How ARRS is transforming the role of dietitians in primary care
By Dr Natalie Jones
The face of primary care is changing, and thanks to the Additional Roles Reimbursement Scheme (ARRS), dietitians are increasingly becoming essential members of the community health workforce. The BDA’s guide for general practice highlights that by including dietitians in primary care networks (PCNs), we are widening access to nutritional expertise and embedding evidence-based dietary care at the heart of everyday healthcare.
From my vantage point as a former ARRS Project Manager for South Yorkshire and through evaluation of ARRS roles, I’ve seen this transformation in action, from recruiting dietetic students to supporting PCNs in embedding dietetic roles. What I’ve witnessed reinforces that dietitians do more than advise on food: they are frontline clinicians shaping prevention, chronic disease management, and community-based care.
Why Dietitians Belong in Primary Care
The BDA guide clearly outlines the rationale for bringing dietitians into PCNs: dietitians are uniquely qualified to assess, diagnose and treat dietary and nutritional problems, at both individual and public-health levels. They bring up-to-date scientific knowledge, behaviour-change techniques (such as motivational interviewing) and, increasingly, digital tools, enabling patients to manage their diets and conditions effectively.
Furthermore, since 2020 the ARRS was expanded to include dietitians, typically at Agenda for Change pay band 7 or above (and from 2021 potentially band 8a), recognising their advanced clinical value in general practice.
By integrating dietitians into PCNs, practices can proactively respond to the rising burden of long-term conditions and support patients to maintain independence, reduce complications, and improve quality of life.
What Dietitians Do in Primary Care: Beyond Traditional Models
With ARRS-enabled PCN roles, dietitians are no longer bound to the traditional “hospital or outpatient specialist” model. Instead, they work as first-contact practitioners (FCPs), offering a broader and more accessible service to the population.
As part of this evolving role, dietitians may:
Manage long-term conditions such as type 2 diabetes, obesity/overweight, cardiovascular disease, and frailty.
Provide specialist care for gastrointestinal conditions, functional bowel disorders, coeliac disease, food allergies/intolerances, malnutrition, and nutritional support for at-risk populations.
Deliver preventive and health-promotion services: dietary assessments, nutritional counselling, early intervention to prevent chronic disease onset and reduce risks.
Use motivational interviewing, behavioural change methods and, if qualified, supplementary prescribing or management of nutritional “borderline” substances (e.g. supplements, enteral feeds, infant formulas where relevant) under agreed protocols.
Provide training and support to other practice staff, e.g. helping GPs or nurses understand nutrition, screening for malnutrition or dietary issues, ensuring dietetic care is integrated across the PCN.
This model, where dietitians act as diagnostic and management clinicians, marks a significant shift from referral-only services to direct, accessible, and proactive nutritional care.
A Patient Story: Leo and Zara
Sometimes the impact of dietetic care is best understood through lived experience. Leo, a 28-year-old living with type II diabetes and asthma, was referred to Zara, a PCN-employed dietitian, after repeated attempts to control his HbA1c levels.
Zara identified that Leo’s diet remained high in carbohydrates. With focused education and personalised planning, she supported him to swap to whole grains, reduce carbohydrate intake, and increase vegetable consumption. She also encouraged short periods of physical activity after meals to aid glycaemic control.
Together, they explored the NHS low-calorie remission programme. Zara, now also a non-medical prescriber, supported medication adjustments and programme enrolment.
Within nine months Leo’s HbA1c had reduced to 53, and he had lost 10lbs.
His journey represents exactly why dietitians belong in primary care — early intervention, tailored support, meaningful change
Evidence of Effectiveness and Impact
The BDA guide draws on multiple sources to demonstrate the clinical and cost-effectiveness of dietetic services in primary care.
Key findings include:
Dietitian-led lifestyle interventions for people at risk of diabetes or with type 2 diabetes are effective at reducing body weight and improving glycaemic control.
Dietetic input for gastrointestinal disorders such as IBS can significantly reduce referrals to secondary care, improve symptoms, and enhance quality of life.
For older or frail patients at risk of malnutrition, dietetic interventions (including nutritional supplementation and tailored dietary advice) can improve outcomes — weight, muscle strength (e.g. hand-grip strength), and reduce risk of hospitalisation.
Dietitians can help rationalise the use of nutritional supplements and “borderline” nutrition products, generating cost savings: for instance, a small-scale review of oral nutritional supplement prescriptions among 27 patients delivered substantial estimated savings.
These data point to the potential for dietetic services in primary care to reduce pressure on secondary care, lower hospital admission rates, and support sustainable healthcare delivery, while delivering high patient satisfaction.
