How to make the service work

The dietitian-led IBS, diet and FODMAP service was adapted by the adoption sites for their local context based on the work of the Bevan Exemplar. They supported individual and group sessions that were delivered by telephone, online and in-person. In this project, NHS Staff and patients were offered the opportunity to join a session based on an open call (for staff) and a referral process managed in primary care or secondary care. These adaptations for how the service was implemented during COVID-19, so took into consideration the changing context for service delivery.

Here is a summary of how it works:

1. A short assessment

  • An assessment is made by telephone, online or email when a person expresses an interest to join a session. This helps establish suitability for the sessions including understanding previous medical history and ensuring that red flags are being eliminated.
  • The people meeting the criteria are asked to complete a one week food and symptom diary prior to attending a session.
  • The people not meeting the criteria are signposted and given advice on next steps, and for some this may include a need to see a GP for symptoms that may be indicating the need for a medical intervention, such as investigations to rule out cancer.
  • This process has been carried out by a dietitian or support team and can take around 20 minutes including the administrative process. One of the adoption sites tested using online forms for this part of the process for inviting NHS Staff to participate, and there are pros and cons for this approach.

2. Two appointments and other interventions

  • The people who attended the sessions came from a range of places including self-referral, GP referral, consultant referral and it is possible to include occupational health referral for staff-based interventions.
  • The appointments were held as individual or group sessions. Where people were attending group sessions, a clear protocol was carried out to make sure that they were sharing appropriately and that an individual follow up was available.
  • There was a variation in how the services can be accessed, and this included telephone, online and in-person sessions. Presented as live sessions, these took approximately one hour per session and all of these were led by the dietitian.
  • One of the new approaches (adaptation) made in an adoption site included the use of pre-recorded videos and activities for the people to follow up with. These could be accessed as an on-demand service and this approach was developed with support from other on-demand services in the UK.

3. Measurements and results

  • Partly because this was part of the national Adopt and Spread programme and for supporting dietitians to track their outcomes, a set of measures were put into place.
  • The usual data points for attendance and following completion of the sessions were collected.
  • Standardised measures were used including a Tracking Tool, symptom scoring, Quality of Life Scale (e.g. Stanford Presenteeism Scale), and where possible self-reporting (or system based data) on medication, GP visits, Consultant appointments, and invasive investigations. Sick leave was measured through self-reporting for the staff-based interventions.
  • The feedback from patients, including comments and qualitative information was collected. This was also important for staff-based sessions to supplement the understanding of how the sessions may have affected their time at work.