SRCCG guidance on the prescribing of gluten free foods

1.Summary

Following a recent decision to decommission the prescribing of gluten free foods to patients aged 18 years and over, this document provides guidance to SRCCG prescribers on when to prescribe gluten free foods on the NHS, and which products are commissioned for prescribing locally.

2. Background

The CCG recently sought to determine whether it should continue to support the prescribing of gluten free products on the NHS, in line with other CCGs in this locality. The CCG undertook a detailed consultation exercise with service users, the wider public and clinicians. The outcome of this consultation in conjunction with review of data and consideration of other local factors, has led the CCG to make the decision not to commission gluten free prescribing for those aged 18 and over. Those aged under 18 years with a proven gluten enteropathy can continue to receive a small range of gluten free products on prescription. A definition of how to determine whether a patient has a gluten free enteropathy is described below.

3. Gluten free products – diagnosis and guidance on prescribing for under 18 year olds

All diagnosis should be in line with national guidance,available on the link below.

Further to the local consultation and a review of the evidence, the CCG has made a decision to continue prescribing a small range of gluten free food products to patients with a confirmed diagnosis only and under the age of 18. The gluten free food products that will continue to be provided are:

. Bread (not rolls, baguettes or other bread products)

. Flour

. Pasta.

Appendix 1 lists the products that are commissioned for use locally in these circumstances.

4. Quantities of gluten free products that can be prescribed for those aged under 18 years

Quantities prescribable on the NHS are in line with guidance from Coeliac UK. These are as follows:

The maximum amount of units prescribed per month should not exceed the quantities stated in the table below:

1 unit is equivalent to / 400g bread
or
250g pasta
2 units is equivalent to / 500g flour

The following table demonstrates the recommended number of units for various groups of patients according to age:

Age group / Recommended number of units
1 - 3 years / 10
4 – 6 years / 11
7 – 10 years / 13
11 – 14 years / 15
15 – 18 years / 18
Higher physical activity / Add 4 units
  • Quantities should be prescribed in no more than one month’s supply at a time
  • Quantities of units stated above should be regarded as an upper limit
  • Appropriate dietetic advice should be given to promote healthy balanced eating,

adequatenutritional and fibre intake. Additional factors that may be relevant,

suchasweightmanagement, should also be discussed.

5. Implementation of guidance

GP practices are asked to implement this guidance.All patients aged 18 and over who are currently prescribed gluten free products should be identified and contacted with advice that their prescription will stop with effect from 1st April 2017. A review of diagnoses of all patients aged under 18 years and currently receiving gluten free products should be made. Patients aged under 18 who have been clinically diagnosed with gluten enteropathy can continue to receive a small range of gluten free products on prescription.

A review of products and quantities prescribed for eligible patients should then be undertaken. Ongoing prescriptions should be in line with this guidance. Support from the CCG prescribing support team is available to aid this implementation.

6. Review of guidance

The guidance will be reviewed annually or sooner if required due to changes in evidence or practice.

Practice level audits of prescribing to determine compliance with the guidance and review of prescribing data will be performed at least every 6 months.

7.Patient resources

The CCG recommends that coeliac patients continue to follow a GF diet, with advice available through various patient support organisations, like Coeliac UK, on how to achieve an appropriate diet through natural and manufactured GF foods. This lifestyle management should help to reduce the risk of long-term complications associated with poor nutrition.

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Appendix 1: Guidance on gluten free products approved for prescribing– age restrictions apply (see ScRCCG guidance document April 2017)

This list is correct as at February 2017.

