INAUGURAL NI AHP
CONFERENCE
2013:
“AHP’s – Transforming Your Care”
Wednesday, 23 October,
Lagan Valley Island,
Lisburn
Extended Scope Practitioner
(ESP) Led Coeliac Clinic
Joy Whelan, Community Dietitian
Anne Gormley, Head of Nutrition and Dietetic
Services
William Dickey, Consultant Gastroenterologist
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
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
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
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
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
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
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
Service improvement

Opportunity for patients to receive dietary advice
as required

Prompt consultant review as needed

Significant cost benefits

Favourable service user feedback
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”
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”
Thank you