Nutrition & Dietetics - For Clinicians

Nutrition & Dietetics - For Clinicians

Inpatient services

• Our acute services team is made up of dietitians who work within North Bristol NHS Trust providing a dietetic service to all the wards. The service is available between 8.30am and 4:30pm Monday to Friday.
• Referrals for an inpatient review should be made on ICE.

Discharge Services

• Patients who continue to need support to increase nutritional intake following discharge from hospital will be referred to the community Nutrition and Dietetic team by the ward dietitian if appropriate.
• Patients who are being fed through a feeding tube will be referred to the Home Management Service (HMS). HMS will make arrangements to deliver feed products at home and to monitor progress.

Dietetic Outpatient Referral Criteria

If your patient has never seen a dietitian and you think that they need to, referrals can be accepted in writing.
Referrals by letter can be emailed to outpatients.appointments@nbt.nhs.uk and should include:-

• PMH
• List of medications
• Weight/height/BMI
• Weight history
• Confirmed diagnosis
• Previous relevant investigations and results

If we feel that another dietetic service was more appropriate, we can offer guidance on signposting.

Some conditions (for example diabetes and coeliac disease) do not need a re-referral if the patient has already seen a dietitian.

Please call our office on 0117 4145428 if you would like to discuss a patient’s situation with us.

Outpatient Services:

Outpatient clinics are run at Southmead Hospital Bristol and Cossham Hospital where patients can be treated for a range of conditions.

• We accept referrals from NBT Consultants in

• Gastroenterology (see below for more info)
• Neurology (see below for more info)
• Chronic Fatigue Syndrome (see below for more info)
• Metabolics (see below for more info)
• Oncology (see below for more info)
• Renal (see below for more info)
• Immunology/Allergy
• Dermatology
• Colorectal/UGI Surgery

• We also accept referrals from GPs for

• Patients with an active, diagnosed gastrointestinal condition
  • For patients known to the BRI GI team, please refer them to the BRI Dietitians.
  • For irritable bowel syndrome (IBS), please refer to your community dietetic team.
• Patients with a neurological condition (see below info)
• Patients with a cancer diagnosis (see below info)
• Patients with kidney disease once under an NBT consultant (see below info)

Referrals may also be accepted from other professionals. See speciality specific information for further guidance.

Patients will be offered a face-face, telephone or video consultation where appropriate. We do not offer home or prison visits.

For information on other community teams including diabetes, weight management and eating disorders please see information below.

For Gastroenterology Referrals:

Dietary advice is evidenced to help the following conditions: -
• IBS:

• Please ensure the patient is given a confirmed diagnosis.
• Please rule out other GI conditions including a recent a-tTG and await any pending results before the referral is made.
• Please do not advise the patient to follow a low FODMAP diet without dietitian advice.
• If the patient has tried the low FODMAP diet in the past with a dietitian, and it has been ineffective, please do not re-refer.

• IBD
• Liver disease
• Chronic Pancreatitis/Pancreatic Exocrine Insufficiency
• Oesophageal or duodenal strictures and stents (send referral to NBT Macmillan dietitian unless benign)
• Oesophageal dysmotility/Barrett's oesophagus
• Pancreatic cancer (send referral to NBT Macmillan dietitian)
• Achalasia
• Gastroparesis:

• If diabetes, please optimise blood glucose control prior to referral
• See below for idiopathic gastroparesis

• Dumping syndrome
• Short bowel syndrome
• Coeliac disease
• Eosinophilic Oesophagitis

Dietary advice has limited scope within the following conditions: Bile salt malabsorption, SIBO, functional bowel disorders other than IBS, GORD and non-specific reactions to foods such as headaches, feeling hot/ sweating.  Please do not refer unless exceptional circumstances e.g. extreme weight loss.

For Idiopathic Gastroparesis referrals:

• Referrals for idiopathic gastroparesis will only be accepted from NBT Gastroenterology Consultants

• If a referral is made directly to the dietitians from General Practice, the referral will be rejected.

