Senior Specialist Dietitian - Home Enteral Nutrition for Adults

Lewisham and Greenwich NHS Trust, (LGT), is a community-focused provider of local and acute care, delivering high-quality services to over one million people living across the London boroughs of Lewisham, Greenwich, and Bexley. We provide whole-life care and are here to support our communities to live healthier lives as well as taking care of them when they need us the most.

Employing almost 7,500 colleagues, affectionately known as Team LGT, we provide services at Queen Elizabeth Hospital in Woolwich, University Hospital Lewisham, and at over a dozen community settings in Lewisham. We also provide some services at Queen Mary’s Hospital in Sidcup.

We have recently launched our new vision and values to mark the LGT10 – the tenth anniversary of our Trust forming in 2013. Our trust vision is to be exceptional. In the quality of our patient care; our support for colleagues; and in the difference we make through our partnerships and in our communities.

To achieve this we value Respect, Compassion, and Inclusion; Being accountable over staying comfortable; Listening over always knowing best; and Succeeding together over achieving alone. You can read more about our visions and values here

Our hospitals and community sites provide a wide range of inpatient and outpatient services, as well as emergency and planned care. The Trust is rated as “good” or “outstanding” in over three-quarters of the services inspected by the Care Quality Commission.

Every year our work includes performing 10,000 procedures in our theatres; bringing seven and a half thousand new lives into the world; carrying out 570,000 visits to patients in their homes or communities and providing emergency care for more than 300,000 patients arriving in our busy Urgent and Emergency Departments.

LGT is a centre for the education and training of medical students enrolled with King’s College London’s GKT School of Medical Education. We are a training centre for nurses, midwives and allied health professionals. We are pioneering new roles that will support the changing needs of our patients and are one of the largest employers of physician associates in the country.

We are committed to working with our partners to deliver the best outcomes for our local communities. This means playing an active role in the South East London Integrated Care System (ICS), and in formal partnerships including the South East London Acute Provider Collaborative, provider partnerships with our local mental health trusts and borough-based boards of the ICS in Bexley, Greenwich and Lewisham.

Job overview

An exciting opportunity has arisen for an enthusiastic and motivated Dietitian to join our friendly and innovative multidisciplinary team.

The Home Enteral Nutrition (HEN) Team is a specialist service providing expert support for people of all ages to safely manage their eating and drinking and tube feeding at home in Lambeth, Southwark and Lewisham. We are part of the Nutrition and Dietetics department at Lewisham and Greenwich NHS Trust and work closely with the acute and community dietetic and specialist nursing teams across Southeast London.

The post will be ideal for a Registered Dietitian with experience in nutritional support who wants to develop and influence the specialist service provided to adults living in the community with a feeding tube.

You will be part of an established multidisciplinary home enteral feeding service. You will be a core member of the multidisciplinary HEN Team of Dietitians, Nutrition Nurse Specialists, Speech and Language Therapists, Support Workers and Administrators and be involved in the training and development of the team.

Main duties of the job

Our experienced team are ready to welcome you and we can’t wait for you to start.

The post is based at Waldron Health Centre in New Cross and involves visiting patients in their own home across Lambeth, Southwark and Lewisham.

Some work can also be carried out remotely through video and telephone clinics.

PLEASE NOTE: We may not be able to offer sponsorship for this post

Working for our organisation

Our people are our greatest asset. When we feel supported and happy at work, this positivity reaches those very people we are here for, the patients. Engaged employees perform at their best and our Equality, Diversity & Inclusion (EDI) initiatives contribute to cultivate a culture of engagement. We have four staff networks, a corporate EDI Team and a suite of programmes and events which aim to insert the 5 aspirations:

1. Improving representation at senior levels of staff with disabilities, from black, Asian, and ethnic minorities background, identify as LGBTQ+ and women, through improved recruitment and leadership development
2. Widening access (anchor institution) and employability
3. Improving the experience of staff with disability
4. Improving the EDI literacy and confidence of trust staff through training and development
5. Making equalities mainstream

Detailed job description and main responsibilities

Job Summary:

Key Result Areas & Performance:

The post holder will be a member of the Home Enteral Nutrition Team.

