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CCGs won't have to offer gluten-free prescriptions, despite DH ruling

Julie Wood: Many CCGs have gone further than DH's decision to reduce gluten-free options
Julie Wood: Many CCGs have gone further than DH's decision to reduce gluten-free options

Clinical commissioning groups (CCGs) will retain control over whether to scrap gluten-free foods from prescriptions, despite a government decision on the issue.

The Department of Health and Social Care (DH) decided last week that gluten-free “bread and [flour] mixes only” should remain available on prescription across England, following a public consultation that received almost 8,000 responses.

But NHS Clinical Commissioners (NHSCC) – the independent organisation representing CCGs in England – told C+D it is “pleased” that the DH's decision “does not affect the statutory authority that a CCG has”.

NHSCC chief executive Julie Wood said CCGs can still “go further” and remove gluten-free foods on prescriptions, “if that is what is supported locally”.

“While our members would have preferred the DH to have gone further, we welcome the decision that does limit a significant proportion of the current spend,” Ms Wood said.

The DH's gluten-free consultation – which ran from March 31-June 22, 2017 – gave respondents three options: make no changes; stop the prescribing of all gluten-free foods; or “only allow the prescribing of certain gluten-free foods (eg bread and flour)”. Seventy per cent of all respondents opting for gluten-free prescribing to be restricted.

According to the DH’s impact assessment, 25 CCGs no longer prescribe gluten-free foods, while 102 implement restrictions around “product type, quantities or patient status”.

"Missed opportunity"

Ms Woods described the outcome of the consultation as a “missed opportunity to release the whole of the £22 million that is currently spent on gluten-free products”.

“If the NHS is to deliver what is expected of it within its current financial allocation, then we must all be bolder in making decisions that mean money being spent on foodstuffs is spent on other priority areas, such as mental health and primary care.”

Ms Wood stressed that CCGs are forced to make difficult decisions on a “daily basis”, that “balance the needs of the individual against those of the entire local population”.

“There are some tough choices that have to be made and many of our members have already taken the decision to go further than the DH,” she added.

In June 2017, C+D hosted a debate – which brought together NHSCC co-chair Graham Jackson, Coeliac UK CEO Sarah Sleet and pharmacy representatives Sandra Gidley and Hitesh Patel – to discuss what plans to scrap certain products and treatments, including gluten-free foods, from prescriptions could mean for the sector. Listen to C+D's podcast of the debate below:

What do you make of NHS Clinical Commissioner's comments?

Adam Hall, Community pharmacist

CCGs will have GPs prescribe (or not) according to how much money they want to cut from the prescribing budget. They have taken, and will continue to take, no notice of national guidance (NICE excepted) because failure to follow NICE lays them open to litigation if it goes wrong, while everything else is just what it says - guidance. Odd, though, how those in charge of prescribing don't stand up to patients who incorrectly think they need antibiotics? #antibioticguardian #getabackbone

Mohammed Patel, Community pharmacist

Gluten-free is only part of the problem. How many of us have dispensed 32 paracetamols? 24 ibuprofen? 100 grams aqueous cream? 24 chlorphenamine? Simple linctus? All on an exempt script!

The list is endless.

Doctors should not be prescribing things which can be bought for under £2 because the NHS has to pay ten times what it is worth. Because they are paying everyone involved in the process of that patient having an appointment and attending the pharmacy.

Billions could be saved if patients were told to buy their own aspirin, ibuprofen, bath products, emollients, nit lotion, antihistamines and so on.

The British empire is long gone, we can't keep giving out free stuff forever, especially when the patient can buy something for the price of a portion of chips.

Meera Sharma, Community pharmacist

There is a consultation out on OTC products as well, so more than likely these items will also be curbed - watch the space!

Caroline Jones, Community pharmacist

Bread products shouldn't be actively encouraged in anyone's diet.....a dietician will tell you the amount of such foods that constitute a balanced diet is in fact very small.....people bymuy bread etc anyway during weekly shop, just buy GF.....take some responsibility for your own health?

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