The Department of Health and Social Care changed their gluten-free food prescription guidelines in February 2018, recommending that clinical commissioning groups (CCGs) limit the items available from GPs to bread and flour mixes.
Coeliac UK have welcomed these new recommendations, as policymakers had been considering completely removing all gluten-free products from being prescribed. Instead they no longer recommend the prescription of items such as pasta, cakes and biscuits.
Some CCGs have already brought in full or partial bans on GPs prescribing gluten-free (GF) foods to people with coeliac disease in a bid to make cost savings in the NHS. The impact that this will have on patients, especially those from deprived areas, is unclear.
The overall aim of the study was to investigate the potential impact of policy changes on patients and NHS spending. We analysed prescribing data from GP practices in England to understand:
- patterns of gluten-free prescribing across CCGs in England
- the potential impact of the policy changes on patients
- the impact on NHS spending on gluten-free food
What we did
We looked at prescribing data and spending on gluten-free products from 94 per cent of GP practices in England between 2012 and 2017.
We linked the prescribing data to demographic information from more than 7,000 GP practices. We explored how spending on gluten-free products had changed over time, and how it varied in regions with different levels of deprivation, rurality, age demographics and gender differences.
Finally, we examined whether NHS CCG regions that had restricted access to gluten-free product prescriptions had lowered their spending.
How we involved people
We didn’t involve patients or the public directly, however there are plans for an additional study more focussed around how patients feel about these policy changes.
What we found and what this means
We found complete bans created savings of more than £2.5million in the CCGs that have adopted them. The new policy is unlikely to bring significant further savings as bread products made up around 65% of spending.
We estimated that if all CCGs in England had introduced a complete ban in 2014, when quarterly spending on gluten-free foods was at its peak at £6.5million, the NHS would have saved £21.1million a year.
Gluten-free prescribing was highest in practices:
- in more affluent areas, as diagnoses of coeliac disease tend to be higher in these populations
- in rural locations, where access to alternative sources of gluten-free foods is more problematic
- with more patients aged 75 plus, as these patients get free prescriptions
More than a quarter of clinical commissioning groups (CCGs) have already either completely banned prescriptions of gluten-free foods to anyone with coeliac disease or banned prescriptions to adults. The introduction of more restrictive gluten-free prescribing policies has been associated with ‘quick wins’ for CCGs under extreme financial pressure. However, these initial savings will be largely negated if CCGs revert to the recently published national recommendations.
Watch the video abstract
Dr Myles-Jay Linton explains the findings from the study.
There is no evidence for how prescribing under the new guidelines, or complete or partial bans, will affect patients. We have plans to evaluate the impact of gluten-free product prescription policy changes on patient health outcomes in Bristol, North Somerset and South Gloucestershire.
CLAHRC BITE (Brokering Innovation Through Evidence)
Links and downloads
- Breaking bread: Examining the impact of policy changes in access to state-funded provisions of gluten-free foods in England Read the full paper
- Amanda Owen-Smith, University of Bristol