Gluten Free Prescribing for Adults and Children in Oxfordshire

Briefing: NHS Prescriptions for Gluten Free Food in Oxfordshire

Following a meeting of the Oxfordshire Clinical Commissioning Group’s Shadow Governing Body yesterday a decision has was made, as a result of a public consultation, to continue to provide some gluten free products on NHS prescriptions for people with Coeliac Disease in Oxfordshire. Bread and flour will be available on NHS prescription; this prescribing change will come into effect from 1st October 2012.

During 2011-12, Oxfordshire Clinical Commissioning Group (OCCG) took responsibility for certain areas of the purchasing and planning of health care from NHS Buckinghamshire and Oxfordshire PCT Cluster, the County’s Primary Care Trust. Part of this work included reviewing the provision of services that are shown to be less clinically effective and provide insufficient health benefits and those that do not represent good value for money.

In Oxfordshire we spend £350,000 each year on prescriptions for gluten-free foods for people with coeliac disease. Given that the NHS does not provide food on prescription for other groups of patients whose diseases are associated with, or affected by, the type of food they eat and due to the availability of gluten free products prescriptions of gluten-free foods were identified as a potential area for review.

GP Localities within OCCG were consulted on their views as to whether to progress the proposal to stop NHS prescriptions for gluten free food to public consultation. This was agreed and a public consultation was launched 6 January 2012 and closed on 2 March 2012.

A number of different engagement methods were used simultaneously to enable maximum reach and feedback from a wide variety of stakeholders during the consultation period. This involved:

A public survey set up on Talking Health (OCCG online consultation tool), along with a briefing document explaining the background behind the proposals.
Hard copy surveys were available on request.
Feedback via email, letter or by phone.
Meetings between key stakeholders (e.g. Coeliacs UK) and GP Leads from OCCG

In total OCCG received 955 direct responses to the consultation:

859 completed surveys
65 letters and emails from the public
12 responses from GP practices and pharmacies
3 letters from advocacy and advice organisations (e.g British Specialist Nutrition Association Ltd, British Dietetic Association and Coeliac UK)
4 letters from gluten free production companies (e.g. Juvela)
6 letters from clinicians, including The department of Nutrition & Dietetics at Oxford University Hospitals NHS Trust and Oxfordshire Local Pharmaceutical Committee
6 MP letters

At the same time further clinical feedback was sought from the Local Medical Committee, hospitals specialists, Dieticians and Pharmacists.

The following themes arose from the consultation:

Cost and affordability: there was an overwhelming concern throughout all the responses that these proposals will have a negative financial impact on those that are elderly, on low incomes or in receipt of benefits.
Availability: there was a clear trend in the responses relating to availability of gluten-free products in supermarkets. Oxfordshire is primarily a rural county and gluten-free products are not consistently available across the county.
Quality: there was wide perception that prescription products are of a superior quality than those available in supermarkets. And for some people that have other co-morbidities, it is clear that the products available in the supermarkets are not of a sufficient nutritional standard to be able to meet their dietary needs. This is especially the case for people with Type 1 Diabetes.
Compliance: People felt very strongly that the prescription helps them to maintain their gluten-free diet.
Support: there was general concern that there is currently little support available to coeliacs to help them manage their diets.
Choice: there was a general feeling that managing a gluten-free diet includes encouraging patient choice. Individuals ‘choose’ what to eat and therefore they need to take responsibility for their diets as a dependency culture has developed. For some people maintaining a gluten-free diet is affordable without prescription and for others they manage the diet without using gluten-free substitutes.
The role of the NHS: some people simply felt that it is not the role of the NHS to provide food for people and that the money saved could be used in other ways.

For further information about the consultation please visit: NHS Buckinghamshire & Oxfordshire Cluster - Adults and children with coeliac disease - prescriptions for gluten-free food - Consultation Homepage