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'Certain' gluten-free foods to remain on prescription, DH decides

Over 1,000 healthcare professionals responded to the consultation on gluten-free prescribing
Over 1,000 healthcare professionals responded to the consultation on gluten-free prescribing

The government has decided to allow “certain” gluten-free foods to continue to be prescribed, after considering scrapping them entirely.

The Department of Health and Social Care (DH) decided that “bread and [flour] mixes only” should remain available across England, it announced today (February 1), following a public consultation that received almost 8,000 responses – including 1,150 healthcare professionals.

The 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)”.

The majority (81%) of respondents said gluten-free foods should be available on prescription, with 70% of all respondents opting for gluten-free prescribing to be restricted.

Availability "issues"

Respondents raised “issues” such as “inconsistencies in [the] availability [of bread and flour mixes], taste differences between prescription-only products and those available in supermarkets, price differences (especially bread), and accessibility – especially those who rely on pharmacy deliveries”, the DH said.

“Many” respondents said that for coeliac patients gluten-free food is “like a medicine and should remain on prescription”, the DH added.

“Others felt it was not a medicine and should not be available on the NHS, and that GP services should not be used as grocers.”

According to the DH, some responses also pointed out that: “Pharmacies...are not equipped to deal with holding large stocks of foods, which often have a short shelf-life, or are bulky.”

In its response to the consultation, the DH said “the health minister’s preferred option” is to “restrict prescribing to certain products”. “This is likely to result in retaining a smaller range of bread and mixes,” it said.

Schedule 1 of the NHS (General Medical Services Contracts) (Prescription of Drugs) Regulations 2004 will have to be amended before the changes are implemented, as will the list of approved gluten-free products on the drug tariff, the DH explained.

"Right decision"

Commenting on the DH's decision, Sarah Sleet, CEO of charity Coeliac UK – which provided “stakeholder” evidence as part of the consultation – said “it is clear the DH has reviewed the strong evidence base…and made the right decision”.

“We still have work to do to ensure the final regulation outcomes are adequate in enabling patients with coeliac disease, especially the most vulnerable, to adhere to the diet and manage their condition,” she added.

RPS "welcomes" DH decision

Royal Pharmaceutical Society (RPS) English pharmacy board chair Sandra Gidley "welcomed" the DH's decision.

"Evidence shows that replacement of core staples such as breads and flours by gluten-free equivalents enables better adherence to a gluten-free diet. This in turn avoids ill-health and expensive treatment of complications," she said.

"Access to gluten-free core staple products on prescription helps to mitigate against the risk of health inequalities too.”

In June 2017, C+D hosted a debate – which brought together Ms Sleet, NHS Clinical Commissioners co-chair Graham Jackson, the Royal Pharmaceutical Society's Sandra Gidley, and Hackney contractor Hitesh Patel – to discuss what plans to scrap certain products and treatments, including gluten-free foods, from prescriptions could mean for pharmacists.

Listen to C+D's podcast of the debate below:

17 Comments
Question: 
Do you agree with the DH's decision?

A B, Community pharmacist

I think GF food would not have been taken off prescription if prescriptions had been limited to a resonable amount of items.

The problem was it spiralled into prescribing all sorts of things and obscure brands incurring excessive OOP expenses. Pharmacies were spending ages messing about trying to source the stuff, don't even get me started on fresh bread ordering.

So either the prescribers were not taking notice of CCG prescribing guidelines or there were no clear guidelines about what was resonable to give on script. Not being a GP or CCG pharmacist I couldn't say who was in the wrong.

I for one don't miss the hassle of dealing with prescriptions for these items but I think if there had been a sensible prescribing strategy to start with this whole debate could have been avoided. In the grand scheme of things I don't think a couple of boxes of mix and 3-4 loaves of bread (more like a brick than a loaf really) a month for diagnosed coeliac patients would make much of a difference to the CCG budget.

Leon The Apothecary, Student

Why does a GF food need to be processed through a Pharmacy?

C A, Community pharmacist

Because setting up a new way of people getting it for free would cost a fortune if previous divestments from pharmacy are anything to go by... oxygen anyone?

Chris Pharmacist, Community pharmacist

Just tell them to buy it...what's so difficult?

GF foods are more expensive to buy but not that much...its a complete waste of time and money. There are so many other causes that need precious NHS funding...not GF bread, biscuits and pizza bases...

Mandy MacDermott, Administration & Support

Chris are you a coeliac? All gluten free products are double the price of normal food Genius bread £3.00 a loaf, normal bread 50p. My food shop for the week is double than my partners food shop! I can tell you it's no fun being a coeliac and it is an illness. I feel other areas need to be looked at all the over prescribed items/waste and the money it costs us, ie paracetamol should not be available on prescription when you can buy a packet for 16p. Coeliac is a diagnosed illness. My doctor in Hastings 5 years ago limited prescriptions to bread or flour or so my units per year. I agree limiting coeliac prescriptions but to stop them completely would be unfair. I pay a NHS prepayment each month by the way.