The team is a unique team providing a comprehensive, specialist, multi-disciplinary service for adults and children receiving nutrition through feeding tubes. The adults seen by the HEN team may live in their own homes, residential and nursing homes within the boroughs of Lambeth, Southwark or Lewisham

1. Senior Specialist Dietitian in the provision and the service development of the adult dietetic service provided by the HEN team.
2. To autonomously assess and provide a nutritional care plan for a specialist dietetic caseload of adults receiving HEN, liaising with their families, carers, and acute and community health care professionals.
3. Responsible for and take an active role in the day-to-day management of band 6 specialist dietitians and a dietetic assistant. This will involve interviewing, delegating, supporting and training.
4. To provide specialist adult dietetic advice and training to patients, carers and all other health professionals
5. To write, update, disseminate and implement policies and procedures related to Adult Home Enteral Feeding. These policies would impact all Health Care Professionals involved in Home Enteral Nutrition
6. To regularly undertake research and audit in specialist area (HEN)

Clinical Duties and Responsibilities

1. To provide expert, specialist, evidence based, dietetic advice and care to adult patients and their carers regarding home enteral nutrition. Communicating highly complex and sensitive information on nutrition using negotiation, counselling and behavioural change skills.
2. To work autonomously when assessing patients, making clinical decisions, selecting treatments and evaluating outcomes of dietetic interventions.
3. To collaborate with team members to ensure the patient receives care and advice on all aspects of tube feeding at home. This will require particularly close liaison with other health care professionals within the HEN MDT.
4. To develop and maintain close communications with all health care professionals (particularly Consultants, GPs, Acute Dietitians, District Nurses, SALTs) private sector companies and other agencies as necessary in order to provide co-ordinated patient centred care.
5. To arrange visits/clinics for patients and their families in various settings. Attend, where appropriate, local hospital or community meetings and clinics as a representative of or with other members of the MDT.
6. To work with families who may have learning disabilities, mental health problems and challenging behaviours
7. To work with patients who have language barriers to effective communication. This may often require the use of interpreting services via the telephone or with a relevant interpreter at the patient’s place of care.
8. To empathise, communicate and reassure families who may be dealing with unpleasant circumstances/diagnosis relating to the patient. This may include relaying additional unwelcome information relating to the long term nutritional requirements of the patient.
9. To use motivational and negotiating skills to facilitate acceptance and ongoing compliance with nutritional treatment plans.
10. To act as a keyworker to certain families. Besides acting as an emotional support for the family the Dietitian will be responsible as the organisational link between all health professionals involved in the acute and community settings ensuring consistency of services.
11. To be involved with patients and their carers who are considered to have a safeguarding risk.
12. To document all activities concerning patient care in the dietetic patient record notes including all confidential correspondence with health care professionals and enteral feed delivery company in accordance with trust policies.
13. To be responsible for ordering and changing regimes for all enteral feeds and tube feeding ancillaries.
14. To produce timely and informative reports for Consultants, GPs and other health professional relevant to a specific patient
15. To negotiate with carers, clients and other members of the multi-disciplinary team around individual case management and to provide support to other team members and health care professionals in the specialist area of home enteral tube feeding.

1. To make all clinical decisions and judgments autonomously guided by broad professional and organisational policies.
2. To implement specialist clinical dietetic assessment, treatment and management of patients referred to the HEN team. This will include the advising, ordering and prescribing of specialist products listed as ACBS (Advisory Committee on Borderline Substances).
3. To analyse dietary intake and calculate nutritional requirements using clinical judgement and experience as well as computer software as required when completing a treatment plan for a specific patient.
4. To be trained to trainer level in the use of anthropometrics equipment for the assessment of nutritional status such as skin fold callipers, portable and hoist scales, enteral feeding pumps and equipment.
5. To take anthropometric measurements and interpret as part of nutrition assessment of patients ongoing monitoring.

