Dietetics in Primary Care in Scotland.
I often have the radio on whilst working. My ears pricked up when I heard the tail end of a report around how GPs were using health professionals to support primary care. As many of you will be aware health is devolved in Scotland in line with the other home nations of Northern Ireland, Wales and England. This means that the nations make their own decisions about healthcare investment, education and workforce plans through their own governments. This leads to differences in healthcare systems, something I experienced first- hand when I moved to Scotland.
So what is happening in Primary Care? How are Allied Health Professionals transforming the landscape?
I’m a Dietitian. Our professional body, the British Dietetic Association (BDA) represents all 4 nations. I have been following with interest the work Health Education England have been driving forward, working with the BDA, to implement first contact practitioners (FCPs) roles for Dietetics. A Roadmap to practice was launched in November 2021.
So your next question might be, is there a ‘Roadmap’ for Dietetics in Scotland?
I’d spotted First Contact Practitioner roles for Physiotherapy on the national recruitment website but had never seen roles for Dietetics
Work around implementation of FCP in Scotland stems from 2018 General Medical Services Contract in Scotland. This provided a refocusing of the GP role as expert medical generalists. It enabled roles historically carried out by GPs to be carried out by members of a wider primary care multidisciplinary team. As a result of this document, the implementation and spread of FCPs in Scotland was accelerated.
The Scottish Government launched the AHP Transforming Roles programme. Transforming Roles aimed to challenge traditional models of care, modernise health and social care and ensure high-quality, person-centred care and integrated services. This shift in perspective included recognition of the roles that Nurses, Midwives and Allied Health Professionals (NMAHPs) could play in delivering Advanced Practice into health care.
NMAHPs are able, and often best placed, to use both their clinical expertise and experience alongside their non-clinical skills in leadership, education and research. This enhances the efficacy and quality of care. These roles are central to help the workforce to better meet population health needs in Scotland. Working within multi-professional teams improving health and making the best use of resources.
What has happened within Transforming roles for Scotland?
Pilot work began in 2019 on delivering a national approach to Advanced Practice across all AHPs, through the development of sustainable and progressive roles together with a structured education and career pathway.
Pilot work was undertaken in 3 priority areas: Reporting Radiography, MSK Advanced Practice in Primary Care, and Unscheduled Care.
The Scottish Government AHP Transforming Roles Short Life Working Group was established and proposed national definitions for Senior, Advanced and Consultant levels of practice to be used for the pilot work.
Expert Groups were established for the 3 pilot areas and a national consistent process of identifying role specific knowledge and skills behaviours (KSBs) associated with AP roles in the pilot areas were developed. The KSBs were mapped to levels of practice across the four pillars of practice:
- Clinical practice
- Facilitation of learning
- Evidence, research and development.
Advanced Practitioners are expected to demonstrate all of the generic KSBs in each of the pillars of practice at level 7 of the NHS Education for Scotland (NES) NMAHP Development Framework and the role specific KSBs developed by the expert groups. The role specific KSBs were developed from profession specific guidelines and frameworks. Pilot work to test the process of developing roles specific KSBs was completed.
Framework – https://www.careerframework.nes.scot.nhs.uk/
The second phase of the project, which was to include mapping of existing roles, a service needs analysis for agreed Advanced Practice roles and an education needs analysis across Scotland, were unfortunately halted due to the Covid-19 pandemic. This work has remobilised under the umbrella of NHS Education for Scotland, NES
NES AHP Transforming roles workstream
Currently there is no consistent and standardised level of FCP practice across Allied Health Professionals in Scotland. The Health Education England roadmap provides a clear framework for career development towards FCP, however this presents challenges for a consistent application of the transforming roles methodology in Scotland. There are potential knock on effects for equity of service delivery and educational governance.
New Year, New focus
It seemed like fate that during late Autumn, I spotted an opportunity to apply to be part of a project team looking at Dietetics in Primary Care. The expression of interest indicated it was a time limited piece of project work. The work aligned closely to existing substantive regional project work I am involved with around the prevention and remission of Type 2 Diabetes.
Advanced Practice within Dietetics in Scotland
A project around Advanced Practice within Dietetics was completed during Spring 2021. The project aimed to scope existing support for advanced practice in dietetics in Scotland, to identify the roles being undertaken by advanced practitioners and to explore what support is needed to embed and develop advanced practice in Scotland. This work and the findings were disseminated by a project team; Dr. Anna Julian, Advanced Specialist Dietitian, NHS Greater Glasgow and Clyde, Kirsty McLachlan, Clinical Lead for Speech and Language Therapy in Head and Neck and Voice, NHS Lothian and Dr. Valerie Blair, AHP Programme Director, NHS Education for Scotland.
Dietetics in Primary Care- Spring 2022- What’s next?
Our project team commenced in post just after the New Year. As a Project trio myself, Sheena and Sheila, all Registered Dietitians, have been linking with an oversight group. The oversight group has been established with representatives from Scottish Government, the British Dietetic Association and NES. Project timelines have been agreed for the work to complete by the end of March 22.
We intend that the outcome of our project work will be to provide a report of recommendations to identified stakeholders to explore and develop Dietetic roles in Primary Care. A service needs analysis will be completed alongside the identification of educational needs for current and future roles.
How can I get involved?
We have been carrying out the field work described above during March. The service needs and educational needs analysis will support identification of the roles that dietitians are currently undertaking in Primary Care in Scotland, the potential roles that could be undertaken, the levels of practice of these roles and the educational underpinning required to introduce, embed and sustain them.
Have you completed the educational needs assessment?
If you work within a health board in Scotland it should have landed in your inbox over the past week. It takes on average just 5 minutes to complete. The link will remain open until Wednesday 16th March.