KHPeople: Dr Alastair Duncan

“I have to admit that I didn’t know what dietitians did until I met one” - find out how Dr Duncan gained his passion, the best thing about the job, and when to not let your line managers off the hook.

Please can you tell us about how you got into dietetics and what motivated you to be a dietitian?

I have to admit that I didn’t know what dietitians did until I met one. This was back in 1993. Some friends were very unwell with HIV and in response I was volunteering with a wonderful charity called The Food Chain www.foodchain.org.uk who provide nutritional services for people living with HIV. I met Hazel Ross, who at the time was one of the only dietitians in the world specialising in HIV care, and I thought “I want to do that!”.

I already had a degree in microbiology so completed the postgrad route into the profession. The first five years of working in HIV dietetics at Guy’s & St Thomas’ NHS FT focussed on dealing with the consequences of opportunistic infections and malnutrition – diarrhoea and wasting for example.

Then with the advent of effective antiretroviral therapy my work changed to managing dyslipidaemia and excessive weight gain. Around 2010 I began to wonder why so many people living with HIV were developing diabetes. I was awarded an NIHR clinical doctoral research fellowship to investigate, and tested a diet and exercise intervention to reduce diabetes risk. It worked, I’m delighted to say.  

Can you tell us a little about your area of work?

In 2016 I was asked to develop a pilot Tier 3 weight management programme in Southwark, testing delivery to their diverse population. Outcomes proved to be positive, and as a result we were asked to expand the pilot across south east London. It is now fully commissioned, with 4,000 patients living with complex obesity being referred each year. I lead the most wonderful multidisciplinary team – physiotherapists, psychologists, doctors, and dietitians, aided by clinical assistants and pathway coordinators.

There are 34 of us delivering over 30,000 appointments annually. I also lead the dietetic service for metabolic surgery, and two Tier 2 weight management services – in Southwark and in Lewisham. The Lewisham service is called Up!Up! and was co-designed with Dr Louise Goff from King’s College London, stakeholders and representatives from Lewisham’s Black communities, in response to evidence that people of Black heritage experience poorer weight management outcomes compared to White people.  

How does this benefit patients?

The Tier 3 weight management programme doesn’t work for everyone, and we do experience attrition from the programme to the same extent as similar programmes across the UK. However it can be literally life changing for patients.

I recall one patient who was approaching 200kg when referred, living with multiple comorbidities and polypharmacy, and using a rollator to move around. He did spectacularly well on the 800 kcal/day total meal replacement intervention we modelled from the DiRECT study. After 12 months with us he weighed 119kg, had ceased all prescribed medicines, and was beginning to enjoy running. Thinking about the Up!Up! programme in Lewisham, evaluation has been highly positive, with one participant telling us “I’ve been waiting for something like this all my life”.

How does being part of a Clinical Academic Partnership help your work?    

I am surrounded by a network of highly talented people who are always willing to help solve problems and offer advice. I strongly believe that to achieve the highest quality of care for our patients we need to work in partnership, not just with each other but with our patients as well. King’s Health Partners fosters this approach.  

What would your advice be to someone starting out as a clinical academic?  

As a Consultant Dietitian I am required to deliver on four pillars of practice at an advanced level: clinical, research and audit, innovation, and education. I love working across all four pillars and find this very rewarding. If you are starting out as a clinical academic then I advise you to identify strengths and areas for development within each pillar.

Chat with the lovely people from Training and Development, devise a plan with your line manager, and find a mentor to bounce ideas off. Finding protected time for personal development will always be a challenge, but it’s your line manager’s job to help you with this – don’t let them off the hook!