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Choosing your career... as a First Contact Dietitian

Siân is now working with the British Dietetic Association as Professional Practice Manager. She previously worked as an Assistant Professor at the University of Nottingham. She has worked in a range of clinical areas, specialising in learning disabilities, palliative care and nutritional support.

Twitter@: siancunningham2

Siân Cunningham, MSc, RD, AFHEA

Professional Practice Manager, BDA

There is a lot of choice when deciding on your dietetic career options! One of the newer areas of practice presents exciting opportunities to work in a role that allows you to diagnose and treat the people that come to see you.

In response to a growing need for appointments in primary care, NHS England championed new roles for allied health professionals (AHPs). This included dietitians, paramedics, occupational therapists and physiotherapists.

A First Contact Dietitian (FCD) can diagnose medical conditions and then provide suitable dietetic treatment for those conditions. FCDs work in primary care (usually in GP surgeries and health centres). The title ‘first contact’ points to the fact that patients can make or be given an appointment with an FCD without having to see the GP first.

There are specific conditions that are appropriate for FCDs depending on their knowledge, experience and scope of practice.

Conditions commonly seen include:

  • Treating people living with overweight and obesity
  • Diabetes
  • Frailty
  • Gastroenterology, i.e. IBS or coeliac disease

Of course, FCDs cannot treat everything that would be seen by a GP and so they work with their healthcare team to make sure that it is clear who they can and cannot treat within the scope of both their individual and dietetic practice. This ensures safe practice and that people are seen by the right healthcare professional in a timely way.

As part of being an FCD you are trained to identify reg flags (signs that there might be a serious underlying pathology, such as cancer) and to make appropriate referrals for further investigations under the two-week wait scheme, something previously only carried out by GPs. Traditionally, dietetics has not been a ‘hands-on’ profession, however, FCDs are trained to carry out physical assessments and are able to directly request appropriate tests to rule out or diagnose suspected conditions, which can include functional bowel disease, type 2 diabetes and coeliac disease. This is a great move towards us carrying out more physical assessments rather than just anthropometry.

Training and education

To be able to call yourself an FCD, you need to undertake specific learning and demonstrate your ability to do the role. This role requires you to be working at the top of your clinical scope of practice. As well as FCDs, dietitians can be First Contact Practitioners (FCPs). Both titles should only be used following primary care specific training and assessment Everything you need to do is set out in the ‘Roadmap’ document for Dietitians.(1)

PILLARS OF PRACTICE

Your undergraduate curriculum and dietetic career framework are both based on four pillars:

  1. Practice
  2. Evidence-based practice research
  3. Facilitated learning
  4. Leadership


DEGREE LEVELS

To be an FCD, you need to be working at the top of the practice pillar at Level 7 (master’s level). As a general rule, your undergraduate degree starts at level 4 in the first year, level 5 in the second year and level 6 with the potential for some level 7 learning in your final year. The training for FCDs can be done via a supported portfolio or by undertaking a master’s level module at a participating university. It is recommended that you have been practising for five years before becoming an FCD to make sure you have the necessary experience and skills to undertake the role.

If you want to find out more about this exciting area you can visit the BDA webpages, join the specialist interest group or read more about the role of an FCD in NHD magazine.

References

  1. First Contact Practitioners and Advanced Practitioners in Primary Care: (Dietitian) A Roadmap to Practice First Contact Practitioners and Advanced Practitioners in Primary Care: (Musculoskeletal) A Roadmap to Practice (hee.nhs.uk)