A change in guidance to request gluten-free foods are no longer routinely prescribed was agreed by the NHS Hampshire and Isle of Wight Integrated Care Board in November 2023, with engagement and implementation to start from January 2024.
This decision was not taken lightly, and the NHS considered a range of both clinical and social factors, including the wider availability of gluten-free products in supermarkets and the need to ensure we deliver best value for money, in what is a challenging time financially for the NHS both locally and nationally.
The ICB estimates around 1,600 people are currently being prescribed gluten-free foods, costing around £350,000 per year, across Hampshire, Portsmouth, and Southampton.
Across the Isle of Wight the decision to stop routinely prescribing gluten-free foods was made in April 2017, which meant there we have had two different policies in place across Hampshire and the Isle of Wight. The discrepancy in policies was discussed within the ICB and it was agreed this could not continue.
The change in guidance was supported by a Quality Impact Assessment (QIA) and in early January the NHS informed, GPs, the Local Pharmaceutical Committee (LPC) and Local Medical Committee of the decision, with an overview of how the changes would be implemented and sought their views on the implementation plan.
Work is now ongoing to communicate this change to patients, stakeholders and clinician colleagues, and the NHS welcomes all views on this guidance change. The ICB medicines optimisation team is currently engaging with each GP practice to discuss the change in guidance and agree how the practice would wish to communicate and implement the changes.
A Frequently Asked Questions document has been produced to help explain the rationale for change and details given for further support.
We took on board the guidance from NHS England in 2017, which states that commissioning organisations can end the prescribing of all gluten free foods if they feel this is appropriate for their population.
We recognise this change in guidance may have a negative impact on some people. If either the person in receipt of gluten-free prescribed foods, or a carer/guardian of a person, feels there is an exceptional medical reason to receive gluten-free foods on prescription, then they can apply for an Individual Funding Request (IFR). They can apply for an IFR via their GP practice. This application will then be considered by the NHS based on:
- the presentation/effect of the condition in the patient differs significantly from that found in the general population of patients with the condition and, as a result
- the patient is likely to gain significantly more benefit from that treatment than might generally be expected for these patients. In addition to this:
There should be sufficient evidence of the effectiveness of the treatment in bringing about the expected benefit for the patient.
The ICB medicines optimisation team will continue to monitor feedback from practices, patients, the IFR process and prescribing information.
Dr Tim Cooper, deputy chief medical officer for NHS Hampshire and Isle of Wight, said: “We have a duty to use the limited amount of NHS funding available in a way that means local people have access to the best possible medical care, treatment and support for their health needs. This means we are constantly needing to make difficult decisions to get best value for money. We are facing complex financial challenges across our local NHS system and are working hard with our partners to address these and, as part of this, we have had to review what is available on prescription and to address disparities.
“The decision to request gluten-free foods are no longer routinely prescribed was not taken lightly and took into consideration a range of both clinical and social factors, including the wider availability of gluten-free products in supermarkets.
“We recognise this change in guidance may have a negative impact on some people. GP practices will continue to support and advise patients on how best to monitor and manage their 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 practice and you may be able to apply for an individual funding request to help. We welcome all feedback on this change and encourage people to share their thoughts.”