Do No Harm

CD affects 1% of the population, putting them at risk of long-term consequences (including subfertility, osteoporosis, lymphoma and poor growth), and the only treatment is a strict GF diet. Children are entitled to free NHS prescriptions, and dietary staples (bread, flour, pasta) have been available within regulated limits since the 1960's.² Since ’gluten intolerance’ (functional symptoms exacerbated by gluten intake) emerged in the 1980’s, GFF is more evident in supermarkets but remains costly. Availability is poor in convenience and budget stores where low-income families and those without transport shop more frequently.³ One patient questionnaire found that 28% struggled to locate stores with GFF, and 27% reported difficulties identifying GFF.⁴

In some CCG consultations, low-quality information reflects press reports claiming “thousands of prescriptions... for custard creams, doughnuts and pizzas”. Anything that prejudices adherence to a strict GF-diet has negative implications for long-term health and NHS resources, and NICE recommends access to GFF prescriptions.⁵ Natural alternatives, such as rice, are less nutritious, with 90% less iron and 82% less calcium than bread.⁶ In an era of rising health inequalities, protecting access to GFF on prescription at no cost to the family should remain a fundamental principle of care for children with CD. Innovative models for providing GFF and a national NHS procurement process could better reduce costs.

References

1. Department of Health.  Open consultation.  Availability of gluten-free foods on NHS prescription.  Published date: March 2017. www.gov.uk/government/consultations/availability-of-gluten-free-foods-on-nhs-prescription. 
2. Coeliac UK. Campaign with us on prescriptions.  www.coeliac.org.uk/get-involved/campaign-with-us/campaign-for-us-on-prescriptions.
3. Burden M, Mooney PD, Blanshard RJ, et al. Cost and availability of gluten-free food in the UK: in store and online. Postgrad Med J 2015;356:622-6
4. Rashid M, Cranney A, Zarkadas M, et al. Celiac disease: evaluation of the diagnosis and dietary compliance in Canadian children. Pediatrics 2005; 1;116(6):e754-9.
5. NICE Clinical knowledge summary. Coeliac disease. https://cks.nice.org.uk/coeliac-disease.
6. O’Connor A. An overview of the role of bread in the UK diet. Nutr Bull 2012;356:193-212.