Commissioning statement – gluten free food

Treatment: Gluten free foods
For the treatment of: Patients diagnosed with gluten sensitivity enteropathies, including Coeliac disease
Commissioning position: Bradford district and Craven CCG does not routinely commission or fund gluten free products.
Date effective from: NHS Bradford City CCG and NHS Bradford Districts CCG effective from 1 December 2016.
NHS Airedale, Wharfedale and Craven CCG effective from 1 September 2017
NHS Bradford district and Craven CCG effective from 1 April 2020
Policy to be reviewed by: Medicines and Prescribing Group
Background information: This decision was based on clinical evidence, financial information and feedback from a public consultation on gluten free (GF) prescribing.

The NHS was spending £25m a year to provide GF products on prescription. In Bradford districts and Craven we were spending around £420,000 a year on this service.

A full consultation was undertaken in Bradford between July and September 2016 and in Airedale, Wharfedale and Craven between January and March 2017.

There are a very small number of patients who currently receive low protein GF food on prescription, but they will be unaffected by this change. They do not have coeliac disease, but have illnesses which require them to eat an extremely restricted diet for which specialist foods are not available on the high street.

Summary of evidence/rationale: Coeliac disease is a serious medical condition where the body’s immune system attacks its own tissue when gluten is eaten.

The only medical treatment for coeliac disease is strict adherence to a gluten-free diet for life. Gluten is not necessary for a healthy diet and patients can safely exclude it from their diet and still eat healthily without purchasing formulated foods. There are a number of naturally gluten free carbohydrates which are widely available that can be used instead of foods containing wheat, rye and barley. These include rice, potatoes and flour alternatives such as millet and corn flour. Naturally gluten free foods include meat, fish, vegetables, fruit, rice and most dairy products.

There is much information available to patients via Coeliac UK about how to eat a healthy gluten free diet or NHS Choices website

Changes to the law mean food labelling has improved and it’s easier to see which foods contain gluten and supermarkets and local stores are increasingly stocking gluten free products.

Non-adherence to gluten free diets can cause serious health problems. Those who are not following a strict gluten free diet are at a higher risk of long term complications, including osteoporosis, ulcerative jejunitis, intestinal malignancy, functional hyposplenism, vitamin D deficiency and iron deficiency.

In December 2018 NHS England completed a consultation on stopping gluten free food on prescription. Their decision was to continue to allow bread and mixes on prescription. All other gluten free items were then ‘blacklisted’ and not available to prescribe at NHS expense. At this time a review was undertaken in Bradford districts and Craven and as we had undertaken a full consultation for our decision we concluded we would not reverse it.

References: The National Institute for Health and Care Excellence (NICE) Coeliac Disease quality standard is available on the NICE website here.

Prescribing Gluten-Free foods in Primary Care: Guidance for Clinical Commissioning Groups is available to read and download on the NHS England and NHS Improvement website here.

Contact for this policy: Senior Head of Medicines Optimisation

Gluten free foods commissioning statement

Approved: Medicines and Prescribing Group July 2020

Review Date: July 2022

You can also download a PDF copy of the gluten free foods commissioning statement here.

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