ACP First Contact Dietitian Led Gastroenterology Clinics

Betsi Cadwaladr University Health Board

Dr T Mathialahan, Gastroenterology and Hepatology Consultant, Clinical Services Lead

Jeanette Starkey, Gastroenterology Dietician, Clinical Lead


An audit in 2017 showed 20% of patients referred to secondary care gastroenterology services within BCUHB East were diagnosed with functional gut issues. There is currently a 144 week (784 patients) waiting list for routine gastroenterology patients, which continues to increase year on year. Urgent waiting list is 53 weeks (328 patients) Consultant Gastroenterology outpatient services at BCUHB East have had a 39% increase in outpatient referrals over the past 4 years; on top of this there is inadequate gastroenterology consultant staffing due to inability to recruit with current staffing at 3 fulltime consultants and 1 part time consultant instead of the recommended 6WTE consultants per 250,000 population. This has increased waiting times as above which has associated financial implications, negative impacts on quality of patient care as well as failing to meet targets set out by national standards for patient groups. Evidence shows that routine gastroenterology patients can be managed successfully in a First Contact Dietitian Led Gastroenterology clinic


  • Reduce the number of non-urgent routine gastroenterology patients who are seen by gastroenterology consultants by triaging them to First Contact Dietitian Led Clinics


  • Reduce the 3 year waiting list for non-urgent gastroenterology patients by offering appointments for assessment and management within the First Contact Dietitian Led Clinics.


  • Reduce waiting times for secondary care gastroenterology consultant outpatient services overall – Enable consultants to see urgent or more complex patients timely reducing risk of admission and improving management plans for patient


  • Provide a more streamlined, safe and effective pathway for the patient



Triage and referral criteria will be developed to enable the gastroenterology consultants to refer appropriate non-urgent gastroenterology patients to an ACP gastroenterology dietitian for initial clinical and dietetic assessment, diagnostics and appropriate management. This will be supported by robust pathways, protocols and scope of practice for clinical governance share across primary and secondary care.

Expected Benefits:

  • Provide alternative timely, safe and effective alternative referral and management pathways for functional gut patients


  • Reduce medication spend – reduced need for endoscopy/colonoscopy


  • Provide a 1-2 month wait for patients to be able to be clinically and nutritionally assessed, differential diagnosis provided and management plan implemented by ACP dietitian


  • Reduce current 3 year medical gastroenterology waiting list


  • Enable gastroenterology consultants to see more urgent and complex patients within a shorter time frame


  • Sustainability: if project is successful, aim to embed this role permanently within BCUHB


  • Integrated approach: develop robust pathways for shared care across primary and secondary care at local, regional and national levels.


  • Value based Care: By continuously monitoring clinical care outcomes, costs and health informatics alongside patient reported experience, we will be able to ensure we provided this value based care within gastroenterology.