FOI/2025/26/325

Request

1. Patient Referrals

a. The number of patients diagnosed with IBS who have been referred to gastroenterology services in each of the past five years.

South West Division: n/a - CLCH does not diagnose patients with IBS or provide Gastro services in South West Division. 

Inner North West Division: 20-30% of our IBS pts are also seeing the Gastroenterologist

Outer North West Division: CLCH ONW division base our criteria on  the ROME IV criteria: if displaying symptoms indicating they require clinical evaluation for other diagnoses. We also look at the patient’s whole clinical picture, there is a long list disorders that can be labelled IBS diagnosis in error. (Coeliac disease/IBD/microscopic colitis/ bile acid malabsorption/ lactose intolerance/ thyroid disease/ small intestine bacterial overgrowth/ pancreatic disorders/ gynaecological disorders to name a few.  We therefore clinically triage all GP referrals for IBS prior to accepting for dietetic input.)

 

 b. The number of patients diagnosed with IBS who have been referred to dietetic services in each of the past five years.

South West Division: CLCH does not diagnose patients with IBS and we do not log IBS as a specific reason for referrals in to our Dietetics service.

Inner North West Division: We do not record clinical reasons for referrals on our clinical system to be able to pull the data you are seeking.

Based on local data held with the service, it is estimated 60-70% of  Gastro referrals are for IBS.

 

Outer North West Division: We do not record clinical reasons for referrals on our clinical system to be able to pull the data you are seeking. Based on local data held with the service, we have approx 50  referrals for IBS as a primary referral for IBS per year.

c. What criteria are used to determine whether an IBS patient is referred to gastroenterology vs dietetics?

South West Division:  CLCH does not diagnose and refer patient. The GPs assess and diagnose their patients. They would then refer to our Adult Dietetic service; if we then discover something whilst providing assessment and intervention, we would flag this to the GP, to consider a referral to the Gastroenterology service. If bloods are abnormal GP would refer to Gastro.

Inner North West Division: As per above.

Outer North West Division: We would base ours on the ROME IV criteria: if displaying symptoms indicating they require clinical evaluation for other diagnoses. We also look at the patient’s whole clinical picture, there is a long list disorders that can be labelled IBS diagnosis in error. (Coeliac disease/IBD/microscopic colitis/ bile acid malabsorption/ lactose intolerance/ thyroid disease/ small intestine bacterial overgrowth/ pancreatic disorders/ gynaecological disorders to name a few.  We therefore clinically triage all GP referrals for IBS prior to accepting for dietetic input.)

2. Workforce

a. The number of dietitians currently employed by the Trust who are trained or specialised in gut health, IBS, or gastrointestinal disorders.

South West Division: Band 6’s (x2) & Band 7 (x1) are all Low FODMAP trained. First-line advice can be delivered by our Band 5; but if requiring specialist Low FODMAP treatment then this needs to be delivered by the B6’s or B7

Inner North West Division: 2 Dietitians

Outer North West Division:  14 adults Dietitians. All adult community Brent and Harrow community dietitians are trained to provide IBS support /can review these patients. IBS is seen in all patient groups: home enteral feeding /obesity/domiciliary patients/nutrition support etc. There is one dietitian that specialises in Disorders of Gut-Brain Interaction (DGBIs).  They provide a specialist clinic for those with DGBIs as a primary reason for referral (specifically DGBIs of the lower gut e.g IBS). This dietitian also provides training and support for the team.  All 10 adult dietitians are able to review IBS patients and the 4 paediatric dietitians also provide support for IBS.

 

3. Waiting Times and Waiting List Size

a. The current average waiting time for a gastroenterology appointment, and the number of IBS patients currently on the gastroenterology waiting list and for how long.

South West Division: N/A - We do not provide Gastro services.

Inner North West Division: N/A to primary care. Secondary care information which the community dietetic service does not have access to

Outer North West Division: As per above

b. The current average waiting time for a dietitian appointment, and the number of IBS patients currently on the dietetic waiting list and for how long.

South West Division: 8-12 weeks. IBS is not logged as a specific reason for referral so it is not possible to provide specific data.

Inner North West Division: 6 patients on the waiting list. Waiting for 5 weeks. Ave wait 4 weeks.

Outer North West Division: 8-12 weeks.

 

4. Service Capacity and Referral Pathways

a. If the Trust is unable to offer appointments to all patients with IBS who are referred to gastroenterology or dietetic services, please describe the process followed.

