Why are there so few PCN dietitians?

Dietitians are among the least hired roles under the additional roles reimbursement scheme (ARRS). Why is this and what’s the value of a PCN dietitian? Jess Hacker reports

As central policy continues to push toward multidisciplinary working in general practice, the ARRS programme is regularly held under scrutiny: often with their numbers marked against perhaps overly-ambitious Government pledges, or by those who see the scheme as lacking the flexibility needed to improve patient care.

And while clinical directors – those who build these multidisciplinary teams (MDTs) – often share how well these staff have settled into practices, with some suggesting not wanting to lose them as their key reason for remaining in the DES, it is clear there is some disparity in hiring.

According to data published by NHS Digital, as of June 2022 there were only around 102 dietitians working in PCNs under the ARRS: seemingly very low uptake given the increase in funding for weight management.

By comparison, there were more than 2,800 care coordinators in post by the same time, and well over 5,600 pharmacists. In fact, the only role with fewer hires than dietitians is podiatrists, at 44.

Experts point to two main reasons for this: the size of the profession and a lack of awareness about the value they bring.

According to the British Dietetic Association, there are around 9,000 dietitians registered in the UK, with that number having grown by nearly 50% over the last decade.

Eleanor Johnstone, professional practice manager at BDA, said: ‘As a small profession, some healthcare professionals may not have worked with a dietitian before and therefore our value and breadth may not be clear to them.’

She said that, when focussing on service users receiving the right care at the right time, it is ‘essential that dietitians are placed in primary care’ to manage dietetic conditions.

‘Take symptoms suggestive of IBS as an example,’ she said.

‘If a first contact dietitian is placed in primary care, they can recommend necessary investigations to manage undifferentiated diagnosis, support the patient to manage symptoms through dietary changes and deprescribe/prescribe necessary medications.’

She noted that this of course allows other members of the practice team to focus on non-dietetic work. Something that is appreciated by GPs in Newham North West PCN.

Clinical director Anil Shah, hired a dietitian to tackle issues such as hypertension, diabetes and high cholesterol. He has seen significant reductions in HbA1c levels and received ‘fantastic patient feedback’ as well as an appreciation of the in-house referral service from GPs.

Aaron Boysen, a registered dietitian and chief executive of Primary Care Dietitians – which works with PCNs to help hire and deploy their dietitians – agrees that people ‘often assume dietitians are only there to support people with weight loss or things like that’.

That contribution can’t be underestimated given the raft of health conditions associated with obesity, and figures from NHS digital which show that in 2018/19 the majority of adults in England (63%) were overweight or obese with 26% of men and 29% of women considered obese or morbidly obese.

And as more funding is directed into weight management in primary care, notably via the enhanced service, the low number of dietitians seems more striking.

He describes digital solutions as ‘very cookie-cutter’, in contrast to the benefit of a dietitian offering ‘customised care’ to those patients.

‘We’ve really noticed that when talking to dietitians particularly in areas of deprivation where the patients need a different approach: it can’t all be the same approach for everybody,’ he says.

He also suggests that other roles covered by the ARRS, such as pharmacists and physios, have been working in primary care much longer and are therefore better established.

‘Dietitian roles are relatively new. The road map to practice [a Health Education England initiative] was only released last year,’ he notes. As a result, GPs might lack an understanding of how to deploy a dietitian. ‘I would not say they’re uninformed at all. They likely all have experience working with dietitians: they are aware of what a dietitian does,’ he said.

‘But they’re probably not aware of what they can add to general practice because we are relatively new to primary care. That is an area they may lack awareness on.’

He adds: ‘There’s definitely an appetite among dietitians to do more. They want to use their expertise in more of these advanced clinical roles. Just as we as we are able to establish ourselves more as a profession, we’re able to support practices and GPs.’

To read more, PCN clinical director Dr Anil Shah recently shared advice and experience from employing a dietitian under the ARRS.