Delays built into the system
A patient living with debilitating Crohn's disease symptoms waited up to a week for treatment despite their dietitian identifying the problem immediately.
Identifying the cause
Christine is an Advanced Practice Gastroenterology Dietitian working in a hospital in Northern Ireland.
Her patient had Crohn’s disease, a condition where parts of the digestive system become inflamed. For around six months the patient had been struggling with diarrhoea, going to the bathroom up to 18 times a day, and they were experiencing fatigue, no appetite, nausea and weight loss. This was seriously impacting their quality of life.
Christine assessed the patient and suspected that they were experiencing bile acid malabsorption. Bile acids are substances made by the liver that help digest fats. Normally, they are reabsorbed further down the small intestine and reused by the body but if this doesn’t happen properly, excess bile acids pass into the large bowel, where they can irritate it and cause symptoms.
A clear treatment plan
She told the patient this and let them know that she would have to speak with the Consultant Gastroenterologist before she could start them on a course of treatment.
“The patient was relieved that some progress might be made as she wasn't due to see her consultant again for another two to three months.”
Waiting for treatment to begin
The consultant agreed with Christine’s assessment. She now had to go back to the patient and seek their agreement to set up a clinical management plan – the process that allows supplementary prescribers to prescribe medication, with oversight from an independent prescriber. Once this was agreed with the patient she had to write up the plan and send it back to the consultant for sign off. Then the patient’s GP needed to issue the prescription.
The impact on the patient
“This is a poor use of dietetic time. The increased administrative tasks delayed the prescription getting actioned. The time between writing the recommended treatment and the patient accessing their medication was up to 1 week in the end.”
The patient responded well to treatment, and was given advice on how to manage their medication at home. Over time they were checked for nutrient deficiencies which revealed low B12, folate and Vitamin D. This required the dietitian to go through the same process all over again to be able to prescribe the necessary supplements.
Although Christine had identified the problem and recommended the appropriate treatment, the patient still had to wait up to a week to access medication because of the additional prescribing steps required. When further deficiencies were later identified, the same process had to be repeated again.
How independent prescribing would have changed this case
Once Christine had identified the cause of her patient's symptoms, independent prescribing would have allowed treatment to begin without unnecessary delays.
✅ Treatment could have started sooner
✅ Fewer steps and less paperwork before prescribing
✅ Reduced inconvenience for the patient
✅ More efficient use of specialist dietetic time
✅ Faster management of future medication needs linked to the condition
