Advancing Clinical Practice in Dietetics

Currently in health and social care the titles 'expert', 'specialist' and 'advanced' are used interchangeably, resulting in a lack of consistency and potential confusion. Many organisations, professions and academics have sought to define 'advanced practice'. While all approach from different angles, there are similarities in the concepts and skills such as:

  • Breadth and depth of practice
  • Leadership, innovation and creativity
  • Service improvement/service development
  • Education and development of others
  • Improve outcomes for service users

It is clear that the how rather than what is the main factor in determining level of practice. As in addition professional definitions tend to include aspects of development of the profession such as through advocacy for the profession, dissemination of good practice (publishing and presenting), influencing at a national and international level, active engagement with professional body and mentoring and development of other dietitians.

Rolfe et al, after Schon (Rolfe, 2001), describes advanced practitioners as working in the swampy marshland where the messy, confusing problems are. This ‘marshland’ has no guide book and the advanced practitioner has to integrate knowledge and skills and reflect on their experience and practice to develop and apply the solutions.

There is, therefore, general agreement that while advanced practice tends to need some years of experience to develop, years of experience do not automatically result in advanced practice; and advanced practice is more than being an excellent practitioner.

Advancing dietetic practice comes in three forms. It is important we put this into context, as depending on the route you are taking the development opportunities will present themselves differently. When we are advancing our clinical practice it is essential we consider how to formalise this to ensure we get the recognition we deserve, and access career opportunities appropriately.

Advancing Practice in Dietetics 

When we talk about advancing practice in dietetics we are referring to specialising. This is when you have accessed post graduate training in a specific area of dietetic practice and take clinical leadership of that area. If we link this into our Post-graduate Professional Development Framework this would relate to moving up through the levels here, at your own pace. You may move up one pillar more quickly than others and this is normal. There is no specific training requirement, it depends on your area of specialism, and the continuous professional development you feel is beneficial to advance your practice within that area.

Advanced Clinical Practice

Advanced Clinical Practice (ACP) relates to more than dietetics. This is when your broadern your clinical scope to take on elements of practice that would usually belong to other professions. Advanced clinical Practice will still follow an area of specialism though you will be encompassing more than dietetic practice into your treatment planning and intervention. Examples could include

  • A basic psychology screening in a weight management clinic using PHQ9 or GADs7 questionnaires.
  • A basic physiotherapy sit to stand assessment as part of a nutrition support clinic
  • A basic speach and language assessment on a ward round if a service user reports a swallowing difficulty.

To take on an ACP role you do require formal training. The training is provided to esure the correct governance for safe clinical practice is in place. This will teach you about scope; what is within your remit as an ACP and when to refer on to the relevant healthcare professional i.e. psychologist, phyiotherapist, speach and language therapist.

The route of training will differ dependent on whether you are already practicing in this way, or would like to develop your practice in this way. You must be practicing at level 3 across all 4 pillars of pratice within our Post-graduate Professional Development Framework. An ACP role requires you meet capabilities outlined in the Multiprofessional Framework for ACP.To find out more visit NHS Health Education England (HEE).

First Contact Practitioner

Here you are practicing as the first point of contact. Before a service user has visited a GP, consultant or other health care professional. You may be the first health professional they have ever seen. This will mean you have no information on them. For this reason formalising your development and governance around this role is essential. These types of roles are in development at the moment.

NHS HEE is currently working to develop a framework to support this type of practice. The BDA will be working on developing a competancy framework to support our members prior to the release of the HEE framework. 

In the meantime, if you would like to find out more about developments here please contact our Policy Officer for Professional Practice - Chloe Adams at c.adams@bda.uk.com