17 April 2018

The BMJ Open has published a paper which adds to the evidence that people with coeliac disease in England are currently facing a postcode lottery for access to gluten free food on prescription.

Clinical commissioning groups (CCGs) are implementing policies at a local level which are impacting on whether or not patients can access gluten free food on prescription. This paper provides further evidence that this variation is due to CCG policies and not due to differences in clinical need.

Access to gluten free food on prescription supports adherence to the gluten free diet, the only available treatment for coeliac disease. The National Institute for Health and Care Excellence (NICE) quality standard for coeliac disease highlights under Equality and Diversity Considerations that gluten free foods are more expensive and usually only available from larger retailers which makes access more difficult for people on low incomes or with limited mobility. As coeliac disease can affect more than one member of a family, this can add to the burden on the family budget. NICE therefore recommends that healthcare professionals should highlight if gluten free foods are available on prescription. This statement emphasises the risk of inequality that is introduced by restrictive CCG policies.

The differences seen in rates of prescribing by socio-economic status and age are unsurprising as this reflects the variations in diagnosis. There are lower rates of diagnosis of coeliac disease in the most deprived areas and most people are diagnosed in their 50s and 60s.

Gluten free prescribing has very recently been reviewed nationally by the Department of Health and Social Care (DHSC) and in February, the DHSC announced their plans to retain access to gluten free bread and flour mixes on prescription. Some CCGs have already restricted further than this, having withdrawn complete access to gluten free food on prescription. The regulations around the approach recommended by the DHSC are currently being developed and it is hoped that this decision will lead to a more consistent approach from CCGs.