In the past year (June 2018 to July 2019), Cannock Chase, East Staffordshire, South East Staffordshire and Seisdon Peninsula and Stafford and Surrounds Clinical Commissioning Groups (CCGs) prescribed 16,023 prescriptions for gluten-free foods at a cost of more than a quarter of a million pounds. The prescription of gluten-free (GF) products is not a cure for coeliac disease, nor does it treat the symptoms. Medical advice given to patients who are gluten intolerant would be to avoid food products containing gluten.
The current prescribing guidelines with south Staffordshire supports the standardisation of prescribing of gluten-free foods in primary care and applies to people with coeliac disease requiring only gluten-free foods. As the CCGs look to control finances and make the best use of NHS resources, difficult decisions have to be made. We are seeking views about proposals to remove GF products for adults from our prescribing policy, which could potentially lead to a reduction in patients receiving gluten-free products on prescription by around 85 per cent.
The proposed policy advises GPs to prescribe gluten-free staple foods to children and adolescents under the age of 18 diagnosed with coeliac disease, other gluten-related enteropathy or dermatitis herpetiformis. The range of foods available on prescription will be restricted to bread and mixes.
A five-week public engagement period will begin on Monday 6 January 2020 and will close at midnight on Sunday 9 February 2020. Findings will then be analysed before being presented to the CCGs’ Governing Bodies later in the year.
Why we are looking to change
In November 2018, NHS England published guidance and the Government restricted prescriptions to gluten-free foods to bread and mixes.
Arrangements for provision of GF foods on the NHS were made when availability was very limited. However, with the increased awareness of coeliac disease and gluten sensitivity, as well as a general trend towards eating less gluten, GF foods are now much easier and accessible to purchase. A wide and expanding range of high-quality GF foods are now available from supermarkets, convenience stores and online.
It is acknowledged that in some supermarkets, the GF food range can be more expensive than the gluten-containing equivalents. However, the price paid by the NHS is much higher than the prices of similar products found in supermarkets. In some cases, the NHS has to pay four times more than a customer would to purchase an equivalent GF product.
The prescription of GF products is not a cure for coeliac disease, nor does it treat the symptoms. Medical advice given to patients who are gluten intolerant would be to avoid food products containing gluten. People who have gluten sensitivity can use other foods that do not contain gluten and yet are a good source of carbohydrate foods such as rice, potatoes, fruits and vegetables are healthy and naturally gluten-free options.
More than a quarter of all CCGs are now restricting or withdrawing GF products on prescription. In the longer term, withdrawal by CCGs will stimulate the market and create more patient choice as the manufacturers will seek to make their products available on the open market.
North Staffordshire CCG and Stoke-on-Trent CCG have already restricted GF food prescribing to children and adolescents under the age of 18 diagnosed with coeliac disease, other gluten-related enteropathy or dermatitis herpetiformis. The range of foods available on prescription will be restricted to bread and mixes.
It may be considered inequitable that one section of the community is able to access significant amounts of food on the NHS but other members of the public who also have other special dietary requirements do not benefit from the same level of access.
Please refer to National Institute for Health and Care Excellence (NICE) NG20 on coeliac disease for further information or Coeliac UK
The online survey has now closed, but you can still view and download our public document , if you wish to. You can also view and download the engagement findings report: Gluten free Engagement Report 2020
By evaluating the results of participation through public and patient involvement, the CCG can learn lessons for the future and continuously improve performance. In the upcoming summary of findings report you will be able to review this project to understand more about what patients said, and what we did as a result of that feedback.