First Contact Dietitian

First Contact Dietitians may cover one of more of the following areas of practice, depending on their knowledge, experience and scope of practice: 

• Gastroenterology including functional bowel disorders, irritable bowel syndrome and coeliac disease
• Overweight and Obesity 
• Frailty
• Diabetes

The roles may include other conditions, dependant on a dietitian’s scope of practice. Dietitians working with undifferentiated diagnosis in paediatric populations must have relevant masters level training and education in the management of nutrition and dietetic practice in paediatrics.

The BDA is producing a series of videos with input from Health Education England, discussing the new roles in England within primary care.

1. The first in the series of videos is aimed at dietitians working, or considering working in primary care as well as dietetic managers being contacted by PCNs and covers:

• what we mean by first contact practitioners (FCPs)
• what the FCP to advance practice roadmap is, and how the implementation of these roles will be supported by the roadmap
• examples of FCP within dietetics
• what the BDA is doing to support these roles.

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2. If you're a primary care training hub or are employing/considering employing occupational therapists (OTs) and dietitians, watch our webinar which provides an overview of the expertise dietitians and OTs can bring to primary care, along with how you, HEE and professional bodies can support these roles. You can access the slides here.

Health Education England has a webpage with a Roadmap FAQ section. 

We’d like to hear any feedback you may have following the video, please get in touch by emailing [email protected].

Additionally, Tanya Rumney (Lead Therapist for Nutrition and Dietetic Service and Paediatric Therapy at Cheshire West Integrated Care Partnership and Primary Care AHP Ambassador for Health Education England) presented a webinar on dietitians as First Contact Practitioners in primary care on 16 February, you can watch this here. 

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3. An introduction to the First Contact Practitioners and Advanced Practitioners in Primary Care dietetic roadmap

This webinar is aimed at dietitians working in primary care to provide an overview of the roadmap for First Contact Practitioners and Advanced Practitioners.

HEE's Amanda Hensman-Crook provides a short introduction into the development of the roadmap before opening the session up to questions from panel members.

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4. Primary Care First Contact Dietitians and Advanced Practitioners in Primary Care: Dietetics Roadmap launch

This webinar is aimed at dietitians working in primary care/interested in working in primary care and those employing dietitians. 

It provides an overview of the Roadmap for First Contact Practitioners and Advanced Practitioners development and implementation process along with supporting documentation.

 

The below are Health Education England (HEE) and BDA responses to questions asked during the First Contact Dietitian webinar series.

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What CPD can newly graduate AHPs do if they aim to one day become a First Contact Practitioner (FCP)?

They can build up a broad base of knowledge across the primary care skillset (overweight/obesity, gastroenterology, frailty, diabetes and paediatrics), arrange to shadow in primary care and develop an understanding of care pathways in each of the above-mentioned skill sets.

When should stage 1 and stage 2 of the roadmap be completed? 

The guidance is below as agreed with NHSE/I:

• Stage 1 must be completed with a portfolio of evidence and verified before employment in Primary Care. The Knowledge Skills and Attributes (KSA) must be completed prior to employment as a FCP or AP in Primary Care to assure patient safety. For clinicians already working in primary care, this can be completed retrospectively.
• Stage 2 is completed with a portfolio of evidence and verified in Primary Care. This is the recognition process of the application of the KSA in Stage 1 to clinical practice in Primary Care. Best practice is that this should be completed within six months for a full-time member of staff but this can be longer provided a completion date is agreed with the employer.

How many years’ experience do I need to become a FCP and do I need to complete the Roadmap?

It is a CQC regulation that all dietitians (full and part-time) working in primary care will need to complete the FCP Roadmap. For any new dietitians moving into primary care, HEE recommend they have at least 5 years’ experience before working in primary care.

I have a post-registration masters, can I become a First Contact Practitioner or Advanced Practitioner in primary Care?

If you have done a non-Advanced Clinical Practitioner (ACP) masters (pre-registration masters does not count), you will need to do stage 1 and 2 (plus 3 for AP) of the Roadmap with a roadmap supervisor. Your masters learning outcomes can be used to evidence the relevant knowledge, skills and attributes in stage 1 of the roadmap

If you have done an ACP masters but your clinical placement was not in primary care, you need to do the eLearning modules and stage 2 (plus stage 3 for AP) of the Roadmap with a roadmap supervisor.

How would trainee FCPs gain the knowledge skills like red flags and safety netting?

Clinical Supervision and masters level training and education such as First Contact Practitioner and Advanced Clinical Assessment courses  

Why are other areas of dietetic practice not considered?

The current 5 areas of practice (overweight/obesity, gastroenterology, frailty, diabetes and paediatrics) are not an exhaustive list. Those with knowledge, training, experience and competence at masters levels in other areas of practice, may support, with agreement from their employer, other clinical conditions in Primary Care

Who would decide whether a patient would be triaged to a First Contact Dietitian (FCD)?

