1. INAUGURAL NI AHP CONFERENCE 2013: Wednesday, 23 October Wednesday, 23 October, Lagan Valley Island, Lisburn “AHP’s – Transforming Your Care”

2. Extended Scope (ESP) Led Coeliac Clinic Extended Scope Practitioner (ESP) Led Coeliac Clinic Joy Whelan, Community Dietitian Anne Gormley, Head of Nutrition and Dietetic Services William Dickey, Consultant Gastroenterologist

3. What is disease? 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. Service Service improvement  Opportunity for patients to receive dietary advice as required  Prompt consultant review as needed  Significant cost benefits  Favourable service user feedback

11. 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”

12. …… 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”

13. Thank you