With the success of the MSK First Contact Practitioner Project, we are expanding the role to other healthcare professionals to include dietitians. We have 2 trainee First Contact Practitioners with experience as a Mental Health Specialist Dietitian and a Community Dietitian with a specialist interest in gastroenterology. Once they have completed their advanced training, they will be able to offer appointments to patients at all 6 GP practices to assess and manage undiagnosed conditions in 4 key areas (frailty, obesity, diabetes and gastroenterology), This will reduce the number of patients needing an appointment with their GP and free up more appointment slots for those who do.

Many specialist dietetic services are under a lot of pressure and have a long waiting lists. Our First Contact Dietitians may be able to support you to resolve your problem without specialist services or can offer first line advice whilst you wait for a specialist dietitian appointment.

What are the benefits of having a Dietitian in the team?

• Free up GP time to deal with complex multi-morbidity patients and add to the scope of the Primary Care MDT
• Improve patient care in both adults and children with early nutrition advise and interventions
• See patients at their first point of contact or from a referral for follow-up management by GPs or external clinicians
• Offer lifestyle, dietary and medication advice and successfully manage patients on oral nutrition supplements and enteral feeds at home
• Reduction of the amount of elderly patients becoming malnourished and leading to frailty with associated complications
• Ensure a smooth transition of patients discharged from hospital back into primary care and continue of their diet plans
• Enabling of self-care of long term conditions
• Reducing need hospitalisation and referrals into secondary care

How to book with a First Contact Dietitian

Once the patient has contacted the practice online or on the phone, the reception team will book them in with a First Contact Dietitian if they are presenting with symptoms from the 4 key areas. The First Contact Dietitian will assess, diagnose and implement a treatment plan for the patient.

The work of a First Contact Dietitians in the 4 Key Areas:

1. Frailty and Nutrition Support
   We can help people who have a low body weight, recent weight loss, reduced appetite or reduced dietary intake.
   
   Malnutrition affects over 3 million people in the UK and can have a significant impact on their quality of life from reduced muscle strength and tiredness making falls more likely to slower and more difficult recovery from illness. People who are malnourished are more likely to be admitted to hospital and stay longer than those who are well nourished.
   
   A dietitian can provide individualized advice to improve your nutritional status, reducing the risk of malnutrition related health problems. If you would like to assess your risk of malnutrition, follow the link to the Malnutrition Self-Screening Assessment
2. Overweight and Obesity
   If you’re unsure whether now is the right time to make diet and lifestyle changes, book in with our First Contact Dietitians who are experienced in supporting you through the decision-making process.
   
   If you decide now is the right time, Trafford has many services available for people wanting to lose weight. Our First Contact Dietitians can discuss the options available in the area including Slimming World, Fit Fans, The NHS Digital Weight Management Programme and the Specialist Weight Management Service. They can support you to decide on a service based on your individual needs and provide tailored dietary advice to get you started.
   
   Although the body mass index (BMI) scale has its limitations, it is one of many tools used by dietitians. To find out more about BMI and calculate your own score, follow the link to the NHS BMI Calculator.
3. Gastroenterology including functional bowel disorders, irritable bowel syndrome (IBS) and coeliac disease
   1 in 12 GP appointments are for a gastrointestinal condition. Those with undiagnosed IBS visit their GP 10 times more often than matched patients. Input from a dietitian has been shown to reduce symptoms for 70% and improve quality of life for 74% of patients.
   
   Coeliac disease is a lifelong condition affecting 1 in 100 people. Although there is no cure for coeliac disease, following a strict gluten-free diet can help to manage the symptoms of coeliac disease and prevent long term complications of the condition such as malnutrition, problems in pregnancy, some cancers, osteoporosis and iron/B12/folate deficiency anaemia. It is recommended people with coeliac disease have an annual review appointment to monitor their height and weight, blood results, symptoms and diet. You can book an annual review with one of our First Contact Dietitians.
   
   If you are struggling with a functional bowel disorder such as constipation, our First Contact Dietitians can help you to optimise your diet. Dietary changes can help reduce the need for laxatives which can often cause unpleasant side effects such as bloating or tummy cramps.
   
   Our First Contact Dietitians can assess for other gastrointestinal conditions such as inflammatory bowel disease or gastrointestinal cancers. If specialist investigations or treatment is needed, they will refer you to secondary care services.
4. Diabetes and Pre-Diabetes
   Our First Contact Dietitians can provide you with an overview of diabetes and the dietary treatment options. They will complete a nutritional assessment with you and provide tailored advice to get you started with improving your blood glucose control.
   
   As with weight management, Trafford offers a range of services to support people with diabetes and pre-diabetes including the National Diabetes Prevention Program, Diabetes My Way online platform, the X-PERT Health program, NHS low calorie diet program and Specialist Diabetes Services at Trafford General. Speak to one of our First Contact Dietitians to help you choose the best option for you.

Watch this short video that explains the role of a Dietitian:

Our MSK First Contact Practitioner (FCP) project is part of a new model that has evolved throughout the UK. We have placed 4 physiotherapists, who have completed advanced training, within our PCN to offer appointments to our patients to assess and triage musculoskeletal problems across all 6 of our GP practices.

More than one in five GP consultations are for MSK problems

Traditionally, patients with MSK conditions are seen by the GP then referred for a physio/MSK appointment. This process can take up to 6 weeks and sometimes even longer.

Our patients bypass the appointment with a GP and go straight to get help from an experienced MSK First Contact Practitioner. This makes wait and recovery times shorter and frees up GP appointments. FCPs have access to referral pathways and diagnostic tests such as x-rays, blood tests and scans just like our GPs. They can also refer the patient back to the GP if they feel this is appropriate.  They can also offer steroid injections and prescriptions, like GPs, if this would help manage your problem.

How to book with an FCP

Once the patient has contacted the practice online or on the phone the reception will book them in with an FCP if the patient is presenting with an MSK problem. The FCP will assess, diagnose and implement a treatment plan for the patient.

Possible interventions

• Give information on self-care and enable and support behaviour change
• Discuss physical activity and health (e.g. smoking cessation and weight management)
• Refer to physiotherapy / orthopaedic / rheumatology / pain services / Social Prescibers / GP
• Request and review investigations and imaging
• Medicines optimisation
• Administer joint / soft tissue injections
• Discuss fitness for work

Social prescribing offers a person-centred approach where your voice is heard, valued and your needs can be supported in a non-medicalised way. To read more, visit our social prescribing page here.

Our Children and Young Person’s (CYP) Social Prescriber supports our patients under the age of 18 who may need support with their health and wellbeing.

This short video explains the role of a CYP social prescriber:

How to book with our CYP Social Prescriber:

A parent or child can contact their usual GP practice either online or by calling the reception team where one of our care navigators can refer into to our CYP social prescribing service. A GP can also decide whether a referral would be beneficial and refer.