1. To manage and act as an independent holder of the adult caseload ensuring high quality dietetic care is delivered. Carrying out systematic review of patients at appropriate intervals according to prioritising criteria and clinical judgement.
2. To liaise with health care professionals regarding hospital discharges or new referrals and offer joint visits as required enabling them to formulate care plans in relation to enteral feeding which are based on specialist assessment and recommendations.
3. To ensure that the enteral feed and equipment delivery company have accurate information on each patients enteral feeding requirements and that all regimen changes are communicated with adequate notice.
4. To provide cover for the other dietitians within the HEN team during periods of staff absence.
5. To devise and implement specialist evidence/research based guidelines and protocols that can be used Trust(s) wide for the dietetic care management in relation to paediatric enteral nutrition.
6. To demonstrate highly skilled clinical expertise within own team and surrounding NHS Trust’s and act as a resource in the specialism of adult enteral nutrition, advising colleagues on the management within the specialist area.

1. To be solely responsible for prioritising and managing own caseload and to jointly oversee the organisation and development of the caseload across the service, identifying shortfalls and issues to be addressed.
2. To supervise dietitians and dietetic assistants who would assist in the care and administration of Adult HEN patients.
3. To provide support and training to the HEN team administration staff.
4. To write and update, disseminate and implement policies and procedures related to all aspects regarding Adult Home Enteral Feeding across Lewisham, Southwark and Lambeth. This will be used as a point of reference for all organisations.
5. To be aware of trust policies and procedure and participate in their creation and development. The dietitian will be responsible for working under these broad guidelines and when the need arises is able to discuss problems as part of a peer review.
6. To assist in the co-ordination of HEN team service objectives and projects contributing to the team service plan.
7. To ensure all equipment defects, accidents, complaints and clinical incidents are reported to the team leader and necessary action is taken by those concerned.

1. To act as one of the lead roles in providing training and up to date information on adult enteral tube feeding to fellow health care professionals across Lewisham, Southwark and Lambeth (acute and community).
2. To provide effective training to individual patients and their carers/families.
3. To assist in the organisation and participate in formal study days, responsible for devising the contents of own specialist dietetic teaching.
4. To participate in the training of student healthcare professionals.
5. To undertake the measurement and evaluation of own work and current practices through the use and application of evidence-based practice projects, audit, research and outcome measures and lead others in doing so.
6. To pursue an active programme of personal continuing professional development, including attendance at in-service training, journal clubs, and education forums and giving feedback to any courses or conferences attended.
7. To attend and contribute to BDA specialist interest groups and other enteral feeding specialist groups.

1. Regularly take lead in clinical audit within the HEN team using research methodology and present/publish results to promote evidence-based practice.
2. Undertakes clinical trials as appropriate in conjunction with the commercial sector
3. To participate in any clinical research programmes and to initiate research as required.
4. To contribute to team presentations and training on a local, regional and national basis.
5. Clinical findings or scientific research should be presented at national conferences or study days.

Person specification

Qualifications & Training

• 4 year degree in dietetics or equivalent
• Specialist adult training/experience working to or at masters level
• Registration with Health Professional Council
• British Dietetic Association member or equivalent professional insurance
• Evidence of ongoing Professional development

• Advanced British Dietetic Association Course in Nutritional Support in Nutritional Support
• Nutritional Support Training
• Interest in Research
• Member of relevant BDA specialist interest group
• Leadership/Management qualification

Experience

• Significant experience of adult dietetics
• Experience of working as part of a multi-disciplinary team
• Evidence of training student dietitians
• Able to decide priorities for own work area, balancing patient-related and managerial role
• Experience of working in a multi-ethnic and cultural setting
• Experience of working in complex safeguarding situations

• • Working in the community setting
• • Previous experience of conducting audits and or research

Knowledge & Skills

• Understand and abide by standards of professional practice, including confidentiality
• Able to demonstrate awareness of current NHS changes and professional issues
• To have an understanding of the roles and responsibilities of the other disciplines within the MDT team
• Computer Literacy, able to use Word, Excel
• Accurate anthropometrics measurement skills
• Able to effectively manage and prioritise workload
• Ability to communicate complex and emotive information
• Able to work under pressure

We reserve the right to close the post before the stated closing date, please apply early. We do not contact applicants with the outcome of the shortlisting. If you have been shortlisted, you will receive an invite to an assessment day or interview.

We have a number of active staff networks including Disability, LGBT+, Multicultural Inclusion and Women’s staff networks to bring staff together and celebrate diversity across our whole workforce.

Please note, not all roles will meet the criteria for a skilled worker visa.