Using our finances wisely

With a growing population, rising demand for services and a limited budget, the CCG, like other NHS organisations, has to evaluate every service it commissions to see if it offers good quality, value for money and is an effective and fair way of using resources.

We need to make sure patients get the most effective care and treatment and that we get the best value for NHS resources.

We constantly review how we allocate the limited resources we have available for the people of Sheffield.

What was this consultation about?

We wanted to change our guidelines to GPs in Sheffield about prescribing Gluten Free foods to people who are diagnosed with coeliac disease.

Our system limited Gluten Free food prescriptions to staples (pasta, bread, flour and bread mixes) and also limited prescribing to eight units per month for adults.

The proposed change would mean that GPs would be asked to suspend prescribing GF foods to adults over 18. Nothing would change for people under 18.

The impact of the change would be monitored by the CCG and reported back to the Governing Body.

The change is expected to save around £100,000 each year.

What are Gluten free foods?

Gluten is a protein found in the cereals wheat, rye and barley. Coeliac disease is a lifelong autoimmune disease caused by a reaction to gluten. 1 in 100 people have the condition and once diagnosed, need to follow a gluten free diet for life.

Lots of foods are naturally gluten free such as fresh fruit and vegetables, including potatoes, meat, chicken, fish, cheese, eggs, rice and lentils. Eating manufactured gluten-free foods is not necessary for a healthy diet.

Gluten free foods have been available on prescription to patients diagnosed with coeliac disease since the late 1960s when there was very limited availability of GF foods.

Today they are far more widely available in supermarkets, as well as a much wider range of naturally GF food types. This means people can obtain these foods much more easily without a prescription than they could decades ago.

Why did you want to make the changes?

Based on the information available we do not believe that the continued prescribing of GF products to adults represents the best use of resources.

Who will be affected by this proposed change? 

People over 18 who have been diagnosed with coeliac disease and who have been receiving gluten free foods on prescription will be affected by this change. 

Will there be any exceptions?

GPs prescribe according to their clinical judgement so this would be a recommendation only. Prescribing GPs will be able to apply discretion in exceptional circumstances where they are sufficiently convinced that there is a genuine risk that a vulnerable individual is, or will become, under nourished if they do not prescribe gluten free products for that individual.

Won’t this change cause problems for people who are currently prescribed GF food?

From previous engagement and conversations with people in Sheffield we know that the main concerns were about:

• The cost of food for people who currently receive free prescriptions
• The availability of GF food, particularly if supermarkets change their range
• Creating greater health inequalities.

GF foods are more widely available than they were when prescribing began in the 1960s. People can also follow a GF diet by consuming foods that are naturally GF such as meat, fish, eggs, fruit, vegetables, rice and most dairy products.

All patients can access dietary advice from their GP, community dietitian or pharmacist. GPs can still prescribe if they feel there is a genuine risk to an individual.

In addition more advice is available at:

NHS Choices: www.nhs.uk/Conditions/Coeliac-disease/Pages/Treatment.aspx

Coeliac UK:  www.coeliac.org.uk/home/

What happens elsewhere in the country?

To date around 50 Clinical Commissioning Groups (CCGs) across the country have stopped prescriptions of GF foods for adults and others are currently consulting on the issue.

The Department of Health recently launched a national consultation on the availability of gluten free foods on prescription in primary care and this closed on June 22, 2017. We are still waiting for the outcome of this consultation.