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Prescription policies

  • Prescribing staple gluten-free food gives patients clinically diagnosed with coeliac disease NHS support to manage their diet which is the only treatment for their condition.
  • Clinical Commissioning Groups (CCGs) are now responsible for the commissioning of NHS services at a local level; this includes the prescribing of gluten-free staple foods.
  • We are campaigning for the ongoing support of people with coeliac disease through the prescription of gluten-free staple foods.
  • The map below provides the policy information for each of the CCGs across England.

Why are prescriptions for gluten-free staples important?

Following a strict gluten-free diet for life is the only treatment for people with coeliac disease and it allows them to live a full and healthy life. To do so, it is crucial that they are able to access gluten-free staple foods, such as bread, flour, breakfast cereals and pasta, which are the staples in the majority of our diets.

Whilst gluten-free staple foods are more widely available today than ever before, they are not readily accessible across the country. If you are reliant on budget stores or convenience stores, research suggests that gluten-free staples are virtually absent. What’s more they are prohibitively expensive for too many people, costing three to four times more than regular gluten-containing foods. Gram for gram, bread is on average five times more expensive, and more than 8 times the cost if you compare the cheapest breads. The result is that our most vulnerable, those on a limited income, the elderly or those living in remote rural areas with reduced mobility are severely disadvantaged in maintaining their gluten-free diet, at potential risk to their health.

Prescription policies across the UK

England

There are 207 CCGs which are responsible for commissioning NHS services locally, replacing the old Primary Care Trusts (PCTs). 

Coeliac UK has written to and spoken with all 207 CCGs making them aware of the National Prescribing Guidelines and the importance of gluten-free staple foods on prescription for those with coeliac disease. With NHS budget cuts we are seeing some areas restricting or cutting gluten-free prescribing but around 80% of CCGs in England continue to recommend that GPs prescribe gluten free foods. We are trying to influence them to rethink these decisions. We continue to follow up and review the policies of each individual CCG as part of our prescriptions campaign.

Gluten-free prescribing map of England

The map below provides the gluten-free prescribing policy information, collected from our recent communications, for each of the CCGs across England. It is primarily aimed at people with coeliac disease to provide up to date information on local gluten-free prescribing. We are looking to ensure that the details of the map are comprehensive and are kept updated with gluten-free prescribing in England, so if you are aware of a prescribing review or of a recent change in policy, please get in touch with us. To navigate you can click and drag your mouse to move the map and use the +/- controls to zoom in and out.

Click on your area to reveal details of the CCGs gluten-free prescribing policy.

Gluten-free prescribing map key

CCG boundary data © NHS England. Contains Ordnance Survey data © Crown copyright and database right [2013]

 

Wales

The All Wales Guide to Prescribing Gluten-free Products’ supports the prescription of gluten-free staples across Wales and is in line with the National Prescribing Guidelines.

In addition, they do recommend the prescription of oat containing breakfast cereals based on the advice of a dietitian. Most people with coeliac disease can eat gluten-free oats; however, a very small number of people may be sensitive to oats. Often, when people are newly diagnosed with coeliac disease, the GP or dietitian may advise to avoid oats, usually for at least six months to allow for gut healing. After this gluten-free oats can then be introduced with monitoring by a GP or dietitian.

The All Wales Medicines Strategy Group, support the prescription of gluten-free staples and say:

It is not recommended that practices limit themselves to a narrow formulary. As nutritional content and ingredients vary, a sufficient range of products is required to accommodate the therapeutic needs of patients, for example, in cases of associated increased calcium requirements, multiple intolerances or constipation. Variety and acceptability of the diet can enhance adherence, with resulting improvements in outcomes

Northern Ireland

The Health and Social Care Board, Northern Ireland, supports the prescription of gluten-free staples both in terms of the quantities and range as within the National Prescribing Guidelines.

Scotland

Each of the 14 NHS Boards across Scotland has its own list of gluten-free products that can be prescribed to people with coeliac disease. These are in line with National Prescribing Guidelines in terms of units. 

Many people are now accessing prescriptions through the Scottish Gluten Free Food Service (those who are not part of that Service can access prescriptions via their GP). To find out more about the Gluten Free Food Service and to see a list of the prescribable items for each Health Board, please visit NHS Inform

Our work

We are campaigning for gluten-free prescribing to remain an essential NHS support for people with coeliac disease. Without NHS support, the most vulnerable patients are most at risk of not maintaining their gluten-free diet, which is the only treatment for their condition. We have been making the case with CCGs and policy makers that, gram for gram, gluten-free bread is five times more expensive than regular gluten-containing bread and pasta and other staples are 3-4 times more expensive. Cost and patchy provision of gluten-free food, makes maintaining the diet day in day out very difficult for people with coeliac disease, and gluten-free food on prescription supports adherence to the diet to ensure that those with the condition are not at risk of other serious conditions.

In the past, we have been aware that several areas restricted the prescribing of gluten-free fresh bread due to concerns about additional handling charges, a complex issue involving manufacturers, wholesalers and pharmacists. We urged manufacturers and distributors to work together to reduce the impact of these costs on gluten-free prescribing. Since 2012, a guarantee has been made to ensure that such additional costs would not be added. Therefore, the cost of fresh bread is not greater than that of long life bread. Throughout 2012 and 2013, we contacted the areas restricting fresh bread to urge them to review their policy after the removal of the additional handling charges. In almost all cases we have succeeded in having fresh bread reinstated on prescription.

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