Jeanette Starkey, Advanced Clinical Practitioner Dietician, Dr Mathialahan, Consultant in Gastroenterology, Betsi Cadwaladr University Health Board
Building Capacity and Reducing Waits in Gasteroenterology Planned Care
Innovation Overview:
The initiative significantly reduces excessive gastroenterology waiting times by diverting approximately 20% of routine secondary care referrals identified as functional complaints to a specialised Gastroenterology Clinic led by an Advanced Clinical Practitioner (ACP) Dietician for assessment, investigations and treatment. This approach releases consultant capacity, enabling them to focus on more urgent cases while maintaining quality care.
Strategic Case for Adoption:
Routine gastroenterology waiting times have exceeded three years in BCUHB, creating a backlog and delaying care. Medically triaged functional cases that do not require surgery can be effectively managed by an ACP Dietician, thus alleviating pressure on consultant gastroenterologists. This innovative approach supports Wales’s priorities for planned care recovery by addressing capacity issues and reducing waiting times in gastroenterology services. Expanding the model across other health boards in Wales would standardise the approach to managing functional cases and optimise existing resources.
Methodology:
Gastroenterology triage secondary care referrals and refer routine patients identified with functional complaints to be seen in a gastroenterology clinic, run by an ACP Dietician. The ACP Dietician will provide an assessment, refer the patient for necessary investigations, review medication requirements, and provide dietary and lifestyle guidance. The ACP Dietician will discuss and if required escalate any complex cases to the Consultant and upon discharge provide a discharge report to the Consultant and referring GP.
Clinical & Systems Impact:
- Reduced Wait Times: Routine gastroenterology waits have been shortened from over three years to just three months.
- Improved Service Delivery: During the pilot, 500 consultant appointment slots were made available, and 318 patients were removed from the Wrexham secondary care waiting list.
- Enhanced Clinical Outcomes: The ACP Dietician’s assessments have led to the detection of some serious conditions, such as lung and breast cancers, through timely investigations, thereby improving patient outcomes.
- Increased Consultant Capacity: Releasing consultant time allows for a higher volume of urgent cases to be addressed, improving overall service efficiency.
The success of the project has led BCUHB to request the scale-up of this model to its other two sites, with the potential for significant benefits if expanded nationally.
Economic Impact:
The initiative presents a cost-effective solution for addressing gastroenterology waiting lists:
- Cost Savings: The initiative has already released £108,000 in consultant time savings at Wrexham Maelor Hospital alone over the pilot period.
- Consultant Support: Gastroenterology consultants are fully supportive of this model, as it effectively optimises their workload.
Key Benefits:
- Reduced Waiting Times: Significant reduction in routine gastroenterology waiting times improving patient access to care.
- Early Intervention and Diagnosis: Prevents delayed or misdiagnosis
- Improved Clinical Outcomes: Timely assessments by the ACP Dietician improving patient safety and care quality.
- Increased Capacity for Urgent Cases: Freeing up consultant time enables quicker access for more urgent referrals (especially important where there is a shortage of Gastroenterology Consultants)
- Enhanced Multidisciplinary Team (MDT) Efficiency: Optimised workflows enhance collaboration and service delivery.
- Staff Upskilling: The ACP Dietician role provides opportunities for professional development within the team.
By reducing routine service pressures through an ACP Dietitian-led clinic, the model has demonstrated success in significantly reducing waiting times, optimising consultant capacity, and improving clinical outcomes. Its proven, scalable approach offers a compelling opportunity for sustainable, system-wide improvement in planned care.
Resources for Health Boards
Relevant Policy
Our Programme for transforming and modernising planned care and reducing waiting lists in Wales (2022).
Goals:
- Effective referral
- Treat accordingly
Priorities:
- Transformation of outpatients
- Prioritisation of diagnostic services
- A focus on early diagnosis and treatment of suspected cancer
- Implementation of a fair and equitable approach to patient prioritisation
- Eliminating long waiters at all stages of the pathway
- Building planned care capacity
- Appropriate information and support
Welsh Innovation Strategy (2023)
Priorities:
- Diagnostics
- Reducing waiting lists
- Supporting a talented workforce
Promote, prevent and prepare for planned care (2023):
Supports:
- Advice and guidance to patients and individualised care along the pathway
- Efficiency of care
- Increased service capacity
- Collection of data
NHS Wales Technical Planning Guidance 2025 – 2028
Supports the ministerial priority of timely Access to Care
Service Presentation Material:
ACP Dietician Gastroenterology Service Presentation
ACP Dietician Gastroenterology Service Poster
Service Implementation Material:
Available upon request:
- Business Case
- Adoption Case for Change
- SBAR
- SOP
Planned Care Innovation Programe
This initiative was selected for piloting as part of the Planned Care Innovation Programme. It was rigorously evaluated with proven substantial benefits (service, staff and patient level).
ACP First Contact Dietitian Led Gastroenterology Clinics – Bevan Commission
NHS Wales Technical Planning Guidance 2025- 2028:
The proven innovation from the Planned Care Innovation was recognised for its potential to support and modernise pathways for outpatients by delivering care within a multi professional team.
Allied Health Professions Conference in Wales in 2024.
This initiative was recognised for its exemplary role in transforming planned care by Ruth Crowder, Chief Allied Professions Adviser for Wales.
Awards:
Advancing Health Care Awards Wales (2023)
BCUHB Innovative Care (2023)
Testimonials:
Dr Mathialahan, Consultant in Gastroenterology
”The Dietitian First Clinic has been very helpful in reducing the waiting time for this group of patients and therefore reduced the time experiencing impaired quality of life and poorly controlled/undiagnosed symptoms”.
Dr B. Ahmad, Consultant in Gastroenterology
”Data presented including patient feedback both strongly suggest that we should continue this service and even try to recruit more to this service. It has also helped in improving staff skills and have given department an extra reliable support for outpatient work”.
Dr P George, Consultant in Gastroenterology
”Dietician led services off load the overstretched gastroenterology service with a waiting time of more than three years. These patients do not need consultant input and are best managed by dieticians. We can triage the right set of patients to this essential service. It is the most cost effective and efficient way to run the clinical service in Wrexham. Failure to do so will result in complete collapse of GI service at Wrexham”.
