The National Institute for Health and Care Excellence (NICE) published a guideline on the recognition, assessment and management of coeliac disease in children and adults in England and Wales in September 2015.  The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) in collaboration with Coeliac UK published guidelines on the diagnosis and management of coeliac disease in children in 2013. These guidelines may be applied in Scotland, as the Scottish Intercollegiate Guidelines Network (SIGN) who develop guidelines for the National Health Service (NHS) in Scotland, have not yet produced guidelines on coeliac disease.

We have further information on diagnosis on our website.

Information on the management of coeliac disease, including new patient appointment and follow up appointment checklists can be found on the Coeliac UK website. You can also refer patients to Coeliac UK for further information and support on the gluten free diet and access to resources. Find out more about the benefits for your patients of joining Coeliac UK.

There is a National Institute of Health and Clinical Excellence (NICE) guideline on recognition, assessment and management of coeliac disease for healthcare professionals in Primary and Secondary care. The guideline outlines the symptoms and patients at risk of coeliac disease and also the appropriate blood tests and the exact process to be completed in order to identify patients with coeliac disease.

The British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) in collaboration with Coeliac UK published guidelines on the diagnosis of coeliac disease in children in 2013. These guidelines suggest that in some cases in children with symptoms and whose blood tests show a high level of antibodies and who have the genes present for coeliac disease, a biopsy may not be needed to confirm diagnosis. We have further information on the diagnosis of coeliac disease on our website.

Wheat is the basis of the staples in the diet and is therefore the most widely consumed grain in the UK. Removing gluten from the diet can therefore have significant impact on the diet.

Rates for adherence to the gluten-free diet can vary between 42-91% ^[1] and gluten free staples on prescription have been related to inadvertent adherence ^[2].  Non-adherence to the gluten free diet, the medical treatment for coeliac disease is associated with increased risk of complications including osteoporosis, infertility problems and in rare cases intestinal malignancy.

Research has shown that gluten free staple foods are 3-4 times more expensive than equivalents containing gluten ^[3,4]. Availability of gluten free food, particularly in budget supermarkets and corner shops is also limited or non-existent. These access problems underpin the need for provision of gluten-free staple food on prescription, particularly for those on a limited income or with limited mobility.

_{[1] Hall, N.J. Rubin, G. & Charnock, A. (2009). Systematic review: adherence to a gluten-free diet in adult patients with coeliac disease. Alimentary Pharmacology & Therapeutics, 30, 315-330.}

_{[2] Hall, N. et al. (2013). Intentional and inadvertent non-adherence in adult coeliac disease. A cross-sectional survey. Appetite 68 56-62}

_{[3] Singh, J. & Whelan, K. (2011). Limited availability and higher cost of gluten-free foods. Journal of Human Nutrition and Dietetics, 24, 479-486.}

_{[4] Burden, M., et al., Cost and availability of gluten-free food in the UK: in store and online. Postgraduate Medical Journal, 2015: p. postgradmedj-2015-133395}

The administration cost of setting up a pharmacy led supply scheme for gluten-free food on prescription should be minimal.

A PCT in Cumbria piloted the pharmacy-led supply scheme in 2009. Existing members of their staff took on the administration tasks required to implement the initiative. This took a part time employee approximately three months – but it should be noted that this was to organise the scheme from scratch. Once the programme was in place, administration requirements comprised of data collection for finance and required approximately one working day per month.

We have designed a toolkit so that there is a template approach which can be simply rolled out in any new area and Coeliac UK is happy to help with communication to promote a smooth implementation.

In Northamptonshire, administration related mainly to devising contracts and paper claims. Initially this took a 0.4FTE around two weeks each month to process the claims. Since 2009 Northamptonshire has processed claims using an online claim service. This has proved very efficient and reliable, heavily reducing workload. The cost of this service would depend on the number of pharmacies and number of services commissioned. Northamptonshire use the online service for six enhanced services.

Editions of Crossed Grain magazine will be sent to departments that have registered for the Resource Pack.

Following the information in your autumn edition of professional eXG, you will be aware that we have made significant changes to the 2017 Food and Drink Information services. As a Healthcare Professional working with patients with coeliac disease you too can access the online Information by becoming an individual Member or purchasing a copy of the printed edition of Food and Drink Guide by contacting our Helpline team on 0333 332 2033.

For further information please see our downloadable leaflet.

Pharmacy supply schemes are currently running in a number of parts of the UK. These schemes have resulted in significant cost savings while continuing to support people with coeliac disease on the gluten-free diet. Read more information on these schemes.

Joining is easy. Simply go to www.coeliac.org.uk/HCPMembership and complete the join form. You will be asked for your professional registration number and other details regarding your profession. Once you’ve completed and submitted the join form you’ll receive an email to activate your online account. You’ll have access to our exclusive HCP web pages and be able to update your personal online scrapbook with all the pages and documents that you find the most useful.

It would be difficult to set up a pharmacy led supply scheme as an independent. If you are interested in setting up a pharmacy led supply scheme we would recommend speaking with your local Clinical Commissioning Group and other GP surgeries in your area to consider the potential for collaboration.

Items supplied on prescription are reimbursed through the national Prescription Pricing Department (PPD). The PPD receives all prescriptions dispensed and reimburses individual pharmacies and GP dispensaries accordingly. The cost of each prescription is taken from the appropriate GP surgery prescribing budget. In Northamptonshire, when the pharmacy led supply scheme was introduced in 2006, the funds came from the existing Primary Care Trust (PCT) prescribing budget.