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CCGs criticised over gluten-free food prescriptions

CCGs: Gluten-free alternatives are readily available

Charity Coeliac UK has spoken out against the way CCGs consult on removing gluten-free prescriptions from their services

Charity Coeliac UK has slammed the “farcical” way that clinical commissioning groups (CCGs) in England consult on whether to axe gluten-free prescriptions, following cuts to schemes in Essex.

Southend CCG and Castle Point and Rochford CCG recently decided to stop providing gluten-free food on prescription, and a group of CCGs in Worcestershire is considering whether to halt the service.

Coeliac UK chief executive Sarah Sleet told C+D that CCGs’ consultations on whether to restrict gluten-free prescriptions are “framed in such a way that they are not [on] an objective, level playing field”.

Ms Sleet argues that the way CCGs word consultations on stopping gluten-free prescriptions is misleading. “If you were a member of the general public, you would think: ‘why do people get these products?’”

“[They] cast [gluten-free prescriptions] as something for nothing and suggest there are much more deserving causes elsewhere,” she said. “It is a bit of a farce. It is seen as a relatively easy thing to cut.”
Model “outdated”
Dr Jose Garcia Lobera, chair of Southend CCG, said the practice of prescribing gluten-free food was “outdated”.

“Gluten-free alternatives are now readily available and prices have come down,” he said.

Chair of Castle Point and Rochford CCG Dr Michael Saad said there is “no evidence” that patients who receive gluten-free food on prescription are more likely to comply with a gluten-free diet.

A group of CCGs in Worcestershire currently consulting on which services to cut said in a patient survey that gluten-free prescriptions in the area cost the NHS around £300,000 a year.

A CCG spokesperson told C+D that the suggestions of services to restrict – which also includes IVF treatment and knee replacements – are “just ideas”.


Pharmacy manager Babir Malik, who is a coeliac, said CCGs that cut gluten-free prescriptions are “short-sighted”.

“There will be short-term gains, but what about the long-term costs involved in complications from potential non-adherence to the gluten-free diet? It’s not as simple as saying that patients can buy it from the supermarket instead."

Does your CCG have a short-sighted attitude to gluten-free prescriptions? 

We want to hear your views, but please express them in the spirit of a constructive, professional debate. For more information about what this means, please click here to see our community principles and information


Barry Pharmacist, Community pharmacist

There should be no debate. The NHS is heading for ruin if we don't take firm action

VAL MADDEN, Hospital pharmacist

There has to be some control over GF food , close definition of who qualifies for it and the quantity per month allowed . It is no longer reasonable to include cakes , biscuits etc with the encouragement if a lower sugar diet . I am sure in some areas there are plenty of readily available gluten free products but in rural areas , with the demise of public transport and out of city centre shopping this could be a problem for the less affluent .This should however be a national decision , not post code prescribing 



Another Pharmacist, Community pharmacist

A sensible approach. In my area the CCG have advised that biscuits and the like should not be prescribed. But they have not banned bread, flour and pasta....yet.

How High?, Community pharmacist

Just how did all this stuff end up in the Drug Tariff anyway? Who vets the additions etc for clinical appropriateness and cost effectiveness? 

Another Pharmacist, Community pharmacist

Advisory Committee on Borderline Substances.

Just take a look at all the other items which are prescribable in this section of the DT. It's not just the GF foods for us poor Coeliac sufferers that you should be having a go at. As I mentioned earlier, I see a lot more excessive prescribing of emollients (which can be purchased at a premium price).And what about wheelbarrow loads of Ensure Plus, Fortisip and the rest. 

We just need a sensible approach, not a knee-jerk banning of ALL GF foods. It can't be fair to single out this narrow group of the ACBS list only.

Anonymous Anonymous, Information Technology

Mrs Crimble by the sound of things!!

R A, Community pharmacist

10 years ago sufferers of these conditions did not have a wide variety of products available and it was not at a affordable price. But these days the price is similar to their normal equivalent even if it is at the premium end. Therefore it begs the question why the NHS should foot the bill for someones food which they would have purchased if it was not available on NHS. 

Another Pharmacist, Community pharmacist

I've read through the comments posted so far and it seems to me that a few contributors are misunderstanding the issues around coeliac disease. It is not an allergy or a food intolerance. It is an auto-immune disease. A coeliac diet is not a lifestyle choice. The sufferer has to make far-reaching changes to diet to resolve immediate symptoms & to prevent health complications in later life. It is not just a matter of swapping like-for-like since the alternatives for staple foods are significantly more expensive - A GF loaf costs about £2.99 compared to a usual price of 60-90p. The difference between pasta is less marked but is typically 50-100% more expensive. I do get that excessive prescribing must be addressed, but a middle-ground approach must be the way forward, perhaps with pharmacy-led initiatives. I see a lot more excessive prescribing of emollients than GF food items anyway. Maybe we should make dry-skin sufferers pay for their treatment - no it's not the same.........but you get my point? Coeliac UK is pushing for debate and consultation around CCG prescribing policies. This way we can save some NHS money without the need for a blanket GF food prescribing ban.

