Harrogate and Rural District Clinical Commissioning Group (HaRD CCG) have at their Governing Body meeting made the decision to only prescribe gluten free products to the most vulnerable people living with coeliac disease in our community.
In 2015, the NHS spent £26 million on prescribing gluten free food with £16.7 million spent on 840,000 prescriptions for bread. The current cost of prescribing gluten free products across Harrogate and the rural district costs around £90,000 a year and with the growing financial restraints placed on the NHS, the CCG is reviewing what it commissions.
Dr Rick Sweeney, Governing Body member at HaRD CCG said
I would like to thank all those who responded to the CCGs survey. As a Governing Body, we have made the decision to restrict prescribing gluten free products due to the significant increase in their availability in supermarkets and via home delivery services. 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 in line with many neighbouring CCGs across Yorkshire and the Humber, we believe this is the right action to take.
Feedback from the survey showed us that 43% of respondents live with coeliac disease with an additional 9% either caring for a child or adult in receipt of gluten free products on prescription and understandably they were unhappy with these proposals.
The CCG recognises that this proposal may not be supported by patients currently receiving gluten free foods on prescription and whilst the price of standard retail gluten free products is now considered affordable, the CCG appreciates, it may be less affordable to some. However the CCG’s responsibility is to the whole population of Harrogate and Rural District.
Through the survey, the CCG received a number of comments around patients who might be classed as ‘vulnerable’. The CCG is committed to ensuring these patients are supported by developing guidelines to aid clinical decision making in General Practice to identify these vulnerable patients.
The CCG will continue to support patients living with coeliac disease in following a gluten free diet, with advice available through various patient support organisations, like Coeliac UK, dietician support and the Living Well team at North Yorkshire County Council on how to achieve an appropriate diet through natural and manufactured gluten free foods.
Coeliac UK is very concerned by the announcement by Harrogate and Rural District CCG that from this autumn all gluten-free prescriptions for people in the region who have coeliac disease will be cut.
Although the charity is pleased to learn the most vulnerable, or those in exceptional circumstances, will still be supported, it is concerned that although 65% of respondents to the consultation disagreed with the CCGs proposal to no longer routinely fund prescriptions for gluten-free products that these opinions were discounted.
The charity also strongly refutes the claim in the board papers that:
The CCG is assured of a good geographical spread of retail outlets across the locality, with a wide and price competitive choice of gluten free products for self-purchase.
Sarah Sleet, chief executive of Coeliac UK, the national charity for people with coeliac disease said:
We have clear evidence from in depth research that the cost of key gluten-free products such as breads and flours in supermarkets has not reduced. We sent this information to the CCG but it has been ignored.
Gram for gram, gluten-free bread is six times more expensive* than regular gluten containing bread in the supermarket. Whilst other gluten-free food staples such as pasta, are three to four times more expensive than gluten-containing counterparts and availability is limited in rural areas, discount supermarkets and small stores. Having access to gluten-free staple foods on prescription provides an essential level of support to individuals trying to keep to the gluten-free diet which is the only treatment for coeliac disease.
Ms Sleet said:
We would urge anyone who will be severely affected by this decision and wish to make a case for prescriptions as an exception to contact the Charity to see how we can take your case forward.
Coeliac disease is a serious autoimmune disease caused by a reaction to gluten. When gluten (a protein found in wheat, rye and barley) is eaten, damage to the gut lining occurs. There is no cure or medication for the condition; the only treatment is a lifelong, strict gluten-free diet. If someone with coeliac disease doesn’t stick to a gluten-free diet, the disease can lead to other conditions such as malnutrition, osteoporosis and small bowel cancer.
.Comparative costs for gluten-free bread and gluten containing bread as of 4 July 2016
Price per 100g
Price per loaf
Tesco-free from white sliced (400g)
Tesco-free from fresh bread (550g) (white or brown)
Asda free from white sliced bread (400g)
Asda free from brown sliced bread (550g)
Sainsbury’s free from sliced (400g) white or brown
Gluten containing loaf
Price per 100g
Price per loaf
Tesco everyday value bread (800g) (white or brown)
Tesco bread (800g) (white or bread)
Asda Baker’s Selection (800g) white or brown
Asda chosen by you (800g) wholemeal
Sainsbury’s basics bread (800g) white or brown
Sainsbury’s bread (800g) white or brown
Waitrose essential (800g) white or brown
Waitrose bread (800g) white or wholegrain
The National Institute of Health and Care Excellence (NICE) estimates that the cost of gluten-free food to the NHS equates to £194.24 per diagnosed patient per year, making it an extremely low cost treatment. Last year, NHS Harrogate and Rural District CCG spent approximately £90,000 on gluten-free foods for both adults and children.
In England, prescriptions for gluten-free food are not free of charge unless someone already qualifies for free prescriptions. Currently 63% of CCGs across the country adhere to National Prescribing Guidelines, providing recommendations for GPs and policymakers on reasonable amounts of gluten-free staple foods such as bread, flour and pasta per patient per month.
The CCG will introduce this change in the autumn and will consider the NICE (The National Institute for Health and Care Excellence) Quality Standards report on coeliac disease when it is published in October.