AHPs Day 2018 - Liz McCreery, Macmillan Specialist Dietitian

The second in our week of features on Allied Health Professionals working at Manchester Local Care Organisation to coincide with AHPs Day 2018.

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As a dietitian working for MLCO, I focus on the food and nutrition needs of patients across Manchester.

I work as part of a community Macmillan specialist team. The Macmillan AHPs see both patients who are palliative but also some with curative conditions with complex needs.

Cancer or life-limiting diseases (e.g. COPD, end-stage heart failure, MND) can impact an individual’s nutritional intake and status.

Food is a very emotive subject – it is part of our daily routines, culture and identity. Food is a major part of special occasions throughout our life; from the happiness of celebrating the birth of a baby, birthdays and weddings, to the sad occasion when someone dies.  

Many illnesses and types of cancer can make it very difficult to eat or enjoy food; this loss of normality can cause a myriad of emotions including fear and anxiety. Rehabilitation is a primary aim for AHPs in our team, where we aim to maximise the individual’s ability to function, to promote their independence and to help them to adapt to their condition. We aim to improve their quality of life no matter how long or short the timescale enabling them to live as well as possible for as long as possible.

As a Macmillan Dietitian I regularly deal with a lot of psychological issues, surrounding weight and body image. Patients may unintentionally lose weight or others may gain excessive amounts of weight due to their treatment and/or medication. A majority of the patients I see have a reduced appetite which can contribute to unintentional weight loss. Some people may lose a considerable amount of weight despite eating well due to their disease progression.

Dramatic unintentional weight loss can be very upsetting for both the patient and the family. Preparing meals and snacks is sometimes one of the few things that the carer feels that they can do, however this can cause tension and stress between individuals if the meals prepared are not eaten.  I often try and help families work through these situations. I may see people before, during and/or after treatment such as surgery, radiotherapy and chemotherapy. 

I am based with the North Manchester Community Macmillan Team. We are quite a large multidisciplinary team consisting of AHPs including an Occupational Therapist, Physiotherapist, Speech and Language Therapist and another part-time dietitian. We also have two part-time Palliative Care Consultants, a GP spending one day a week in our team, manager, nurses, assistant practitioners, volunteer coordinator and well as admin support. Our team works seven days a week, 8am to 8pm. We have a rota for clinicians (AHP or nurse) to cover triage. The role of the triage clinician is to process the referrals that come in during the shift. Also the role of the triage clinician is to take any phone calls during the shift and to action anything where appropriate. This role can vary considerably.

Our team has been working seven days a week for a few years and the result has been to reduce the number of unnecessary admissions and better communication between professionals.  

One of our aims is to help facilitate a person’s choice where they wish to spend their last weeks or days of their life and to prevent inappropriate admission to hospital when they are approaching end of life and want to stay at home. Sometimes family members may just need extra reassurance that they are doing a great job at an especially difficult time.

How we work

I work three and half days so have a caseload of around 45 patients at any one time. It varies how often I will review patients between weekly to monthly depending on their dietetic need. Most of the patients that I see will be in their own homes or nursing homes but I may see patients in our clinic and occasionally I have seen patients in Strangeways Prison. A typical day starts with a short 9am meeting with the Macmillan team where we discuss patients that are being seen that day.

I may see two or three patients in the morning and the same in the afternoon. We have a 12.30pm meeting where the Macmillan team meets with a district nurse from each of the 4 north hubs. We discuss any new referrals and phone calls that have come in during that shift and any complex issues that have arisen with patients. The district nurses have an opportunity to raise any concerns they have about patients and refer patients to our team.  This meeting has enabled better communication and hence better support for the care of our patients.

We also attend a weekly palliative care MDT meeting at North Manchester General Hospital and Manchester Royal Infirmary. The palliative care team at the hospital will talk about current in-patients and we have the opportunity to discuss any new patients seen in the community and any complex issues. This helps ensure that the care we give our patients are as seamless as possible.

I am also involved with teaching to both qualified and unqualified staff and patient support groups. I have taught at the university and at a local hospice.

How I became an AHP

I was encouraged to become a dietitian from an early age as my Mum was a dietetic secretary and she felt that this was the right career for me! I had the opportunity to shadow dietitians and this gave me a better insight into the types of patients dietitians are involved in.  I have now been qualified for 21 years and I have worked in various parts of the country including Reading, Birmingham and Blackpool in a variety of specialities including gastroenterology, renal, paediatrics, intensive care and home enteral feeding. I have worked in Manchester for 13 years and for Macmillan for 8 of those.  I love working with the huge diversity of Manchester residents.

The best part of my role is quite simply the patients. I feel very fortunate to work as part of the Macmillan Team. I love my job and feel well supported. Every day is so different; it can be challenging but also extremely rewarding.

Find out more about careers in dietetics and the roles of dietitians at the British Dietetic Association website.