Position Statement on Gluten Free Products
HVCCG recommends restricting the prescribing of Gluten Free products for patients who are diagnosed with the following ACBS conditions:
Coeliac Disease (CD)
Dermatitis Herpetiformis (DH)
Recommendations
· Table 1: Recommended units for prescribing per month.
All patients (children & adults) / 8 unitsBreastfeeding / 12 units
3rd trimester pregnancy / 9 units
· Table 2: Number of units per prescribable food item
400g fresh or long-life bread / 1 unit500g bread/flour mix / 2 units
500g pasta / 2 units
For example: Each month a patient could request 4 x 400g loaves bread (4 units) & 1 x 500g bread/flour mix (2 units) & 1 x 500g pasta (2 units) = 8 units
· Make patients aware fresh bread will be baked to order and will be delivered to pharmacies. Patients to pick up orders promptly and freeze excess loaves to reduce wastage.
· Patients should be advised to purchase other products e.g. pizza bases, biscuits, over the counter (OTC).
· All prescriptions should be clearly marked ACBS.1
· A gluten-free support sheet devised by HVCCG is available to patients/carers/guardians.
· A patient information letter is available.
Rationale
· A range of gluten free products are available in supermarkets at prices that are lower than what the NHS is charged.
· HVCCG Commissioning Executive agreed on 31 March 2016 to restrict gluten free prescribing
· NICE NG20 (2015) does not have any recommendations on what to prescribe. See additional information for the recommendations.2
Additional information
Gluten-free Guarantee (GfG)
The Coeliac Society has set up a Gluten-free Guarantee (GfG) campaign, supermarkets are agreeing to make available a basket of eight staple gluten-free food products in all stores, improving availability and helping people with coeliac disease to manage their gluten-free diet.
The basket of eight is:
Herts Valleys CCG Position Statement: Gluten Free Products
31st March 2016 Page 1 of 3
•Fresh white bread
•Fresh brown bread
•Bread rolls
•Breakfast cereals
•Pasta
•Flour
•Crackers
•Cereal bars
Herts Valleys CCG Position Statement: Gluten Free Products
31st March 2016 Page 1 of 3
Asda and Morrisons are currently committed to the GfG, and three other leading supermarkets, Waitrose, Tesco and Marks & Spencer have also made significant progress in meeting the GfG.3
NICE NG20 – Information and support
A healthcare professional with a specialist knowledge of coeliac disease should tell people with a confirmed diagnosis of coeliac disease (and their family members or carers, where appropriate) about the importance of a gluten‑free diet and give them information to help them follow it. This should include:
· Information on which types of food contain gluten and suitable alternatives, including gluten‑free substitutes.
· Explanations of food labelling.
· Information sources about gluten‑free diets, recipe ideas and cookbooks.
· How to manage social situations, eating out and travelling away from home, including travel abroad.
· Avoiding cross contamination in the home and minimising the risk of accidental gluten intake when eating out.
· The role of national and local coeliac support groups.
NICE NG20 - Monitoring
· Offer an annual review
o measure weight and height
o review symptoms
o consider the need for assessment of diet and adherence to the gluten free diet
o consider the need for specialist dietetic and nutritional advice.
· Refer the person to a GP or consultant if concerns are raised in the annual review. The GP or consultant should assess all of the following:
o the need for a dual energy X ray absorptiometry (DEXA) scan (in line with the NICE guideline on osteoporosis: assessing the risk of fragility fracture) or active treatment of bone disease
o the need for specific blood tests
o the risk of long term complications and comorbidities
o the need for specialist referral.
Vaccinations
About a third of coeliac patients suffer from splenic atrophy or hyposplenism. Due to this impairment of the immune system, on clinical judgment patients should be offered:
o An annual influenza vaccination
o Pneumococcal vaccination every 5 years
References
1. British Society of Gastroenterology. Guidelines for the management of patients with coeliac disease. Available at www.bsg.org.uk/pdf_word_docs/coeliac.doc
2. National Institute for Health and Care Excellence (2015) NG20 Coeliac disease: recognition, assessment and management. Available at https://www.nice.org.uk/guidance/ng20
3. Coeliac UK (2016) Gluten-free Guarantee. Available at https://www.coeliac.org.uk/campaigns-and-research/campaigning-on-food/
4. NHS Oxfordshire Clinical Commissioning policy statement 42c NHS prescribing of gluten free foods updated December 2013 issued January 2014
5. PrescQIPP (2015) Guidance on the prescribing of gluten-free foods. Available at https://www.prescqipp.info/gluten-free/finish/204-gluten-free/1586-bulletin-69-gluten-free-prescrbing Accessed on 4/4/16
Acknowledgements
Berkshire East CCGsBerkshire West Area Prescribing Committee
Coeliac UK
Great Yarmouth & Waveney CCG
Ipswich & East Suffolk CCG
North East Essex CCG
North Norfolk CCG / Norwich CCG
Nottingham North and East CCG
Oxford CCG
South Norfolk CCG
Suffolk CCG
Vale of York CCG
West Norfolk CCG
Herts Valleys CCG Position Statement: Gluten Free Products
31st March 2016 Page 1 of 3
Herts Valleys CCG Position Statement: Gluten Free Products
31st March 2016 Page 1 of 3