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The NHS is currently facing supply issues with glucagon-like peptide-1 receptor agonists (GLP-1 RAs), a range of drugs used for managing blood glucose levels in people with type 2 diabetes.  

 

Guidance change for prescribing gluten-free foods across the Hampshire, Portsmouth, and Southampton 

Frequently asked questions:


Is there a change in the way gluten-free food is prescribed?
Yes – the local NHS is advising gluten-free food should no longer be available on prescription for most patients.

Will the overall management of my coeliac disease change?
No, the local NHS still follows the guidelines outlined here in the National Institute for Health and Care Excellence (NICE) guidelines - Coeliac disease: recognition, assessment, and management. You can see the guidelines here.

When will this change take place? 
GP practices across Hampshire, Portsmouth and Southampton are being requested to stop prescribing gluten-free food from January 2024. 

Who is making this request?
The NHS Hampshire and Isle of Wight Integrated Care Board (ICB) is requesting this change from GP practices. The ICB manages the local NHS budget and plans services across Hampshire and the Isle of Wight.

Who will be affected by this change? 
Most people prescribed gluten-free foods will be affected by this change. This  includes people who have been diagnosed with coeliac disease, established gluten sensitive enteropathies and dermatitis herpetiformis. 

Will any patients continue to receive gluten-free foods on prescription? 
Some patients with exceptional clinical circumstances may continue to receive gluten-free foods on prescription.
 
Will food for other conditions, such as those who need to follow a low-protein diet, continue to be prescribed?
This guidance change refers only to the prescribing of gluten-free foods. Other conditions that require a supplementary food prescription will continue, as specialist products for these conditions are not widely available in supermarkets and shops.
 

How many people in Hampshire, Portsmouth and Southampton will be affected by this change? 
The ICB estimates around 1,600 people are currently being prescribed gluten-free foods.

Why has this change been put into place? 
There are three broad reasons for this change:

  • Gluten-free foods are now more widely available in supermarkets, restaurants, and shops. Historically these types of foods were only available on prescription. 

  • The NHS has a limited prescribing budget and stopping prescribing of glutenfree foods, the ICB estimates a saving of more than £350,000 a year. This money will be reinvested back into patient care.

  • The Isle of Wight stopped routinely prescribing gluten-free foods in April 2017. This change will bring Hampshire, Portsmouth, and Southampton in line with the Isle of Wight.

My family member has a long-term condition, which will make it difficult for them to maintain a gluten-free diet. Is it recommended that they continue to receive gluten-free foods on prescription? 
The recommendation to stop prescribing gluten-free foods applies to everyone with coeliac disease. 

We do recognise that this change may have more of an impact on some vulnerable people, including those with learning disabilities, dementia, a mental health problem or another long-term condition.

If you think you, or someone you care for, has an exceptional medical reason to receive gluten-free foods on prescription, please discuss this with your GP and you may be able to apply for an individual funding request (IFR). 

Decisions will be made on a case-by-case basis. If an IFR is successful, GPs will take NHS England’s prescribing guidelines into account alongside the individual’s needs. 

Will you be offering extra support and help for people who will no longer receive gluten-free foods on prescription? 
We will continue to support, advise and monitor patients, diagnosed with coeliac disease or other established gluten-sensitive enteropathies, through our GP practices, community dietetics services and gastroenterology departments as before. 

We will prepare GPs, dietitians, and gastroenterologists for this proposed change so that they are particularly alert to any potential risks to vulnerable patients. 

We encourage patients with coeliac disease who are having difficulty maintaining a gluten-free diet to seek advice and support from Coeliac UK.

If I struggle to maintain a gluten-free diet without prescribed foods, what should I do? 
If you are having difficulty maintaining a gluten-free diet, please seek advice and support from your GP, community pharmacy and/or dietitian. Coeliac UK also has a lot of useful resources, information, recipes, and contacts on their website.

I cannot afford to buy gluten-free foods as I am on a low income. Can I still receive gluten-free foods on prescription? 
The recommendation applies to everyone with coeliac disease. Recipes and tips for managing a gluten-free diet on a budget is available via the Coeliac UK website.

Will children continue to receive gluten-free foods on prescription?
The recommendation applies to children as well as adults. 

How will this change affect people who have coeliac-type symptoms but have not been tested or diagnosed? 
This proposed change will not directly affect people who have not been formally diagnosed. The NHS should only be prescribing gluten-free foods for patients with a confirmed diagnosis of coeliac disease or other established gluten-sensitive enteropathies.

Useful patient resources: 

Climate Change and Medicines

In October 2020, the NHS became the world’s first health service to commit to reaching carbon net zero, in response to the profound and growing threat to health posed by climate change. The “Delivering a Net Zero Health Service” report sets out a clear ambition and two evidence-based targets.

The NHS Long Term Plan includes:

  • To reduce the NHS carbon footprint by 51% by 2025
  • Delivering a ‘net zero NHS’: reaching net zero carbon emissions by 2040

Medicines are the most common intervention in healthcare, and account for about 25% of carbon emissions within the NHS. There are different ways of thinking about how we prescribe and use medications that can reduce their impact on climate change, for example:

  • Choice of medicines e.g. some inhaler devices are ‘greener’ than others
  • The supply chain of medicines
  • Medicines waste and how medicines are disposed of or recycled
  • Over-prescribing of medicines that are not providing benefit to patients, or are not being taken as prescribed
  • Medicines packaging
  • Hospital admissions for patients with long term conditions, not being adequately managed with their current medication regimens

The ICB medicines optimisation teams are committed to supporting the NHS Long Term Plan by understanding and developing ways to reduce the environmental impact of medicines, working with colleagues in other organisations.

The ICB Respiratory Sustainability Group, in conjunction with local hospitals and community pharmacies, have been working with GPs and respiratory nurses to prioritise the optimisation of medicines for patients with respiratory diseases such as asthma and COPD (Chronic Obstructive Pulmonary Disease). This not only will provide health benefits for these patients but will also support the ‘Green Agenda’. As part of patient – centred annual reviews, the opportunity for ‘greener’ inhaler devices to be prescribed is also discussed with patients. Watch the video below and read this quick guide to choosing the right inhaler for more information regarding the impact of inhaler devices on the environment.

 

Emollients

As a result of national MHRA alerts regarding the fire risks of emollient use, further resources have been developed for patients and their families/carers.

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