01 Jul 2018
Coeliac disease is a lifelong autoimmune condition caused by an abnormal immune response to eating gluten. It is one of the most common gastrointestinal conditions that require dietetic support. If untreated, coeliac disease leads to extensive intestinal villous atrophy that causes malabsorption of essential nutrients such as calcium, iron vitamin B12 and folate. In the long term, untreated coeliac disease can lead to complications such as osteoporosis, lymphoma and small bowel cancer, depression and infertility. A gluten‐free (GF) diet is the sole treatment for coeliac disease and many patients find this extremely challenging. The provision of GF staple foods on prescription plays an essential role in supporting people with this condition to adhere to a strict, life‐long GF diet.
The BDA states that:
- Coeliac disease is a condition that warrants the continued availability of staple GF foods on prescription. It is a lifelong autoimmune disease with serious complications associated with non-adherence to a GF diet. The ingestion of even small amounts of gluten causes damage to the lining of the small intestine leading to malabsorption, and therefore subsequent nutritional deficiencies, in addition to an increased risk of osteoporosis, depression, infertility and malignancy.
- People diagnosed with coeliac disease require access to staple GF foods on prescription. National prescribing guidelines (1) recommend a monthly unit allowance that, ensures equality in treatment for all with the diagnosis of coeliac disease. Gluten free prescriptions:
- maximise adherence and facilitate the prevention of long term medical consequences associated with non-adherence to the GF diet
- support individuals in meeting raised nutritional requirements, as GF foods on prescription are fortified with calcium and B vitamins.
- reduce the financial burden of purchasing GF products
- ensure equitable access to GF products
- Dietitians may make recommendations that deviate from the national prescribing guidance (which are currently under review) but these will be based on individualised expert assessment, taking into account the individual’s clinical condition and overall nutritional requirements.
- In line with the NICE Quality Standard for Coeliac Disease (2), all patients diagnosed with Coeliac Disease should receive an annual review, preferably with a dietitian. This will support GF dietary adherence and nutritional adequacy, allow symptoms to be reviewed and further appropriate information, advice and support to be provided.
- The NHS should take advantage of new and innovative models for the provision of GF foods using dietetic-led (e.g. dietitian prescribing in Rotherham) or pharmacy-led schemes (e.g. Gluten Free Food Service in Scotland). These models have been found to be cost effective and convenient for patients and healthcare professionals.
- The cost to the NHS of supplying prescribed GF foods is complex involving manufacturers, pharmacies and wholesalers. In some cases, additional handling charges are placed by wholesalers. The BDA urges Clinical Commissioning Groups (CCGs) and other NHS providers to work with pharmacists and local healthcare professionals in getting the best price for providing GF food on prescription. It is possible to reduce the overall costs of supplying GF staple foods via new innovative schemes that save GP time and provide better cost control.
- Where provider organisations are reviewing the provision of GF staple foods on prescription, the BDA recommends that Coeliac UK, local dietitians, gastroenterologists, pharmacy prescribing leads, GPs and patient representatives are fully involved in the review process. In England, the BDA would recommend that providers should, as a minimum, adhere to the outcomes of the national consultation that recommended GF bread, flour and flour mixes remain on prescription. Dietetic and patient representation is particularly important when considering rationalisation of the categories and brands of GF foods available so as to ensure the needs of the coeliac population in general, and the specific nutritional needs of each individual patient are understood and considered.