Allied Health Professional Clinical Manager at Primary Care Sheffield and previous Additional Roles Reimbursement Scheme Project Manager for South Yorkshire Dr. Natalie Jones explores how the role of the dietician in primary care is evolving thanks to the impact of the ARRS scheme.

Through the ARRS scheme, primary care networks (PCNs) can recruit for 17 roles within their multidisciplinary teams – including social prescribers, dieticians and clinical pharmacists – to meet the needs of their local populations.

The landscape of primary care is undergoing significant change, and dietitians are very much involved in the heart of it. Thanks to the Additional Roles Reimbursement Scheme (ARRS), Primary Care Networks (PCNs) across England are integrating dietetic expertise into their multi-professional teams, transforming how nutritional care is delivered at the community level.

As the Place-based ARRS Project Manager for South Yorkshire Integrated Care Board, I had the privilege of witnessing this transformation first-hand. From organising leadership placements for dietetic students to working alongside primary care teams, I’ve seen how dietitians are not only enhancing patient outcomes but also reshaping the way we think about preventative and chronic disease care.

Expanding the dietician’s role

Dr Natalie Jones

Dietitians in primary care are no longer confined to hospital settings or specialist clinics. Their roles now span a wide spectrum of responsibilities:

• Chronic disease management: Dietitians play a pivotal role in managing conditions like diabetes, cardiovascular disease, and obesity. Through personalised dietary planning and education, they help patients take control of their health.
• Preventive care: Nutritional assessments and health promotion activities are key tools dietitians use to prevent the onset of chronic conditions. Their work helps identify risks early and empowers patients to make healthier choices.
• Patient education and counselling: From tailored dietary advice to behavioural counselling, dietitians support patients in making sustainable lifestyle changes.
• Support for specific populations: Whether working with children, pregnant women, or the elderly, dietitians adapt their approach to meet diverse nutritional needs.
• Collaboration with healthcare teams: Dietitians are integral members of multidisciplinary teams, coordinating care plans and contributing to holistic patient management.
• Specialised dietary interventions: They offer expert guidance on managing food allergies, intolerances, and gastrointestinal disorders, ensuring patients receive safe and effective nutritional care.

A patient story: Leo and Zara

The example of Leo and Zara really illustrate the impact of dietitians in primary care,.

Leo, a 28-year-old with type II diabetes and asthma, was referred to Zara by a practice nurse working within the PCN. His diet was high in carbohydrates, and despite some initial changes, his HbA1c levels remained high a year after diagnosis. Zara provided targeted dietary education, helping Leo switch to whole grain bread, reduce carbohydrate intake, and incorporate vegetables into his meals. She also encouraged light physical activity after meals to aid glycemic control.

Together, they explored the NHS low-calorie dietary programme aimed at diabetes remission. Zara, now a non-medical prescriber, facilitated Leo’s enrolment and medication adjustments. Nine months into the programme, Leo’s HbA1c dropped to 53, and he lost 10lbs – clear evidence of the programme’s success and Zara’s vital role in his journey.

What can GPs expect when employing a dietitian?

The integration of dietitians into primary care brings clear and tangible benefits:

• Improved Patient Outcomes: Effective dietary interventions lead to better chronic disease management and increased patient satisfaction.
• Reduced Healthcare Costs: Preventive care and improved disease management reduce hospital admissions and long-term treatment costs.
• Enhanced Access to Care: Dietitians provide timely nutritional interventions, expanding the scope of services available in primary care.

Implementation and integration

To maximise the impact of dietitians in primary care, several factors must be considered:

• Funding and resources: ARRS funding supports the inclusion of dietitians in PCNs, making their integration financially viable.
• Training and support: Continuous professional development and interdisciplinary training ensure dietitians remain current and collaborative.
• Patient awareness: Education campaigns and clear referral pathways help patients understand and access dietetic services.

Looking ahead: Recommendations for the future

As we continue to strengthen ARRS roles, there’s a compelling case for expanding the scope of dietitians in primary care. GPs should consider community-based dietitians who can work beyond clinical settings, partnering with local organisations to deliver holistic care.

As one practice manager aptly put it:

“Our dietitian has revolutionised our practice. Patients now feel more supported, and we can focus on delivering the highest quality of care. It’s a win-win for everyone involved.”

Initiatives like wellness hubs, frailty services, and peer-to-peer support programmes offer promising models for sustainable, preventative healthcare. These will only continue to grow in the wake of the 10-year health plan and its strong focus on neighbourhood health. By embedding dietitians into these frameworks, we can create a truly person-centred approach to managing long-term conditions, which plays to both the hospital to community and sickness to prevention shifts.

For more information about ARRS roles and the multi-disciplinary team visit: NHS England » Expanding our workforce