General Community

What we offer

Community Dietitians advise people with a wide range of conditions (see our criteria below)

The service is delivered in community locations including outpatient clinics, home visits (including care homes) and in groups. Service is delivered via hybrid approach: telephone, video and face to face consultations.

Staff will often need to liaise with relatives and carers about improving a person's nutritional intake.

Assistant Practitioners and Dietetic Assistants in our team are trained to work with people who need nutrition support for a variety of reasons.

Our current acceptance criteria for urgent dietetic advice (we aim to contact the patient within 8 weeks) are as follows:

We will accept patients who meet any of the following:

Malnutrition Universal Screening Tool (MUST) score of 3
MUST score of 2, with either:
- BMI (Body Mass Index) < 16
- Increased risk of rapid deterioration due to:
  - Rapid weight loss
  - Underlying medical condition
  - Challenging social circumstances
  - Concerns about ability to implement "food first" advice
MUST score of 1 and one of the following conditions:
- Grade three pressure sore
- Motor Neurone Disease (MND)
- Decompensated liver disease (Please note: if the patient is on a transplant list, they will be directed to the appropriate specialist service)
Hyperemesis
Hyperkalaemia

Our current acceptance criteria for priority dietetic advice (we aim to contact the patient within 4 weeks) are as follows:

MUST 2 - that does not meet urgent criteria (we will send to patients first line advice whilst they are waiting for an appointment)
MUST score of 1 with either:
- first line advice has been implemented by the GP / healthcare professional referring to our service
- Further deterioration is likely - due to other neurological conditions / dysphagia / cancer etc
- Severe IBS (Irritable Bowel Syndrome significantly is affecting quality of life or leading to overly restricted diet or MUST 1)
Newly diagnosed Coeliac disease
Type 2 Diabetes - new to insulin
Motor Neuron Disease (MND) with a MUST of 0
Decompensated liver disease with a MUST of 0 (Please note: if the patient is on a transplant list, they will be directed to the appropriate specialist service)

Our current acceptance criteria for routine dietetic advice (we aim to contact the patient within 18 weeks) are as follows:

Review of Type 2 Diabetes (if the patient needs weight reducing advice - they should be referred to the appropriate weight management service)
Obesity requiring specialist dietary advice (due to circumstances or medical condition) and does not meet criteria for weight management services
Irritable Bowel Syndrome (IBS)
Reactive Hypoglycaemia
Any First Line Advice conditions (see information below) needing one to one support

We will provide written First Line Advice explaining how diet plays a part in treating some conditions. Over time, following this advice can lead to better management of your condition. Patients will have an option to discuss their diet in more detail by contacting us within 12 months.

The First Line Advice may be sent out for the following conditions:

Diverticular disease
Hyperlipidaemia / Hypertriglyceridemia
Gall Stones
Hiatus Hernia
Gout
Acid Reflux
Single vitamin / mineral deficiencies that would be suitable for First Line Advice (using clinical judgement)
Other health conditions that would be suitable for First Line Advice (using clinical judgement)

Unfortunately, we are unable to accept all referrals. The following are outside the current acceptance criteria for our dietetic service:

Paediatrics

Children under 16 years of age
Children under 18 years of age under the care of an acute paediatrician (e.g., gastroenterology, cardiology)
Children meeting criteria for a weight management service

Eating Disorders

Current eating disorder diagnoses (including disordered eating or ARFID)
- These cases will only be accepted if they meet the urgent criteria outlined above
- Referrals solely for general dietary assessment or advice will not be accepted
For mild to moderate eating disorders, please contact Eating Matters

Weight Management / Obesity

General obesity management
BMI > 40kg/m² with co-morbidities or BMI > 50kg/m² - patients should be directed to the appropriate weight management service
Weight loss support, unless specialist dietary advice is clinically required (e.g., for social or medical reasons)
Otherwise, please refer to the local service:
Weight Management - Norfolk County Council

Diabetes

Patients currently under the care of the Elsie Bertram Diabetes Centre
Newly diagnosed Type 2 Diabetes Mellitus, unless a 1:1 interpreter is needed
In other cases, please direct patients to:
Diabetes NoW

Allergies

Suspected IGE-mediated allergy without confirmed diagnosis or treatment plan
- May be directed to Addenbrooke's Allergy Service
Complex allergy presentations
Dietary advice for breastfeeding mothers due to suspected milk allergy in infants
- May be referred to paediatric dietitians

Renal / Kidney Disease

Patients already under the care of renal consultants
CKD Stage 4 or 5, or rapid deterioration from Stage 3 (without existing consultant involvement)
- GP should refer to renal consultants
Renal transplant patients

Nutrition Support

Patients in end-of-life care (GSF Red)
MUST score 1, without a significant medical history affecting nutrition (e.g., cancer, dysphagia, neurological disease)
MUST score of 2 for acute disease effect (i.e., no or minimal intake >5 days)
- Requires urgent medical review
Patients at high risk of refeeding syndrome
- Should be directed to NNUH

Gastrointestinal Conditions

(These should be managed by specialist services; referring professionals will be advised accordingly.)

Complex Cyclical Vomiting Syndrome
IBS without adequate diagnosis
Bile Acid Malabsorption
Ulcerative Colitis (during flare)
Crohn's Disease (during flare)
Orofacial Granulomatosis
High Output Stoma
Eosinophilic Oesophagitis
Protein Losing Enteropathy
Decompensated liver disease on transplant list
Acute pancreatitis requiring PERT advice (post-inpatient)
NASH requiring weight loss advice
- Patient should be directed to weight management services
Non-responsive / refractory coeliac disease

Bariatric Surgery

Post-bariatric patients (managed by the Specialist Weight Management Service per NICE guidelines)
- GP may re-engage this service if nutrition-related issues arise
Patients who had bariatric surgery abroad
Aftercare is not routinely commissioned by Norfolk & Waveney ICB
- Patients should contact their surgery provider
- If unavailable, they should seek a private dietitian experienced in bariatric care
- For signs of surgical complications, advise attendance at Emergency Department

More information on private treatment abroad

Inherited Metabolic Conditions

These should be directed to the Guy's and St Thomas' metabolic dietetic team

Other Scenarios Outside Scope

General tiredness or fatigue not linked to nutritional deficiency (e.g., no iron deficiency anaemia)
Requests for:
- General healthy eating advice (e.g., pregnancy, pre-conception, breastfeeding)
- Advice on vegan or vegetarian diets
- Wants to eat healthier without clinical indication

Referrals

The General Community Service accepts referrals from any registered healthcare professional. Referrals are submitted electronically to the Central Booking team, who then forward them to the Clinical Triage team. The Clinical Triage team conducts a preliminary assessment to determine the urgency and type of treatment required based on the information provided.

Care home referrals - Care home staff can now make direct referrals to dietetic services for patients requiring nutrition support by contacting the Central Booking team, who will provide the appropriate referral form: centralbooking@nchc.nhs.uk

For any other dietary advice needed for patients in care homes, referrals must be discussed with and made by a registered healthcare professional.