• CR 87: Eating disorders in the UK: policies for service development and training

• Primary care protocol for the management of adults with eating disorders

The National Service Framework specifies that primary care protocols for the management of eating disorders should be in place by the first of April 2001.

The attached primary care protocol was adapted by the Eating Disorders Special Interest Group with permission from Primary Care Protocols for Common Mental Illnesses April 2001, developed for use in Croydon by Dr Maggie Bruce, Croydon Health Authority. Individuals wishing to use this protocol in their area may need to adapted it further to fit their local circumstances. They should also bear in mind the following points:

1. The protocol does not mention specifically the needs of patients with the diagnosis of eating disorder not otherwise specified (EDNOS) - at least a third of patients seen in clinical practice fit into this clinically heterogeneous category. However, it should always be possible to make a clinical decision on whether an EDNOS case is more similar to anorexia nervosa or bulimia nervosa and to follow the paths outlined for either of these two disorders.
2. The protocol does not cover the management of children and adolescents with eating disorders. Anorexia nervosa in children often requires more rapid intervention than advocated here, as children are more vulnerable to rapid physical deterioration.
3. The protocol as it stands does assume that access to an eating disorder unit is available to the referring General practitioner. We are aware that this is not the case in many parts of the country and the protocol may need to be altered accordingly to fit local needs.

• NICE guidelines for eating disorders

This guideline makes recommendations for the identification, treatment and management of anorexia nervosa, bulimia nervosa and atypical eating disorders (including binge eating disorder) in primary, secondary and tertiary care. The guideline applies to adults, adolescents and children aged 8 years and older.

• Types of eating problems (in children)

• Intercollegiate Group on Nutrition

The Intercollegiate Group on Nutrition (ICGN) was established in December 1996 with a primary aim of improving the competence in human nutrition of doctors and other health professionals. The Group now has formal representation from 11 medical Royal Colleges, including the Royal College of Psychiatrists, together with nursing, dietetic and pharmacist representatives. It issued its first report to the parent medical Royal Colleges in July 1997, where it recommended addressing two levels of competence through intercollegiate qualifications - a Certificate in Human Nutrition which would define a minimal level of core competence in the principles of nutrition, whereas a Diploma in Clinical Nutrition would ensure possession of competence relevant to an individual's clinical practice. Since that time, the group has been working mainly on a course to achieve the first level of core competence.

A pilot course was held at the University of Southampton in September 1998, to bring together members of the ICGN (including the undersigned) and also some individuals who would wish to be future trainers, to help clarify content and methods of delivery. The course was also attended by an educational task force, supported by Rank Prize Funds, who provide support in co-ordinating and standardising the delivery of the course. Some of the key points from this meeting included unanimous agreement of the need for such a course to complement the present level of education in human nutrition. Specific aims of the course will be:

1. To enable doctors to extend their knowledge of nutritional principles.
2. To bring together sub-specialities to study nutrition in relation to disease processes and across boundaries of care.
3. To encourage the application of effective nutrition in relation to the promotion of health and in the treatment of disease.
4. The course design will balance nutritional concepts and supporting science with practical examples, real life experience, and cases relevant to all participants.
5. Evidence based human nutrition will provide one of several unified themes.
6. The course will take place over 5 days, shortened on the first and last days to facilitate travel. The course will be residential, allowing time for informal inter-disciplinary discussion and study.
7. The most likely participants will be trainees with an interest in nutrition, usually at SpR level. In addition, some consultants and GPs who are developing a special interest in nutrition are likely to attend. Within psychiatry, doctors with an interest in growth and development, eating disorders, the physical health of patients with psychiatric disorder, mental health of the elderly and others will find this course very helpful. The course will also be open to other professional groups with an equivalent interest and background in nutrition.

The Group held two courses in 1999, one in Glasgow on May 24-28, and the second in Southampton on September 13-17, both well attended by trainees and consultants. The interactive nature of the course limits the number able to attend to about 25-30.

Extensive feedback was obtained from the participants and from the trainers at these two courses and this has been used to re-evaluate the course content and delivery, and modifications have been proposed for future courses. It is intended to hold a rolling programme of 3-4 courses each year, the basic structure and content of the course being similar at all sites throughout the UK. The number of courses will be determined partly by demand and partly by the availability of funding. A number of Post-Graduate Deans have already recognised this course and Training Subcommittees are beginning to include it in training programmes. There are not, as yet, formal arrangements for an Intercollegiate qualification, but participants receive a Certificate of Attendance, and, where relevant, a CPD/CME.

Alan Shenkin
Chairman
Intercollegiate Group on Nutrition