My Role as a FCD in CVD and T2DM Management
By Hannah Seymour at Bay Medical Group
My name is Hannah, and I am a first contact dietitian at Bay Medical Group (BMG) in north Lancashire. BMG is a large primary care network with approximately 55,000 patients operating out of five sites, with myself working across two. The practice serves a population facing challenges with high deprivation and high rates of cardiovascular disease and premature mortality. With diet and obesity playing a significant impact in both preventing and managing cardiovascular disease and diabetes, my role is well suited to supporting these conditions, and in a “one stop shop” to reduce the number of appointments required. Cardiovascular disease management and diabetes control also serves a substantial proportion of QOF points as well as local enhanced services (LES) contracts, so my role is well placed in meeting these.
Initially newly diagnosed patients were just seen by a nurse. However, knowing how crucial diet is in the treatment and remission of type 2 diabetes, I completed a quality improvement project with thedevelopment of a joint diabetes clinic, whereby patients see a nurse and dietitian during their initial appointment. The patient has an hour appointment, firstly seeing the nurse for a discussion around diabetes, foot checks and initiation of medications. Then the patient will be seen by me for discussion around managing blood glucose levels through the diet, and if required around weight management support and cholesterol lowering. Blood pressures are taken during this appointment also with the aim to optimise blood pressure. Comparing patients in a nurse only clinic versus a joint diabetes clinic showed average reductions in HbA1c of 74% versus 94% respectively. In terms of lipid lowering, 50% reduced their cholesterol levels in a nurse only clinic versus 90% in a joint clinic. As such, a joint clinic was established for all newly diagnosed patients.
I also run a diabetes duty clinic which involves supporting patients with medication optimisation, and dietary management. Again, during this appointment, I aim to optimise their blood pressure and lipid levels. Referrals are also made to NHS digital, local weight management services and the NHS Type 2 Diabetes Path to Remission Programme. I am currently in training to complete diabetic foot checks also, which will support in contribution to QOF points.
I also work in a cardiovascular optimisation team, alongside an advanced clinical practitioner (ACP), pharmacist, pharmacy technician and nurse associate. We all work together in one office so that we can support each other if needed, however patients can also be seen face to face if required. I advise on appropriate blood pressure and lipid lowering medications, and order ambulatory blood pressure in their local pharmacy. I then request the ACP and pharmacist in the team to prescribe the medication that I had discussed with the patient. With diet playing a huge part in blood pressure and cholesterol levels, advice is given on supporting this, alongside weight management advice, and physical activity. I also refer to local weight management programmes, and NHS digital. If patients have completed these, as per local ICB guidance, I am able to offer referral to tier 3 weight management services with the option of weight loss injections, or to tier 4 bariatric services.
In Spring 2026, I am hoping to start an advanced practice course, as well as non-medical prescribing with the aim to continue my role with long term conditions in primary care.