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: