The Department of Health consulted (until 22 June)1 on withdrawing gluten-free food (GFF) prescriptions for patients with coeliac disease (CD), aiming to save £25 million. Many CCGs have already stopped or restricted prescribing, stating that families should buy their own GFF instead.
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 1960s.2 Since ’gluten intolerance’ (functional symptoms exacerbated by gluten intake) emerged in the 1980s, 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.
- © British Journal of General Practice 2017