National survey evaluating the provision of gastroenterology dietetic services in England

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Little is known regarding the provision of gastrointestinal (GI) dietetic services in England. The aim of the study was to assess the current provision of dietetic services for CD, IBS and IBD. 

The last survey of this nature was conducted in 2007 (38% response rate), considered only coeliac management and found that dietetic provision was just one third of that which is recommended by the British Society of Gastroenterology (BSG) guidelines for the management of coeliac disease (CD). Dietetic input is essential in GI services. In CD, dietitians educate individuals on a gluten-free diet, monitor adherence and ensure adequate nutrient intake. There has been a rapid expansion in the role of dietary therapies in IBS with dietitians required at the forefront to deliver these therapies effectively. Nutritional input from dietitians is also essential in the management of IBD.

Dietetic departments within all England NHS Trusts were approached between February and July 2019 and asked to complete a questionnaire investigating time allocated to GI services, settings in which patients are seen, waiting times, average consultation time and teaching methods used. Trusts that did not provide any GI dietetic services were excluded.

Surveys were completed by 123 out of 158 trusts (78%) with GI dietetic services. The full time equivalent (FTE) dietitians per head of population was 3.64/100,000 (range 0.15-16.60). There was a statistically significant difference (p=0.03) between regions with the highest provision in the North East and Yorkshire (5.86 FTE/100,000) and lowest being noted in the North West (2.16 FTE/100,000). Ninety five percent of trusts provided a general dietetic service for adults with CD, 96% provided a general dietetic service for IBS and 94% for IBD. The most frequent waiting time was <2 months (CD and IBD) and 2-4 months for IBS. The most frequent consultation length was 15-30 minutes for patients with CD, IBS and IBD. The majority of dietitians with the main responsibility for delivering dietetic services for these conditions were band 6. Fifty two percent of them had received post registration training in CD, 92% had received post-registration training in IBS and 57% had received post registration training in IBD and. Only 49%, 50% and 72% of trusts provided specialist clinics (as opposed to general clinics) for CD, IBS and IBD patients, respectively. Forty seven percent of trusts had policies for the dietetic management of CD, 54% for IBS and just 24% for IBD. The majority of trusts deliver teaching on dietetic therapies on a one-to-one basis, but a large number also offer group therapy sessions for CD and IBS (32% and 34%, respectively). Only 1% of trusts offer group sessions for IBD patients.

 

Key conclusions:

  • There is significant inequity of GI dietetic services across England, with regional differences in the level of provision.
  • A large proportion of trusts provide a general dietetic service for CD, IBS and IBD but many do not offer a specialist dietetic GI service, therefore many patients are failing to receive the specialist advice that is required in order to successfully manage these conditions.
  • A greater proportion of dietitians are receiving post-registration training in IBS versus CD and IBD, likely due to increasing knowledge of the role of dietary therapies in IBS. As dietetic training in IBS is commonly delivered through paid courses, it could be argued that this knowledge should now be embedded within dietetic teaching curriculums, particularly in view of the high prevalence of IBS (approx 10%).
  • There is a disparity between recommended consultation length for the conditions investigated (e.g the literature recommends 45-60 minutes to education a new patient regarding the low FODMAP diet) and actual consultation length, found to be 15-30 mins in this study. The option to deliver education via group sessions potentially offers a method to bridge capacity issues and deliver dietetic therapies effectively.

Frontline Gastroenterology Published Online First: 16 June 2020. doi: 10.1136/flgastro-2020-101493