This guidance is part of the Community Nutrition and Dietetic Service Referral Guidance
Prior to referral, adults should be provided with the following first line dietary advice: Fibre | British Dietetic Association (BDA)
Additionally the importance of fluids should be emphasised with the following first line advice: Dehydration - Illnesses & conditions | NHS inform.
Adults for whom the first line advice is ineffective can then be referred to the community dietitian.
Patients can access first line information via Crohn's & Colitis UK
Patients who do not respond to first line dietary advice and are not under the care of Gastroenterology can be referred to the community dietitian.
Patients under the care of Gastroenterology should access dietetic care via their Consultant or contact their IBD Helpline. The IBD helpline numbers are:
A diagnosis of dementia can increase the risk of malnutrition, swallowing difficulties and other nutritional related problems. Please refer to Nutrition Support and Dysphagia sections below for further information.
All adults newly diagnosed with Type 2 Diabetes will be invited to attend our education programme called ‘Control It Plus’. This programme provides detailed dietary advice for patients newly diagnosed with diabetes. Patients who did not engage at the time of their diagnosis or who are not newly diagnosed can also be referred by calling our T2D Hub on 0141 531 8901 or emailing: ggc.type2diabeteshub@nhs.scot
Additionally patients may find the following web link helpful: Type 2 Diabetes Hub - NHSGGC
Newly diagnosed patients will also automatically be referred for weight management support, if eligible. For other patients who require weight management, please follow the NHSGGC Weight Management pathway: Manage your weight - NHSGGC Full referral guidance can be found here.
Adults with Type 2 Diabetes who would prefer an individual appointment, require additional dietary advice or patients with deteriorating or sub-optimal diabetes control, can be referred to the community dietitian for dietary assessment and advice.
As people with pre-diabetes are now formally recognised as being "at risk" of developing diabetes, they can also be referred into the Weight Management Services. Links to self-help weight management materials and referral guidance are included in the information above.
NHSGGC has developed a video to provide advice to people with pre-diabetes. Patients may also find the following link provides them with helpful information:
NHSGGC - Information on Prediabetes - YouTube
How to prevent type 2 diabetes | Diabetes UK
N.B. Referrals for patients with Type 1 Diabetes are not appropriate for the community dietetic service. These patients should be manged via secondary care services.
Patients suspected of having a swallowing problem should be referred, in the first instance, to a Speech and Language Therapist (SLT). If, the SLT confirms the patient has dysphagia and recommends an appropriate IDDSI level(s) a referral can be made to the community dietitian. The community dietitian will support the patient with implementation of the SLT recommendations, whilst ensuring nutritional adequacy of their nutritional intake. The following link provides further information: IDDSI - IDDSI Framework
All patients on Home Enteral Feeding should already be under the care of a dietitian. The majority of patients will be under the care of a community dietitian and a small number of patients will be under the care of a specialist hospital dietitian or the Community Rehabilitation Dietitian.
Dietitians regularly correspond with GPs regarding patients on enteral feeding and their contact details will be contained within these letters. In addition to this, for patients under the care of a community or hospital dietitian, you can view the patient’s electronic record on Clinical Portal.
If you have any questions relating to enteral feeding, please contact your local community dietitian. Details of how to contact your local community dietitian can be found in Section 5.
Patients require to be under the care of a Gastroenterologist to enable MDT management of dietary interventions.
Patients under the care of Gastroenterology should access dietetic care via their Consultant.
Dietary changes can often help improve IBS symptoms. All adults with IBS should be provided with the following first line advice: Irritable Bowel Syndrome (IBS) - NHSGGC
All adults with a confirmed diagnosis of IBS who continue to experience symptoms that do not respond to first line advice, can be referred to the community dietitian for an initial first line appointment. Advice on a Low Fodmap diet will only be offered, if appropriate, following an initial appointment.
N.B. Prior to referral, the dietetic service requests that patients have had symptoms for 6 months or more and that coeliac disease, Inflammatory Bowel Disease (IBD) and other red flag indicators have been excluded: NICE CG61 - Diagnosing IBS
Patients with Decompensated Liver Disease (cirrhosis with symptoms of ascites/oedema, encephalopathy, jaundice, varices etc.) should not be referred to the community dietitian. Such patients should access specialist dietetic advice via their consultant.
Patients with Decompensated Non-Alcoholic Fatty Liver Disease (NAFLD) cirrhosis should not be referred to the community dietitian. Such patients should access specialist dietetic advice via their consultant.
Patients with Compensated Liver Disease with no symptoms of decompensation can be referred to the community dietitian.
Compensated NAFLD can be referred to the community dietitian or if appropriate the patient should be referred to Glasgow & Clyde Weight Management Services. See weight management section for further information.
Many conditions can result in weight loss and lead to adults being at risk of malnutrition.
If you suspect your patient is at risk of malnutrition, you may wish to complete the screening tool called MUST: MUST Calculator This tool, which is quick and easy, calculates the level of malnutrition risk.
Patients at risk of malnutrition should be provided with the following first line advice: Eating to Feel Better Leaflet
NHSGGC has developed the following patient pathway for adults at risk of malnutrition Managing Adult Malnutrition
If first line nutrition support advice does not address the risk of malnutrition, patients can be referred to the community dietitian. Referral details should include current weight and height, previous weights for the last 6 months and preferably the MUST Score.
If the patient is a resident in a care home, please ask the care home to refer to the community dietitian directly. Care home referrals for nutrition support advice can only be accepted if they include a copy of the “MUST Step 5”. Follow this link for further information: NHSGGC: Care Homes
Some patients with or at risk of malnutrition, will require Oral Nutritional Supplements (ONS) as part of their dietary management. Within NHSGGC, as part of the move towards dietetic only initiation of ONS, the Community Pharmacy Nutrition Support Service (CPNSS) was implemented Board wide in March 2022. To support the aims and implementation of this service, GPs and other prescribers in NHSGGC are asked NOT to prescribe ONS products, however, the following exceptional circumstances apply:
For any more information on the CPNSS service: click here
Patients with Chronic Kidney Disease (CKD) 1 - 3 can be directed to the following self-management materials: NHSGGC - Diet and Chronic Kidney Disease (CKD)
However, if dietetic advice is required, this type of patient can be referred to the community dietitian.
If the patient has a raised potassium level or phosphate level, they require specialist renal dietetic advice which would be accessed via the patient’s renal consultant.
Patients who are under the care of a renal consultant with CKD 4 and 5 (eGFR ≤ 30 ml / min) should not be referred to the community dietitian. Such patients should access specialist dietetic advice via their consultant.
NHSGGC Dietetic Service website provides further information for patients: Dietetic website
Patients should be provided the following first line advice by accessing: Crohn's & Colitis UK
Patients who do not respond to first line dietary advice and are not under the care of Gastroenterology can be referred to the community dietitian.
Patients under the care of Gastroenterology should access dietetic care via their Consultant or contact their IBD Helpline.
The IBD helpline numbers are:
GGC - Primary Care