Caroline Jones, Community pharmacist

GF pasta x 500g = £2.78 and 2 x 12" pizza bases £2.99 (roll your own dough) - what else other than a loaf of bread needs to be bought? Surely she you are allergic/intolerant to something you avoid buying/eating it and make different choices? 

 

 

 

Chris Pharmacist, Community pharmacist

I'd say a normal loaf of bread is £1 - £1.50 depending on make...but not 50p.

Genius GF bread £2.70...Warburtons GF bread £1.75 (Tesco on-line). GF Pastas reasonably priced, again more than ordinary but hardly extortionate. Supermarkets now cater for GF diets pretty well.

 

And I don't think just Coeliacs should rely less on the NHS for foods/medicines...we all should. Agree - ban Paracetamol Rx's, the NHS can't go on as it is...

 

 

Brian Smith, Pharmacy technician

There has to be a cut off point with these things but i firmly believe no GF products should be allowed on prescription. All GF items are now freely available in every supermarket at competitive prices. Years ago there wasn’t but now it’s become fashionable to have a GF diet, the choice is astonishing. My friend was diagnosed in the 80’s and given everything on prescription. She was recently re-tested and found not to have a gluten intolerance but IBS!! How much has this cost the tax payer!?!? I have seen so many patients taking the proverbial over the years as far as GF items go. In these days of financial issues with the NHS we can do without this extra burden. 

Ben Merriman, Community pharmacist

As with prescribing of locally "blacklisted" products and OTC medicines, the only way to completely stop prescribing of "non-approved" products will be to either have a GF allowed list or a GF blacklist.

Can I suggest a scheme like we have in Cumbria where, once the diagnosis has been confirmed, the GP has nothing to do with supplies as being the best way for all concerned? The patient visits the pharmacy who supply products from an approved formulary up to a maximum number of "units" as per Coeliac Society guidelines. Easier to get hold of, enforcement of formularies, no legislative changes needed.

Valentine Trodd, Community pharmacist

This should be solved at a national level. Why do we need local variation with different local schemes? Surely the needs of coeliacs in Cumbria are the same as those in Cambridge or Chester? What's wrong with putting allowed GF items on the DT allowed appliances list?

John Urwin, Community pharmacist

Couldn’t agree more Val. Ben was suggesting that the Cumbrian scheme could be the basis for a national scheme. It was one of the (3?) schemes examined and used as the basis for Scotland’s national GF scheme. GPs are only interested in the outcome and really don’t want the bother of issuing GF food scripts. For pharmacy staff, getting scripts altered to allow experimentation and deal with availability issues can be a nightmare. A limited formulary as proposed and limits on monthly quantities, coupled with bypassing the surgery works in the best interests of patient,surgery and pharmacy. 

Ben Merriman, Community pharmacist

Bullseye, John. No reason why NHSE couldn't roll out what we have in Cumbria nationally. Why reinvent the wheel. Surgeries like it because they don't have to faff around with a seemingly infinite number of products. Patients like it as they get what they've asked for. Pharmacies like it as it's easier than getting prescriptions.

David Bennett, Buying

Ben Merriman & John Urwin's seem to be the most measured comments here.  Yes, a sensible prescribing strategy should have been put in place years ago.  I am a coeliac and used the prescription service (in a sensible manner) until 2016, when my CCG withdrew it.  This was mostly to obtain Glutafin bread and Juvela bread mix, neither of which I could buy in supermarkets.  I am not poor and would buy these products if I could find them, but they still don't seem to be available to the man in the street well over a year since they NHS withdrew them.  The excessive price differential for GF biscuits, pasta etc. still grates and I feel sorry for families on a budget.   Since I was diagnosed in 2006 Genius bread has become widely available and is a good substitute for Glutafin.  Most other GF flour mix and bread is only good for making house bricks. 

On www.chemist.net (which I assume is for "the trade") Juvela bread mix costs £8.95 for 500g - how is such a price justified?  I think part of the problem is the NHS Procurement don't seem to have don't seem to have the power, or more likely the will, to negotiate sensible prices.  My perception is that this is systemic and that NHS pay over the odds for many drugs.  Is this where the Department of Health and Social Care should be applying pressure?    I might be wrong in this in which case blame the media. 

I didn't ask to be a coeliac.  We are a soft target.   Many of the silent majority think charging for gastric bands, or for drunks using A&E, both addressing lifestyle choices would more easily justified.   Both of these choices might free up NHS resources.  

PoPeYe- Popeys Car Wash, Locum pharmacist

I didn't do a degree to hand write prescriptions for CORNFLAKES. The Scottish "Gluten-Free Foods Service". Note the word "foods". A bit like "fools".

Abid P, Primary care pharmacist

Wish they would make their mind up. All the work has been done to take gluten-free off patient records and inform the patient. Now I'll have to ring them up and reverse what we've been telling them. Cheers!

Barry Pharmacist, Community pharmacist

So does this mean CCGs that stopped bread and flour mixes will start prescribing again or are they free to have a local FUDGE policy that says no? 

Adam Hall, Community pharmacist

What, they're supplying fudge on FP10? Is that with a side order of insulin ;) ?

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