Practical Integration: How PCNs Can Employ Dietitians
The guide provides practical advice for PCNs looking to bring dietitians into their teams.
Options include:
A service-level agreement with a local NHS Trust dietetic department, ideal where existing infrastructure supports supervision, cover for leave, training, and continuity of care.
Contracting a freelance dietitian, flexible arrangement, though requires clarity around supervision, indemnity, and continuing professional development.
Employing a dietitian directly within the PCN, ensuring full integration within the team, though the PCN needs to provide CPD, supervision, and professional indemnity, as well as arrangements for leave and professional development.
The guide also recommends that PCNs set clear objectives and measurable outcomes when establishing dietetic services, both to evaluate clinical impact and demonstrate value (e.g. reductions in hospital referrals, improved chronic disease markers, patient satisfaction, cost savings).
What This Means for GPs, Practices, and Patients and Where We Go From Here
The shift toward embedding dietitians in primary care is more than a structural change. It’s a paradigm shift in how we approach nutrition, chronic disease, prevention, and community health.
For GPs and practices, employing dietitians can reduce workload by managing diet-related care, freeing up GP time for complex medical issues. It also expands the scope and reach of your service, allowing you to offer faster, more specialised nutritional care without referring to secondary care, and to embed preventive health into routine practice.
For patients, it means easier access to expert dietary care at the point of first contact. Whether it’s managing diabetes, preparing for pregnancy, dealing with IBS, or preventing malnutrition in older age, dietitians bring specialist expertise and a holistic approach to care.
For the wider health system, it strengthens preventive care infrastructure, reduces avoidable complications, supports self-management, and potentially reduces cost burdens through fewer hospital admissions or long-term complications.
Looking ahead, I believe there is strong justification for expanding dietitians’ scope further, by embedding them in community health hubs, frailty services, wellness programmes, and population-health initiatives. As the BDA guide suggests, dietitians are uniquely placed to support integrated care models that prioritise prevention and holistic wellbeing.
Conclusion
The BDA guid, in combination with the opportunities created by ARRS, underlines a clear truth: dietitians are not just “nice-to-have” extras, they are essential clinicians for modern, community-based primary care.
By embracing their role as first-contact practitioners, integrating dietetic services into PCNs, and committing to training, governance, and evaluation, we have the opportunity to redefine nutritional care, improve population health, and make primary care more responsive, sustainable and person-centred.
For practices yet to consider this route, it is a timely moment to explore adding a dietitian to your team.
📚 References
British Dietetic Association. Dietitians in primary care: A guide for general practice. BDA. British Dietetic Association+1
British Dietetic Association. Dietitians in Primary care. BDA discussion paper — arguing for a recognised “expert generalist” dietitian role in general practice. British Dietetic Association
Gloucestershire Primary Care Workforce Centre. The Role of Dietitians in Primary Care Networks. — noting that, since April 2020, dietitians are included in the Additional Roles Reimbursement Scheme (ARRS) for PCNs. glosprimarycare.co.uk+1
NHS Training Hub (e.g. Kent & Medway, Sussex) — summarising that dietitians in primary care: diagnose and treat nutritional problems (diabetes, IBS, obesity, etc.), support long-term condition management, enable prevention and self-management, and may act as First Contact Practitioners. Kent & Medway Primary Care Training Hub+1
The contribution of dietitians to the primary health care workforce (Howatson A, Wall CR, Turner-Benny P; Journal of Primary Health Care, 2015) — a systematic review showing that dietetic intervention in primary health care leads to significant improvements in health outcomes (obesity, diabetes, cardiovascular disease, malnutrition in older adults) and is cost-effective compared to “usual care.” ResearchGate
Impact of a dietitian in general practice: Care of the frail and malnourished (Journal of Human Nutrition & Dietetics, 2021) — demonstrating how dietitians, acting as first contact practitioners within general practice teams, deliver significant improvements for older patients at risk of malnutrition and frailty, including cost savings. ewin.nhs.uk+1
Effectiveness of Nutritional Intervention Led by Clinical Dietitians on Nutritional and Functional Status in Patients (Mlakar-Mastnak D, et al., 2024) — reporting that dietitian-led nutritional interventions improved patients’ nutritional intake, nutritional status, and functional outcomes. PMC
A case study of the impact of a dietitian in the multi‑disciplinary general practice team (Hickson M, Child J, Collinson A; BDA-commissioned PCN study) — showing reductions in GP/secondary-care contacts, faster referral-to-dietitian times, and improved outcomes for e.g. paediatric food allergy and GI disorders under a dietetic-led model, compared to traditional referral pathways. glosprimarycare.co.uk+1