A triaging process would need to be agreed between the receptionist, dietitian, GPs and other staff members within the GP practice.

Who can become a roadmap supervisor and how do I learn more? 

The following can become a supervisor once they have completed the necessary HEE training:

• AHP with a post registration Master’s degree
• First Contact Practitioner
• Advanced Practitioner
• GP

You can find out more via the Primary Care training hubs. If you contact your local hub, they will be able to advise you. There will also be dates on the roadmap landing page.

Where can we find guidance about preparing a portfolio of evidence and what will be required?

All information is on the roadmap landing page.

Are there any issues around roadmap supervisors not having any personal experience of the FCP role other than doing the two-day course?

The supervisor is assessing a portfolio of evidence at a master’s level of practice so they do not necessarily need to be in an FCP role to be able to do this.

The current ACP includes a mandatory 30 credit module, 'Advanced physical assessment and consultation skills'. Will OTs and dietitians require this module if taking a portfolio route?

No, but it will need to be demonstrated that they are working at an advanced level (master’s level) in assessment and consultation skills i.e. complex clinical reasoning, academically in stage 1 and in practice in stage 2.

What support is available for the practical contracting arrangements - service specifications, clinical governance frameworks etc for community health services being commissioned to provide the ARRs roles?

Your regional NHSE/I representative should be able to help as it is not in the remit of HEE.

Are you envisaging AHPs gaining ACP status before they move into primary care or obtain this in-post?

They need to have completed stage 1 before moving into primary care, then work through stage 2 and 3 or start on an ACP master’s degree.

Could there be a situation where a less experienced supervisor supervises an experienced AHPs?

Supervisors are trained to mark and sign off academic work and application of academic knowledge into practice. This is not something that an AHP will know how to do unless they have been trained to do it during the two-day course.

Are there criteria for supervision after placement?

Regular CPD and clinical supervision post-training.

Given the existing demands for supervisors for FCPs, is there an issue regarding supply & demand to ensure sufficient numbers?

There is a national roadmap supervisor strategy in place and running via the training hubs. Clinicians should ensure that they have an 80% clinical 20% non-clinical split in their workplan to ensure that they are being supervised and can supervise others.

Once a clinician has completed FCP or ACP training and is recognised as an FCP/AP via HEE Centre for Advanced Practice, the idea is that they then go onto the two-day roadmap supervision course and help to build up the roadmap supervisor infrastructure across PCNs.

In reality, how long can it take for a dietitian to become signed off as an FCP or AP?

It depends on the experience and capability of the individual. Stage 1 could take four months for an experienced clinician and stage 2 could take six months.

What can the role of a dietitian look like within a PCN until this is achieved?

That is down to local negotiation and agreement.

If you are applying for a role and will be employed by the primary care network directly, before signing a contract, consider the follow:

1.       Hours of work:                                                                                                   

The contract will say the hours per week but may not necessarily stipulate days of the week. Therefore, the primary care network (PCN) could request you work in evenings or weekends.

2.       Pension:

The PCN may provide the NHS pension scheme, their own or the state one – it’s worth checking with them.

3.       Holidays:

PCNs have to provide 20 days statutory leave plus bank holidays. They may also give additional leave but this is unlikely to be the same amount as the NHS – it’s worth checking with them.

4.       Sickness:

They have to provide statutory sickness as a minimum. The NHS provides 6-month full pay and 6-month half pay. It is very unlikely that the PCN would provide the same.

5.       Pay:

If you are being employed under the Additional Roles Reimbursement Scheme, the annual maximum reimbursement amount for dietitians is £54,841 (if working at masters level clinically) or £62,705 (if working AS AN Advanced Practitioner). However, PCNs can set their own rate of pay.

6.       NHS Service:

If you are employed directly by the PCN, you will break your NHS continuous service (break of more than one week) so if you return to the NHS, you will start collecting towards continuous service again and have to work for 2 years to qualify for redundancy pay.

7.       CPD:

They will support training and development possibly with paid time but it is most likely to be to be related to the job your employed by them to do (standard in private sector).

If you want to do something to develop your skills with view to getting better job (outside the PCN) that may have to be done in your own time.

8.       Employment rights:

Should you need to go to a tribunal, you will need to work for the PCN for 2 years to qualify for employment rights to go to tribunal with a case regarding unfair dismissal (some exceptions may apply).

If you have any questions about any of the above, please contact the trade union team.

We attended the 2021 RCGP Annual Conference to highlight the benefits of the First Contact Dietitian to GPs, with a number of printed resources which are now available for you to download and print:

• First Contact Dietitian A4 flyer
• What could a first contact dietitian do for you? postcard
• Diabetes and Obesity: Dietitians can support diagnosis & management of pre-diabetes and diabetes postcard
• Frailty: Dietitians can reduce frailty & manage malnutrition postcard
• Gastro: Dietitians can support diagnosis & management of IBS postcard

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