The NHS is desperately cash-strapped. Choices have to be made. Gluten-free food should not be available on the NHS. Now let's move on please....

Paul Samuels, Community pharmacist

Totally agree--it may not save a huge sum in the overall scheme of things but it makes good  economic sense.

I see enough abuse of the supply of gluten free products  in my travels.

SydBashford Sold&Retired&DeRegistered, Community pharmacist

I think I should get my Veggie food free on NHS, cos I may suffer psychological trauma if I had to decide whether to buy it myself or choose to eat meat and sufffffffer!!!

Christopher Donaldson, Community pharmacist

In my humble opinion, food should to be charged to the NHS. Most of our customers are able to afford bread etc. But because it's free on script they 'stock up'! Huddersfield A&E is under threat of closure and other more essential services are under severe financial pressure. I say stop this free service.

Leon The Apothecary, Student

I agree. NHS resources could be better used elsewhere.

Peter Magirr, Primary care pharmacist

I agree a debate on this would be useful - suggest it should take into account the following:

Whether it is possible to eat a healthy diet eating naturally gluten free foods

The availability and cost of GF products available on retail sale

The high prices commanded by GF foods on prescription - and hence high cost to the NHS

The marketing strategies of the companies that provide NHS GF products -including the sponsorship arrangements they have in place



Leon The Apothecary, Student

I definitely agree that this is something that needs to be debated to protect the already stretched NHS budget. I believe the issue that seems to be echoed here is the question of ensuring patients are able to source GF foods. In this modern age, we are able to acquire a huge number of items through online shopping to nearly everywhere in the world at good prices, as evidenced by companies such as Amazon. Would this have an impact on assessing if pharmacy needs to provide these products?

Meera Sharma, Community pharmacist

The prescription side was valid when the gluten-free foods were not readily available and quite pricey. But go to any supermarket today anywhere in the country and the choice is enormous, not to mention how competitive the prices ahve become as well. If the rest of the population is facing food bills, why should one set of patients have it on prescription? Especially as this cost is now equivalent to your average non-coeliac food shopper. Definately does not justify it. In addition, it has become a fashion-trend to become gluten-free and this is impacting on prescription numbers and cost. Definately time for an overhaul. Like you said, somebody who's collecting 48 loaves and pizza bases in this day & age just does not make sense, especially as the NHS is so stretched at present.

Stephen Eggleston, Community pharmacist

My question would have to be "Why should coeliac patients get food on the NHS" - considering guidance on health eating, bread, pasta & cakes are no longer "staples" - fruit & veg should make up the bulk, wit a bit of carb & some protein. That, and the reduction in cost for patients to buy for themselves, makes the current system outmoded.

It wouldn't be so bad if some patients didn't abuse the system by getting 48 loaves of bread on one prescription! (for example)

Mark Galloway, Pharmacy

There should be a debate about this as there is so much gluten free product choice now in supermarkets many coeliac patients do not seek prescription GF products at all.

There is probably a happy middle line to be had here but it would be inappropriate, in my view, to maitain the staus quo in this area.

John Urwin, Community pharmacist

All very well if you are coeliac and live in an affluent area with lots of supermarkets and sufficient "worried well" daft enough to believe that eating GF is a good idea for non-coeliacs. In poorer, more rural areas there is not the same choice and availability of GF foods. In Cumbria we have a pharmacy-led GF food scheme that does not include cake and biscuits. The monthly allowance is nutritionally appropriate for the individual's weight and activity level. The abuses seen elsewhere with prescription GF foods feeding whole families cannot occur in Cumbria.

Anonymous Anonymous, Information Technology

Well when my father first came to this country he couldn't get houmous anywhere... Now we know that there are potential benefits to health of eating houmous shall we recommend putting that on prescription too??!

Leon The Apothecary, Student

I agree with John's assessment here. In some areas there is a lack of availablity, and these areas should be catered to to a certain degree. However, my counter to your argument would be that pretty much everywhere in the UK there is the ability to have things delivered to your home, so perhaps a more effective solution that would work nationally would be to have GF foods managed by a third party and not pharmacy instead?

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