Drug Tariff September 2016 - list of products under heading "Gluten Free" that are commissioned by ScR CCG. No other products are to be prescribed. / Units per product
(per 400g loaf, 250g pasta, 500g flour)
Barkat gluten-free brown rice bread / 1
Barkat gluten-free buckwheat pasta (penne, spirals) / 1
Barkat gluten-free home fresh country loaf (formerly Barkat gluten-free par-baked country sliced loaf) / 1
Barkat gluten-free lasagne / 1
Barkat gluten-free par-baked white bread / 1
Barkat gluten-free par-baked white sliced bread / 1
Barkat gluten-free pasta (alphabet, animal shapes, macaroni, shells, spaghetti, spirals, tagliatelle) / 1
Barkat gluten-free potato pasta gnocchi / 1
Barkat gluten-free wheat-free multi grain bread / 1
Barkat gluten-free white rice bread / 1
Barkat gluten-free wholemeal sliced bread / 1
BiAlimenta gluten-free pasta (acini di pepe (pasta grains), formatimisti (variety pack), penne, sagnette, spirali (spirals), tubetti) / 1
BiAlimenta gluten-free potato pasta gnocchi / 1
BiAlimenta gluten-free potato pasta perle di gnocchi / 1
Dietary Specials gluten-free white multigrain sliced loaf / 1
Ener-G gluten-free brown rice bread / 1
Ener-G gluten-free rice loaf / 1
Ener-G gluten-free Seattle brown loaf / 1
Ener-G gluten-free tapioca bread / 1
Ener-G gluten-free white rice bread / 1
General Dietary gluten-free rice pasta (lasagne, macaroni, small shells, spaghetti, vermicelli)
(formerly Ener-G gluten free rice pasta) / 1
Genius gluten-free brown bread / 1
Genius gluten-free white bread / 1
Genius gluten-free sandwich bread (brown sliced) / 1
Genius gluten-free sandwich bread (white sliced) / 1
Genius gluten-free sliced brown bread / 1
Genius gluten-free sliced white bread / 1
Glutafin gluten-free fibre loaf sliced / 1
Glutafin gluten-free high fibre loaf / 1
Glutafin gluten-free pasta (lasagne, long-cut spaghetti, macaroni penne, shells, spirals) / 1
Glutafin gluten-free pasta fibre (fusilli) / 1
Glutafin gluten-free white loaf sliced / 1
Glutafin gluten-free Select fibre loaf sliced / 1
Glutafin gluten-free Select fresh brown loaf sliced / 1
Glutafin gluten-free Select fresh seeded loaf sliced / 1
Glutafin gluten-free Select fresh white loaf sliced / 1
Glutafin gluten-free Select seeded loaf sliced / 1
Glutafin gluten-free Select white loaf sliced / 1
Gratis gluten-free pasta (alphabets, macaroni, shells, short cut spaghetti, spirals) / 1
Innovative Solutions Pure brown rice flour / 2
Innovative Solutions Pure potato flour / 2
Innovative Solutions Pure gluten-free blended flour / 2
Innovative Solutions Pure tapioca flour / 2
Innovative Solutions Pure teff brown flour / 2
Innovative Solutions Pure teff white flour / 2
Innovative Solutions Pure white rice flour / 2
Just: gluten-free good white bread / 1
Just: gluten-free white sandwich bread / 1
Juvela gluten-free fibre linguine / 1
Juvela gluten-free fibre loaf (sliced and unsliced) / 1
Juvela gluten-free fibre penne / 1
Juvela gluten-free fresh sliced fibre loaf / 1
Juvela gluten-free fresh sliced white loaf / 1
Juvela gluten-free lasagne / 1
Juvela gluten-free loaf (sliced and unsliced) / 1
Juvela gluten-free part-baked fibre loaf / 1
Juvela gluten-free part-baked loaf / 1
Juvela gluten-free pasta (fusilli, lasagne, macaroni, spaghetti) / 1
Juvela gluten-free tagliatelle / 1
Lifestyle gluten-free brown bread / 1
Lifestyle gluten-free high fibre bread / 1
Lifestyle gluten-free white bread / 1
Livwell gluten-free sliced white bread / 1
Mrs Crimbles gluten-free fresh bread / 1
Orgran gluten-free buckwheat spirals pasta / 1
Orgran gluten-free corn spirals pasta / 1
Orgran gluten-free rice spirals / 1
Orgran gluten-free rice and millet spirals / 1
Orgran gluten-free riso'mais (rice and maize) lasagne, riso'mais spirals / 1
Orgranris 'o' mais macaroni / 1
Orgran self-raising flour / 2
Proceli white flour / 2
Rizopia brown rice pasta (fusilli, lasagne, penne, spaghetti) / 1
TobiaTeff brown flour / 2
TobiaTeff white flour / 2
Warburtons gluten free brown bread / 1
Warburtons gluten-free seeded loaf / 1
Warburtons gluten free white bread / 1
Wellfoods gluten-free loaf / 1
Wellfoods gluten-free flour alternative / 2
Wellfoods gluten-free sliced loaf / 1