Re: Gluten-Free Prescribing

Sanger House 5220 Valiant Court Gloucester Business Park Brockworth Gloucester GL3 4FE

Tel: 0300 421 1636 Email: [email protected]

11 November 2016

Dear colleague

Re: Gluten-free prescribing

Further to recent communications from both the CCG and the LMC about the proposed cessation of prescribing gluten-free products, we are writing to update you on our current position.

We have held discussions both within the CCG and with the LMC, and having also reviewed other CCG policies, we have decided to revise our initial policy proposal.

We continue to recommend the cessation of gluten-free prescribing from 30 November 2016 on the basis that such products are not on the countywide joint formulary but with allowance being made to prescribe gluten- free products for patients who have exceptional circumstances. This policy is supported by the LMC and, we believe it will allow GPs to cease prescribing gluten-free products for virtually all their patients, which we know is an action also supported by the vast majority of you.

Whilst the slight change in policy should have almost the same net consequences, it does allow a GP to provide a gluten-free product on prescription under exceptional circumstances. Such prescriptions should be kept to a minimum and restricted to breads and flour/bread mixes only.

A summary of gluten-free prescribing follows this letter. Further information including Frequently Asked Questions, a letter to be sent out to all coeliac patients on your list and other useful information (Resource Pack) is attached to this e-mail. Printing and postage costs will be reimbursed by the CCG if required.

Thank you for your patience with this matter and for your support in implementing the policy.

Yours sincerely

Dr Andy Seymour Dr Charles Buckley Clinical Chair GP Prescribing Clinical Lead NHS Gloucestershire CCG NHS Gloucestershire CCG Gluten-free prescribing summary

 From 30 November 2016, the CCG requests all GPs to cease prescribing gluten-free products on NHS prescriptions in Gloucestershire.  The CCG continues to advise patients affected to follow a gluten-free diet. Many foods are naturally free from gluten such as rice, potatoes, corn, meat, fish, fruit and vegetables.  Gluten-free alternative products, such as breads and pasta, are now widely available to buy, with improved choice and quality.  The total cost to the NHS of gluten-free pasta or bread on prescription is much more expensive than the price of a similar gluten-free product in local shops due to prescription logistics and supply issues.  Any prescriptions made in exceptional circumstances should be restricted to bread loaves and flour/bread mixes only. The CCG will monitor adherence to this.  The prescribing of any other gluten-free items such as bread rolls, baguettes, pizza bases, wraps, cakes, biscuits, crackers and breakfast cereals is not approved by the CCG.  Allowing exceptionality will allow us to overcome concerns regarding specific groups, which NICE QS134 has recognised as those with low income or limited mobility.  Access to shops is rarely an issue as patients will be visiting shops (or having deliveries) for other shopping, where either gluten-free products or foods naturally free in gluten will be available to buy. There is information in the Resource Pack to help patients with this.  In exceptional cases, patients can be referred to the CCG Prescribing Support Dietitian for additional advice and support in maintaining a gluten-free diet. Please email [email protected] with the patient’s contact details and supporting information.