the five-year GP (General Medical Services) contract framework from 2019/20
- You can read the GP forward view from NHS England
- Read the Wales Primary Care Plan.
- Read Healthcare Improvement Scotland's strategic direction for Primary Care.
- Read Northern Ireland's Primary Care strategy.