Norfolk General Community Dietetics Team

We aim to contact the patient within 4 weeks.

We will accept patients who meet any of our acceptance criteria:

• Malnutrition Universal Screening Tool (MUST) score of 3
• MUST score of 2 with either:
  • BMI (Body Mass Index) <16
  • increased risk of rapid deterioration due to:
    • rapid weight loss
    • underlying medical condition
    • challenging social circumstances
    • concerns about ability to implement "food first" advice
• MUST score of 1 and one of the following conditions:
  • grade 3 pressure sore
  • Motor Neurone Disease (MND)
  • decompensated liver disease (if the patient is on a transplant list, they will be directed to the appropriate specialist service)
• Hyperemesis
• Hyperkalaemia

We aim to contact the patient within 8 weeks.

We will accept patients who meet any of our acceptance criteria:

• Malnutrition Universal Screening Tool (MUST) score of 2 that does not meet urgent criteria - we will send to patients first line advice whilst they are waiting for an appointment
• MUST score of 1 with either:
  • first line advice has been implemented by the GP or healthcare professional referring to our service
  • further deterioration is likely - due to other neurological conditions, dysphagia,  cancer etc
  • severe IBS (Irritable Bowel Syndrome significantly is affecting quality of life or leading to overly restricted diet or MUST 1)
• newly diagnosed Coeliac disease
• type 2 Diabetes - new to insulin
• Motor Neuron Disease (MND) with a MUST of 0
• decompensated liver disease with a MUST of 0 (if the patient is on a transplant list, they will be directed to the appropriate specialist service)

We aim to contact the patient within 18 weeks.

We will accept patients who meet any of our acceptance criteria:

• review of type 2 diabetes (excluding weight-reducing advice)
• obesity requiring specialist dietary advice and does not meet the criteria for weight management services 
• Irritable Bowel Syndrome (IBS)
• reactive hypoglycemia
• needing one-to-one support with First Line Advice conditions:
  • diverticular disease
  • hyperlipidaemia or hypertriglyceridemia
  • gall stones
  • hiatus hernia
  • gout
  • acid reflux
  • single vitamin or mineral deficiencies that would be suitable for First Line Advice (using clinical judgement)
  • other health conditions that would be suitable for First Line Advice (using clinical judgement)

If the patient needs weight reducing advice, please refer to the appropriate weight management service.

We will provide written First Line Advice explaining how diet plays a part in treating some conditions. Over time, following this advice can lead to better management of your condition. Patients will have an option to discuss their diet in more detail by contacting us within 12 months.

We do not accept referrals for:

• Children 16 years old or under
• Children 18 years old or under in under the care of an acute paediatrician (like gastroenterology or cardiology)
• Children meeting criteria for a weight management service

We do not accept referrals for current eating disorder diagnoses (including disordered eating or ARFID). Referrals solely for general dietary assessment or advice will not be accepted.

We will only accept eating disorder referrals if they meet the urgent criteria.

For mild to moderate eating disorders, please contact Eating Matters.

We do not accept referrals for:

• general obesity management
• BMI > 40kg/m² with co-morbidities
• BMI > 50kg/m²
• weight loss support, unless the specialist dietary advice is clinically required like for social or medical reasons

Please refer to the local service, Weight Management - Norfolk County Council

We do not accept referrals for:

• patients currently under the care of the Elsie Bertram Diabetes Centre
• newly diagnosed type 2 diabetes mellitus, unless a 1:1 interpreter is needed

Please direct patients to Diabetes NoW.

We do not accept referrals for:

• suspected IGE-mediated allergy without confirmed diagnosis or treatment plan
• complex allergy presentations
• dietary advice for breastfeeding mothers due to suspected milk allergy in infants

For suspected IGE-mediated allergy without confirmed diagnosis or treatment plan, refer to Addenbrooke's Allergy Service.

For dietary advice for breastfeeding mothers due to suspected milk allergy in infants, refer to paediatrics dietitians.

We do not accept referrals for:

• patients already under the care of renal consultants
• CKD Stage 4 or 5, or rapid deterioration from Stage 3 (without existing consultant involvements
• Renal transplant patients

If your patient has CKD Stage 4 or 5, or rapid deterioration from Stage 3, refer to renal consultants.

We do not accept referrals for:

• patients in end-of-life care (GSF Red)
• Malnutrition Universal Screening Tool (MUST) score 1, without a significant medical history affecting nutrition like cancer, dysphagia, neurological disease
• MUST score of 2 for acute disease effect (minimal or no intake in more than 5 days)
• patients at high risk of refeeding syndrome

If your patient has a MUST score of 2 for acute disease effect, they require an urgent medical review.

If your patient is at high risk of refeeding syndrome, refer them to Norfolk and Norwich University Hospitals.

We do not accept referrals for:

• complex cyclical vomiting syndrome
• IBS without adequate diagnosis
• bile acid malabsorption
• ulcerative colitis (during flare)
• Crohn's disease (during flare)
• orofacial granulomatosis
• high output stoma
• eosinophilic oesophagitis
• protein losing enteropathy
• decompensated liver disease on transplant list
• acute pancreatitis requiring PERT advice (post-inpatient)
• NASH requiring weight loss advice
• non-responsive or refractory coeliac disease

These conditions managed by specialist services. Refer to relevant professionals.

If your patient has NASH requiring weight loss advice, redirect to weight management services.

For signs of surgical complications, visit your local A&E. 

We do not accept referrals for:

• post-bariatric patients
• patients who had bariatric surgery abroad

Aftercare is not routinely commissioned by Norfolk and Waveney ICB. Patients should contact their surgery provider. If unavailable, they should seek a private dietitian experienced in bariatric care. 

More information on private treatment abroad

If you have a post-bariatric surgery patient, they will be managed by the Specialist Weight Management Service (per NICE guidelines). GPs may re-engage this service if nutrition-related issues appear.

Inherited metabolic conditions should be referred into the Guy's and St Thomas' metabolic dietetic team.

We do not accept referrals for:

• general tiredness or fatigue not linked to nutritional deficiency for example no iron deficiency anaemia
• general healthy eating advice such as for pregnancy, pre-conception and breastfeeding
• advice on vegan or vegetarian diets
• advice on eating healthier without clinical indication