The Autumn Budget (1) was released on October 30th by the new Labour government, with a promise of a 10-year plan for the NHS to be released in spring 2025. The budget describes its ambitions to fund £25.6 billion into the NHS over the next two years, which is the largest spend on the NHS since 2010 (excluding COVID-19 years). A summary of other points include:

• Provide an additional 40,000 elective appointments a week
• £1.5 billion to fund new surgical hubs to help build capacity for over 30,000 additional procedures, and more than 1.25 million additional diagnostic tests (which use CT or MRI scanners)
• £70 million to invest in new radiotherapy machines to improve cancer treatment
• Over £2 billion for NHS technology and digital improvements to increase productivity and save staff time
• Over £600 million increase in local government spending to support social care
• £26 million to open new mental health crisis centres

The budget describes having a commitment to preventative care as opposed to treating sickness. It discusses a soft drink levy and increased tax on smoking products to support this.(2) However, I expect the biggest changes to be released in the spring 10-year plan.

HAVE YOUR SAY

On the 21st of October 2024, the government launched the Change NHS Online Platform (3) whereby members of the public, NHS staff and experts can share their ideas on how the government’s 10-year plan can be shaped to help ‘fix’ the NHS. The aim is for patients and members of the public to be able to influence what matters most in the NHS.

Dietitians are experts in supporting patients with their diet and lifestyle to manage and prevent clinical conditions, (4,5) therefore, dietitian input earlier on in patient’s health journeys can help to reduce disease progression and keep patients well and out of hospital. This makes dietitians exceptional professionals to support the government’s 10-year plan with a focus on preventative care. Achieving this earlier input can be utilised in dietitians in community-based roles or those working in Primary Care – where dietitians can work as ‘First Contact Dietitians’ (FCDs).

FIRST CONTACT DIETITIANS

NHS England describes a first contact practitioner (FCP) as being 'a diagnostic clinician working in Primary Care at the top of their clinical scope of practice at Masters level, Agenda for Change Band 7 or equivalent and above. This allows the FCP to be able to assess and manage undifferentiated and undiagnosed presentations'.(6) This means that they are seeing patients at the start or earlier on in their health presentations.

Working as an FCP involves additional training to enable the dietitian to order relevant diagnostic tests, undertake suitable clinical examinations and action urgent referrals if needed, as well as providing holistic dietary, lifestyle and medication advice. This fits with the NHS’ aims of ‘seeing the right clinician at the right time’ and helps with continuity, whilst supporting faster diagnosis/treatment.

The holistic approach at an earlier point in a patient's care can help to provide faster disease management or prevention, as it can remove the need for the patient to be referred to services with a long waiting list. FCDs are also well-placed to direct patients to supportive programmes to help with disease prevention, such as NHS weight loss programmes, diabetes management courses and diabetes prevention programmes. An FCD can be an excellent addition to a general practice team helping to manage patients and keep up to date with changes in weight management/diabetes pathways.

In November 2021 the First Contact Practitioners and Advanced Practitioners in Primary Care: (Dietitian) A Roadmap to Practice was published.(7) The roadmap includes:

• Descriptions of first contact/advanced practice
• The areas dietitians will be expert generalists in
• Educational pathways
• How to build the evidence to achieve these roles.

Although changes to roadmaps have been released,(8) they still provide structured information on how the roles can work.

First Contact Dietitians are employed by PCNs through the Additional Roles Reimbursement Scheme (ARRS). This is a scheme whereby the government provides funding to PCNs for them to employ a range of AHPs, including pharmacists, physios, mental health practitioners and physician associates. In 2023, the employment of Advanced Nurse Practitioners was included in ARRS and the new 2024/25 GP contract will include the employment of recently qualified GPs. This is in response to feedback from GPs in Primary Care and to support the unemployment gap of newly qualified GPs.(9)

Currently, there are approximately 139 First Contact Dietitians employed in Primary Care, which is a low number when compared with our First Contact Physiotherapist colleagues.(10) This may be for several reasons: partly due to FCDs being a relatively new primary care profession, the changes to which roles are available on the ARRS funding influencing what professions PCNs want and there being a lack of evidence on the benefits of dietitians in primary care.

This is a point that will hopefully soon be changing, as the BDA FCD Specialist group has an outcomes project underway to produce pieces of research demonstrating the worth of FCDs in the process.