Jenny Ward, a PCN dietitian employed by University Hospital Coventry and Warwickshire NHS Trust is contracted under the additional roles reimbursement scheme (ARRS) to work for Unity PCN in Coventry across three GP practices. She also provides services to students at Coventry and Warwick Universities.
In her first column for Pulse PCN, Jenny explained how dietitians prioritise prevention in primary care. Here, she demonstrates the value she brings by providing a glimpse into a busy – but rewarding – day in her role.
Thursday 27 February
Thursdays are always busy with double clinic – which means back-to-back appointments. After a week’s annual leave, I also have 25 new patient tasks to catch up on and I’m helping one of the GPs reach out to the pre-diabetic patients to remind them to have their annual HbA1c check, so I’ve been fitting that in as time allows.
9 am: My first patient is a follow-up for a low FODMAP diet – a 45 year-old woman with IBS who had been struggling with gastro pain for months. After stabilising her weight and improving her overall diet, we’d focused on identifying potential food triggers. Today, she reports a significant reduction in her symptoms after eliminating lactose, onions and garlic. She is incredibly grateful and I’m happy to discharge her.
9.20: I see a 42-year-old man with Type 2 diabetes, diagnosed in 2023. This is his third appointment and I’m thrilled that his HbA1c has improved from 56 to 50 over the past six months and he’s lost 3.8kg, bringing him to a healthy BMI. He’s made changes to his diet and exercise routine and feels confident in maintaining them. His long-term goal is to stop his metformin and potentially put his diabetes into remission.
9.40: I call a new patient, a 27-year-old woman with pre-diabetes, low iron and irritable bowel syndrome. We discuss ways to achieve a more balanced diet and ensure she gets adequate iron intake. I request a faecal calprotectin test and we go over some first-line IBS advice; she’s keen to keep a food and symptom diary. I schedule a follow-up for one month’s time.
10.20: Another new patient. She has had Type 2 diabetes for five years and her HbA1c has recently increased from 49 to 60; she’s also gained 6kg. Through our discussion, she recognises that she has been snacking more frequently and eating larger portions. We discuss the T-plate model for meal planning, incorporating more wholegrain carbohydrates into her diet and increasing her daily step count. I gave her a blood form to recheck her HbA1c in three months, and she’ll book another appointment then if needed.
11.00: A no-show gives me time to work through my tasks and call one of my nutritional support patients, who is now seeking help again after cancelling a previous appointment. I re-issue her supplement prescription and schedule a face-to-face appointment for a few weeks’ time to check her weight and compliance.
11.20: My final morning appointment is with a 66-year-old woman with COPD. She has been struggling to gain weight, and we discuss switching one of her cups of tea to a nutritional supplement drink. I update her prescription for the GP to authorise.
After finishing my clinic notes, I contact patients referred to me to offer appointments, grab a quick lunch with the team and head downstairs to send text reminders to the pre-diabetic patients.
Afternoon
1.30pm: This clinic begins with another no-show (who doesn’t answer her phone when I call), so I continue sending text reminders.
1.50: Next comes a follow-up for weight management. Although the patient has not yet lost weight, she has made many positive changes to her diet and started at the gym. She has questions about her recent blood tests, and I explain the implications of her raised triglycerides and how her lifestyle changes will help. She declines referral to the hospital weight management service, preferring to continue with monthly support in the surgery.
2.10: A nutritional support review; this patient has successfully increased his weight despite reducing his oral nutritional supplement drinks, so I’m able to discontinue his supplement prescription. He agrees to monitor his weight fortnightly and will return to me if it starts decreasing again.
2.30: I see a 23-year-old student who has been struggling to increase her weight to a BMI of 18.5 to start her ADHD medication. Over the past two months, she has remained focused and consistent with her supplements and had gained 8%, achieving a BMI of 18.8. This means the GP is able to refer her back to psych services for her medication. A follow-up is booked for two months’ time.
2.50: Another student attends with a BMI of 17.5 – referred for nutritional support by the eating disorder team as she had not met the criteria for an eating disorder. While she has maintained her weight since her first appointment, she has not gained any. Recently diagnosed with ASD, she is happy to incorporate a nutritional supplement drink into her routine and we discuss how the structure of having a drink might help her manage her stress around eating. I arrange for samples to be sent to her home and will follow up regarding her preferences.
3.30: The next patient doesn’t attend (but I phone him and he apologises and rebooks). He has started making changes to his diet since our previous review and wis keen to discuss his progress.
3.50: My final appointment is a telephone consultation for nutritional support. It’s tricky as the patient’s on the bus, but she’s happy to update me on her progress, noting that she has gained 2kg by adding homemade milkshakes to her diet. We agree to follow up in two months.
I wrap up my admin and check tomorrow’s clinic to ensure all slots are filled. Today has been varied, busy and filled with successes. It’s rewarding to see progress in my patients and to know that the support I provide is making a difference to them – and to general practice.