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).
An 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.
Please read the BDA Dietitians in Primary Care: A Guide to General Practice to learn more about the role and effectiveness of dietitians in primary care. It also includes information on pay structures, how you can access a dietitian, and a useful checklist for PCNs.
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 of videos 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.
2. If you're a primary care training hub or are employing/considering employing occupational therapists (OTs) and dietitians, watch our webinar which provides an overview of the expertise dietitians and OTs can bring to primary care, along with how you, HEE and professional bodies can support these roles. You can access the slides here.
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.
3. An introduction to the First Contact Practitioners and Advanced Practitioners in Primary Care dietetic roadmap
This webinar is aimed at dietitians working in primary care to provide an overview of the roadmap for First Contact Practitioners and Advanced Practitioners.
HEE's Amanda Hensman-Crook provides a short introduction into the development of the roadmap before opening the session up to questions from panel members.
The below are Health Education England (HEE) responses to questions asked during the First Contact Dietitian webinar series.
What CPD can newly graduate AHPs do if they aim to one day become an FCP?
They can build up a broad base of knowledge across the primary care skillset (overweight/obesity, gastroenterology, frailty, diabetes and paediatrics), arrange to shadow in primary care and develop an understanding of care pathways in each of the above-mentioned skill sets.
How can I register interest to become trained as an ACP supervisor / verifier?
Via the Primary Care training hubs. If you contact your local hub, they will be able to advise you. There will also be dates on the roadmap landing page.
We are looking to recruit someone new to a PCN role, can they do stage 1 of the roadmap in a primary care role?
The guidance is below as agreed with NHSE/I:
- Stage 1 must be completed with a portfolio of evidence and verified before employment in Primary Care. The KSA must be completed prior to employment as a FCP or AP in Primary Care to assure patient safety. For clinicians already working in primary care, this can be completed retrospectively.
- Stage 2 is completed with a portfolio of evidence and verified in Primary Care. This is the recognition process of the application of the KSA in Stage 1 to clinical practice in Primary Care. Best practice is that this should be completed within six months for a full-time member of staff but this can be longer provided a completion date is agreed with the employer.
Are there any issues around roadmap supervisors not having any personal experience of the FCP role other than doing the two-day course?
The supervisor is assessing a portfolio of evidence at a master’s level of practice so they do not necessarily need to be in an FCP role to be able to do this.
The current ACP includes a mandatory 30 credit module, 'Advanced physical assessment and consultation skills'. Will OTs and dietitians require this module if taking a portfolio route?
No, but it will need to be demonstrated that they are working at an advanced level (master’s level) in assessment and consultation skills i.e. complex clinical reasoning, academically in stage 1 and in practice in stage 2.
What support is available for the practical contracting arrangements - service specifications, clinical governance frameworks etc for community health services being commissioned to provide the ARRs roles?
Your regional NHSE/I representative should be able to help as it is not in the remit of HEE.
Are you envisaging AHPs gaining ACP status before they move into primary care or obtain this in-post?
They need to have completed stage 1 before moving into primary care, then work through stage 2 and 3 or start on an ACP master’s degree.
Could there be a situation where a less experienced supervisor supervises hugely experienced AHPs?
Supervisors are trained to mark and sign off academic work and application of academic knowledge into practice. This is not something that an AHP will know how to do unless they have been trained to do it during the two-day course.
Do you have to have a master's to become a national supervisor trainer?
You have to have a master's; experience is not proof of capability of working at masters’ level. Once you have completed either the portfolio or taught route to FCP, you can then do the two-day roadmap supervision course as you have proof of working at a master's level both academically and in practice.
Where can we find guidance about preparing a portfolio of evidence and what will be required?
All information is on the roadmap landing page.
Are there criteria for supervision after placement?
Regular CPD and clinical supervision post-training.
Given the existing demands for supervisors for FCPs and paramedics, is there an issue regarding supply & demand to ensure sufficient numbers?
There is a national roadmap supervisor strategy in place and running via the training hubs. Clinicians should ensure that they have an 80% clinical 20% non-clinical split in their workplan to ensure that they are being supervised and can supervise others.
Once a clinician has completed FCP or ACP training and is on the directory, the idea is that they then go onto the two-day roadmap supervision course and help to build up the roadmap supervisor infrastructure across PCNs.
In reality, how long can it take for a dietitian to become signed off as an FCP or AP?
It depends on the experience and capability of the individual. Stage 1 could take four months for an experienced clinician and stage 2 could take six months.
What can the role of a dietitian look like within a PCN until this is achieved?
That is down to local negotiation and agreement.
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.