• All referrals with upper gastrointestinal symptoms should be directed to the Consultant Gastroenterologist who will refer to dietetics following MDT

For Neurology referrals:

All patients with a neurological condition may have queries regarding the best diet for their condition regardless of current symptoms and can be referred for general advice. Neurology referrals are also accepted from GP, MND coordinator, Specialist nurses, Speech and Language therapist and the Community team.

If experiencing any issues with weight maintenance, appetite, dysphagia or gastrointestinal concerns then dietary advice is evidenced to help in the following conditions:

• Parkinson’s Disease
• Huntington’s Disease
• Motor Neurone Disease
• Multiple Sclerosis
• Progressive Supranuclear Palsy (PSP)
• Multi System Atrophy (MSA)
• Duchenne’s Muscular Dystrophy
• Any neuromuscular disorder such as Myotonic Dystrophy

For Chronic Fatigue Syndrome (CFS)/ Myalgic Encephalomyelitis (ME) referrals:

For patients with Chronic Fatigue Syndrome / Myalgic Encephalomyelitis, referrals can be sent from the specialist CFS or specialist ME team.

For Inherited Metabolic Condition referrals:

• Referrals are only accepted if the patient is under Inherited Metabolic Disease team and the Consultant Chemical Pathologist. The dietitian then sees patients who attend the Adult Metabolic Clinic.

• For more info on referring to this service see Clinical Biochemistry Clinics page

For Macmillan Dietitian referrals:

• Vicky Jane Macmillan Dietitian can provide nutrition support to patients at any stage following a cancer diagnosis.
• Self-referral forms are available in the NGS Macmillan Wellbeing Centre or download the form on Remedy

• Can also email referral details to Vicky Jane: MacmillanDietitianReferrals@nbt.nhs.uk

For Kidney Failure/Renal referrals:

The specialist renal dietitians can only accept referrals for patients with an eGFR of less than 20ml/min, under the ongoing care of the nephrologists at Southmead Hospital. The patient will be offered a consultation via phone, video or face to face. 

For patients with an eGFR of above 20ml/min you may wish to signpost them to the following websites for more information:

• North Bristol NHS Renal Dietitians Fact Sheets Nutrition & Dietetics: Kidney Disease and Food | North Bristol NHS Trust (nbt.nhs.uk)
• Kidney Care UK https://www.kidneycareuk.org/about-kidney-health/living-kidney-disease]

Patients with kidney disease may be at higher risk of malnutrition, so please refer to local guidelines for referral to community dietetics. If within BNSSG then please find a link here to nutrition & dietetic services in the community. (https://remedy.bnssgccg.nhs.uk/media/4707/nutrition-and-dietetcisreferral-and-criteria-pathway-v5-a3.pdf). 

Other Community Dietetic Teams:

For Weight Management referrals:

For weight management (Tier 3 or 4) please refer to the North Bristol Centre for Weight Loss, Metabolic & Bariatric Surgery. The referral criteria and GP referral forms can be found here: https://www.nbt.nhs.uk/clinicians/services-referral/bristol-weight-management-bariatric-service-bwmbs-clinicians.

NBT consultants should refer via e-referrals. 

For Diabetes referrals:

If you are a clinician looking to refer a patient, please see indications for referral to North Bristol Trust’s Multi-disciplinary Diabetes Clinics here: https://www.nbt.nhs.uk/clinicians/services-referral/diabetes-endocrinology-clinicians

For Eating Disorder referrals:

If the patient is under 18:

• Refer to the Department of Nutrition and Dietetics at Bristol Children’s Hospital.

If the patient is over 18:

• GPs in North Somerset, South Gloucestershire or BANES should refer to the Primary Care Liaison Service.
• GPs in Bristol should refer directly to the STEPs eating disorders service (0117 414 6645).

For dietary advice relating to other mental health conditions, you can refer to the AWP dietitians if the patient is currently under AWP (awp.dietetics@nhs.net)