Wellbeing Team - Dietitian

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Newham North West 2 Primary Care Network

Dr Samuel & Dr Kahn Practice | East End Medical Centre
Stratford Health Centre | The Forest Practice
Upton Lane Medical Centre


Welcome to the NW2 PCN Dietitians Service

What does a Dietitian do?

Dietitians are registered healthcare professionals with the Health Care Professions Council in the UK. The diagram below describes the Knowledge, Skills and Experience of Registered dietitians:


Interpret the science of nutrition to improve health and treat diseases/conditions


Assess, Diagnose, Treat Dietry and Nutritional Problems 


Work as integral members of multi-disciplinary teams to treat complex clinical conditions

Working as a dietitian in General practice is part of the new NHS Long Term GP Contract Framework - Primary Care implementation project. Working in Primary Care allows me to take a more holistic approach to what I do focussing on improving the health and wellbeing outcomes of the patients I see.

Aim of the Dietetic service:

To provide a personalised care plan based on ‘what matters the most to the patient’, I see. As a result, I am able to provide a tailored and intensive dietetic assessment, management and monitoring approach to me role. In addition, I use a health coaching approach to educate, empower and support patients to self-manage their condition (as appropriate) and improve their health and wellbeing and Quality of Life outcomes.

Rationale of the Dietetic service:

As part of working within the wider PCN health and wellbeing team, I provide a holistic and collaborative service provision to all the patients across the 5 GP practices. Therefore, my dietetic role is aimed at adding value to the existing service provision to better manage and support patients with complex nutritional needs and those patients who require more intensive individualised dietetic input. 

The Value of Dietitians working in primary care:

Research commissioned by the British Dietetic Association (BDA) highlights the impact of dietitians working in primary care, demonstrating how diet and Obesity influence the onset of many long-term conditions including, diabetes, hyperlipidaemia, hypertension, stroke, heart disease, and mental health conditions.  

In addition, the research highlights the high volume of people (96%), living with malnutrition in the community, necessitating efforts to prevent avoidable hospital admissions related to malnutrition. Moreover, the research highlights the high-cost burden associated with food related ill-health, identified to be responsible for approximately 10% of all morbidity and mortality in the UK, with an annual cost to the NHS of £6 billion. For this reason, it is important to identify the close connection between the impact of nutrition interventions on health outcomes, and the need to find better ways to influence people’s diet and lifestyle choices to ensure optimal health (BDA, 2015).

The Types of patients currently seen in as part of the Dietitians service: 

  • Complex Diabetes and weight management patients
  • Nutrition support patients
  • Care and Residential home patients
  • House bound patients
  • Weekly General Clinic - for patients with complex nutritional needs

As many patients within the Borough and PCN are at risk or already suffer with complications associated with Obesity and diabetes and need to lose weight safely, the dietetic service provides 3 presentations tailored to support these groups of patients.

Each presentation is based on The Eat Well Guide – Healthy Eating principles, more information is available on the NHS Live Well Website. Each presentation is therefore broken into 3 parts as follows:

Part 1: Healthy Eating – The Eat Well Guide

Part 2: A focus on the specific problem –

  1. Healthy eating
  2. Healthy Eating for steady weight loss and
  3. Healthy Eating for Pre -diabetes or diabetes)

Part 3: A Health coaching approach to determine where you are at in relation to your health. I developed the ASSESS Model as a tool to help patients think about the importance of their health, and to assess their current levels of motivation and confidence to be able to make lasting changes to improve their health and wellbeing outcomes through behaviour change and adopting new diet and lifestyle habits.

Dietetic Outcome measures:

Dietetic input can have a positive impact on a range of health and wellbeing outcomes including the following: 

  • Reduction in HbA1C levels
  • Improvement in clinical risk factors – Blood glucose control, Blood Cholesterol, Blood pressure, weight 
  • Improvement in malnutrition risk (MUST Score)
  • Improvement in eating pattern/habits/food choices
  • Patients transitioning off from supplements to food first nutritional support – normal diet
  • Effective monitoring of patients on supplements
  • Reduction in number of inappropriate ONS prescriptions
  • Improvement in patient’s behaviour change activation
  • Improvement in patient motivation, confidence and empowerment to self –manage
  • Improvement/ engagement with self-care – taking self-responsibility
  • Improvement in ADL’s and functionality
  • Improvement in QOL –
  • Reduction in GP clinic appointment – hospital admissions

I look forward to engaging with many of you on your journey to improved health and wellbeing.

Claudine Matthews  





Local Services, Let
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