A First Contact Practitioner (FCP) is a diagnostic clinician working in Primary Care at the top of their clinical scope of practice at Agenda for Change Band 7 or equivalent and above. This allows the FCP to be able to assess and manage undifferentiated and undiagnosed presentations (HEE, 2021).
A FCP is working at level 7 clinically and likely to have some experience of the other three pillars of advanced practice as defined by advanced practice frameworks across the UK (Leadership and Management, Education and Research). Whereas, an Advanced Practitioner (AP) is working at level 7 in all four pillars of practice: Clinical, Leadership and Management, Education and Research.
The current key requirements for these roles can be found within the Network Contract Directed Enhanced Service (DES) Contract Specification 2021/22 – PCN Entitlements and Requirements.
As FCPs, dietitians may take on more generalist roles covering a breath of practice, likely to include:
- Gastroenterology including Functional bowel disorders, IBS and coeliac disease
- Overweight and Obesity
The roles may include other conditions, dependant on a dietitians scope of practice. Dietitians working with undifferentiated diagnosis in paediatric populations must have relevant masters level training and education in the management of nutrition and dietetic practice in paediatrics.
See an example job description outlining the role of FCP and AP dietitians in primary care.
See the 'What is the BDA doing' section to find out how we are supporting the development of these roles.
There are several ways to access a dietitian through DES in a Primary Care Network, these include:
- A service level agreement with a local NHS Trust dietetic department – this is likely to be the preferred option for most PCNs as training, profession-specific supervision and mentoring will already be in place, along with cover for annual leave, sickness and maternity leave. It also prevents potential duplication of services.
- Service contract with a freelance dietitian - working on a contractual basis.
- A dietitian employed directly by the PCN.
The HCPC requires that dietitians participate in training, supervision (CPD and clinical) and mentoring. As local NHS Trust dietetic departments have a structure in place to support this, this may be the preferable option for both the PCN practice and dietitian.
The BDA is currently producing guidance documents for dietitians and PCNs to highlight the different employment options.
The BDA commissioned Plymouth University to undertake a research project to collect and evaluate data on the effectiveness of dietitians working in primary care. This was part funded by HEE and will give us a firm evidence basis on which to base our calls for more dietetic posts in primary care. The three phases to the project have now finished, and we are awaiting the final analysis and write up. The three phases were:
- Phase 1 scoping review focusing on the effectiveness of dietitian-led care in primary care
- Phase 2 an on-line survey of dietitians working in primary care
- Phase 3 collecting observational data to evaluate how dietitians could work in primary care. This consisted of three models:
- Dietitians working as a First Contact Practitioner to treat frailty and malnutrition within the general practice setting.
- Dietitians working to enhance the multi-disciplinary team (MDT) within general practice.
- Paediatric allergy which is usually delivered through referral to secondary care.
We are currently working closely with HEE to develop the FCP to AP Dietitians in Primary Care: A Roadmap to Practice document. This will be a supportive document that provides a clear educational pathway for dietitians wishing to pursue a career in primary care. Updates on this roadmap can be found on the HEE Multi-Profession Roadmap landing page, where the document will also sit once it has been published. This is due to be published in July 2021, more information can be found on our First Contact Dietitian webpage.
The BDA is producing a series of videos with input from Health Education England, discussing the new roles in England within primary care.
1. The first in the series video is aimed at dietitians working, or considering working in primary care as well as dietetic managers being contacted by PCNs and covers:what we mean by first contact practitioners (FCPs)
- what the FCP to advance practice roadmap is, and how the implementation of these roles will be supported by the roadmap
- examples of FCP within dietetics
- what the BDA is doing to support these roles.
We’d like to hear any feedback you may have following the video, please get in touch by emailing firstname.lastname@example.org.
Additionally, Tanya Rumney (Lead Therapist for Nutrition and Dietetic Service and Paediatric Therapy at Cheshire West Integrated Care Partnership and Primary Care AHP Ambassador for Health Education England) presented a webinar on dietitians as First Contact Practitioners in primary care on 16 February, you can watch this here.
The BDA has created a Dietetic Primary Care Discussion Forum for all dietitians with an interest in these roles to join and share experiences, knowledge and recourses such as business cases and job descriptions. Please email us directly if you would like to be added to the forum.