• Where are these patients directed or signposted to (e.g., community services, external providers, self-management resources)?

South West Division: Anyone referred with IBS would be offered an appointment with the Adult Dietetic service in Merton. An initial 1:1 session and then potentially waitlisted for a specialist Low FODMAP group session.

FODMAP – elimination / re-intro session

Inner North West Division: Dietitians offer all IBS pts appointments if they meet the criteria for diagnosis as per NICE guidance - CG61

Outer North West Division: if a patient is displaying red flags as per Rome IV criteria. But our request would go via the GP, we cannot refer directly to secondary care. For red flags we would request a referral to gastroenterology before we provide further input for functional disorders.

5. Service provision:

 • Does the Trust offer any specialist IBS clinics or multidisciplinary clinics?

South West Division: Yes

Inner North West Division: Yes

Outer North West Division: No

• What patient education or self-management resources are provided for IBS?

South West Division: As per above

Inner North West Division:

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British Dietetic Association IBS fact sheet; IBS (patient webinars): https://patientwebinars.co.uk/condition/ibs/  . A food and symptom diary 

 

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When relevant - below:

British Dietetic Association fact sheet - Fibre, Mindful Eating, Probiotics and gut health 

IBS medications - https://www.nhs.uk/medicines/peppermint-oil/ and https://www.nhs.uk/medicines/buscopan-hyoscine-butylbromide/  https://www.nhs.uk/medicines/mebeverine/ (when relevant)

King College London FODMAP Publications. Reducing Fermentable Carbohydrates, the Low FODMAP Way

Suitable Products for the Low FODMAP diet. Reintroducing FODMAPS

Constipation (Patient Webinars): Webinars on Constipation - patientwebinars.co.uk

Reflux (Patient Webinars): Overview of Reflux Disease - patientwebinars.co.uk

https://www.bladderandbowel.org/bowel/bowel-resources/toilet-positions/

Signposting to talking therapies in patients’ borough:  Westminster NHS Talking Therapies  Hammersmith and Fulham talking therapies  Kensington and Chelsea :: CNWL Talking Therapies  

Self-support - Meditation and Sleep Made Simple - Headspace  Nerva: IBS Self-Guided Hypnotherapy | Mindset Health  Calm - The #1 App for Meditation and Sleep

 

Outer North West Division: Written copy of all information discussed on initial education session looking at IBS pathogenesis: e.g environmental, psychological, and inflammatory variables. Information and signposting on probiotics, sleep and stress management, increasing plant-based food diversity, prebiotics to improve phytonutrients and microbiome and increase total daily fibre. Kings Low FODMAP booklets if required/ GUTs UK website/mindfulness apps and talking therapy information as examples. 

• Does the Trust outsource IBS-related dietetic or gastroenterology care to private or third-party providers? If so, to which providers and how many patients in each of the last five years?

South West Division: No

Inner North West Division: No

Outer North West Division: No

6. Follow-up and discharge policy:• What is the Trust’s policy for follow-up appointments for IBS patients?• Under what circumstances are IBS patients discharged back to GP care?

South West Division: Depends on individual case – If symptoms improved after first-line advice, would discharge back to GP

If improvement after attending the Low FODMAP group, would be discharged at last group session

If no symptom improvement, would offer one 1:1 session and then discharge to GP, with recommendation for GP to consider onward referrals / other diagnostics (GP to consider alternative medical treatment - SSRI)

Inner North West Division:

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The dietitian provides a package of care. Initial contact is 1:1; 2nd appt 4-6 weeks later to check symptoms; 3rd appt Low FODMAP group education; 4th appt Reintroduction and support group education. If patients are not suitable for group sessions eg. English is not their first language, they are offered 1:1 for their package of care.

When the package of care and treatment for IBS with the dietitian is completed or if clinical concerns are identified by the dietitian during the package of care, which is not typical for IBS and require further assessment and/or investigation or if a patient requests to self-discharge before treatment is complete or if a patient has not attended 2 consecutive appts and have not made contact with the service

 

Outer North West Division:  Offered 3-4 appointments on initial referral. (For a small percentage this may be extended if patient has complex mental health or complex gastroenterological conditions in addition to IBS). Initial appointment 60 mins where there is a detailed assessment followed by education on the Pathophysiology of functional gastrointestinal disorders. Follow up appointments are 45 mins. Patients are discharged once they are satisfied with their GI Symptoms – for the IBS clinic this tends to be an average of 3-4 appointments. They can be referred back at any time if required.