INAUGURAL NI AHP CONFERENCE 2013:

1. INAUGURAL NI AHP CONFERENCE2013: “AHP’s – Transforming Your Care” Wednesday, 23 October, Lagan Valley Island, Lisburn

2. Extended Scope Practitioner (ESP) Led Coeliac Clinic • Joy Whelan, Community Dietitian • Anne Gormley, Head of Nutrition and Dietetic Services • William Dickey, Consultant Gastroenterologist

3. What is coeliac disease? • An inherited autoimmune sensitivity to gluten proteins of wheat, barley and rye • Common (1% of population, many undiagnosed) • Multisystem: most commonly gut symptoms, but any organ system can be affected • Treatment (gluten-free diet) effective but can be very difficult for the patient • Long term condition needing long-term follow-up

4. The Background Northern Sector: • Current number of patients attending the consultant clinic is approximately 1300 • 50 new patients, on average, are diagnosed each year • Nearly 400 patients were overdue their consultant review appointment by 12 months plus • Funding from the acute medical waiting list initiative was obtained for one year 

5. Extended Scope Practitioner (ESP) Led Coeliac Clinic • “ESPs are highly qualified expert therapists who work in an extended role and provide a range of interventions which include treatment, education and advice” • A weekly clinic was set up to review all medically stable coeliac patients by a dietitian instead of a consultant gastroenterologist

6. Extended role training • Fulfilled set criteria: • At least 5 years Band 6 experience or equivalent • At least 2 years extensive experience in the dietary treatment of patients with coeliac disease • Beneficial to have completed the referrer’s course for medical imaging • Shadowed Consultant’s review coeliac clinic • Protocol was jointly designed • Audit of service

7. Assessment • Current symptoms, relevant medical and medications history  • Weight, body mass index (BMI) and gain/loss • Bone scan/pneumococcal vaccination • Current dietary concerns • Coeliac UK membership • Address any other medical issues • Order bloods

8. Referral for consultant assessment • Concerning symptoms, abnormal results forwarded to consultant by e-mail • Clinical decision made on basis of e-mail alone or review of patient file if appropriate: -no action -advice to patient or GP -consultant clinic review • Full feed back received

9. Outcome • The initial backlog of 389 patients was eliminated within the year Of the 179 patients seen within audit period (24 clinics): • 20 (11%) needed consultant review • 159 (89%) managed completely by dietitian +/- consultant advice • Every 10 clinics run by dietitian would require 1 clinic run by consultant gastroenterologist

10. Service improvement • Opportunity for patients to receive dietary advice as required • Prompt consultant review as needed • Significant cost benefits • Favourable service user feedback

11. Service User Feedback • “As I am aware that I can be referred to the Consultant again if there are any problems I would be very happy to continue to see the dietitian for my review appointment”

12. Fit for the Future…… • Project was first of its kind in Northern Ireland but would be transferable to other Trusts • Having coeliac specialist dietetic posts in each Trust that could review this group of patients • Possibility of moving the service to primary care – thereby “ensuring the provision of a safe, sustainable, resilient and effective service provided in the right place at the right time, by the right people”

13. Thank you