How much should be prescribed?
Your GP is ultimately responsible for the clinical decision making about the amounts of gluten free staples that are prescribed and should take into account your nutritional needs.
What gluten free food is available on prescription will depend on the policy in your area. In England, this is set by your local Integrated Care Board (ICB), in Scotland and Wales by your Health Board and in Northern Ireland, by the Health and Social Care board.
Coeliac UK has helped develop the below National Prescribing Guidelines. Our recommendations outline how many units someone with coeliac disease should be able to access based on average nutritional needs for their age and sex. These are illustrative guidelines only and prescribers should take account of individual activity levels and nutritional requirements. For information on our recommendations for England, please see additional guidance further down the page.
Across the UK
England
In England, gluten free prescriptions are limited to bread and flour mixes only and some local areas may restrict further. For example, your local area may limit what is available based on your age or other qualifying factors like pregnancy. In some places, it has been withdrawn altogether and is available only on a case by case basis.
Scotland, Wales and Northern Ireland
In Scotland, Wales and Northern Ireland, anyone with a diagnosis of coeliac disease can access gluten free staple products such as bread, flour and pasta in line with National Prescribing Guidelines. How this is provided differs between the nations though. For example, in Scotland prescriptions are delivered through your pharmacy as part of the Scottish Gluten Free Food Service while if you live in Hywel Dda University Health Board, in Wales, there is a top up card scheme available. In all other eligible areas your GP can write a prescription for gluten free staple food which you can collect from your pharmacist, just like getting medicine on prescription.
The National Prescribing Guidelines
The National Prescribing Guidelines for gluten-free food were produced by a working group made up of NHS healthcare professionals, first launched in 2004 and are endorsed by Primary Care Society for Gastroenterology (PCSG) and the British Dietetic Association (BDA). They offer guidance on the amounts of gluten free food to be made available on prescription, per patient, per month, taking into account the average energy requirements for age and sex and other factors such as pregnancy or breast feeding.
The standards assume that patients with coeliac disease are also consuming naturally gluten free staples such as rice and potatoes and that the prescription does not meet entire nutritional needs alone.
These are illustrative guidelines only and prescribers should take account of individual nutritional requirements.
Number of units for different foods
The below table shows roughly how many units different foods equate to in table below. This gives flexibility about how you use your units so you can choose what's right for you. Remember only bread and flour is available in England.
| Food item | Number of units |
|---|---|
| 500g bread mix/flour mix | 2 |
| 200g savoury biscuits/crackers | 1 |
| 250g pasta | 1 |
| 500g oats | 1.5 |
| 300g breakfast cereals | 1.5 |
| 2 × 110–180g pizza bases | 1 |
| 100–170g xanthan gum | 1 |
| 400g bread/rolls/baguettes | 1 |
Recommended amounts per month
These are illustrative guidelines only and prescribers should take account of individual nutritional requirements.
| Age and sex | Number of units |
|---|---|
| Child (1-3 years) | 10 |
| Child (4-6 years) | 11 |
| Child (7-10 years) | 13 |
| Child (11-14 years) | 15 |
| Child (15-18 years) | 18 |
| Male (19-59 years) | 18 |
| Male (60-74 years) | 16 |
| Male (75+ years) | 14 |
| Female (19-74 years) | 14 |
| Female (75+ years) | 12 |
| Breastfeeding | Add 4 |
| 3rd trimester pregnancy | Add 1 |
Additional guidance for England (bread and flour mixes only)
In England, only bread and flour mixes are available on prescription. Because of this, additional guidance based on national data on bread consumption in the UK is also available for prescribers in England.
| Age and sex | Number of units |
|---|---|
| Child under 10 years | 8 |
| Child 11 - 18 years | 12 |
| Female 19 years and older | 8 |
| Male 19 years and older | 12 |
| Breastfeeding and 3rd trimester pregnancy | Refer to National Prescribing Guidelines (Add 4 units for breastfeeding, add 1 unit for 3rd trimester pregnancy) |
Additional consideration for prescribers
Prescribers should use their clinical judgement and take energy requirements into account when deciding on appropriate quantities to prescribe. They should seek advice from a dietitian if they are unsure.
Our Helpline is always happy to help with any enquiries you may have on gluten free prescribing: call them on 0333 332 2033 Mon-Fri 10am-4pm
How the guidelines were calculated
The above units are calculated according to established average energy requirements for age and sex and draws on consumption data from the National Diet and Nutrition Surveys. It assumes that individuals will be getting additional carbohydrates from rice and potatoes alongside staple products. In the case of England specific recommendations this is based on energy requirements for bread and flour only.
Basis of the guidelines:
- Average energy requirements based on age and sex ( Scientific Advisory Committee on Nutrition (SCAN) Dietary Reference Values for Energy 2011 )
- Dietary recommendations for balanced eating (Scientific Advisory Committee on Nutrition (SCAN) on carbohydrates and health 2015)
- Review of consumption data from National Diet and Nutrition Surveys (Whitton et al, 2011)
- It is also assumed that people with coeliac disease don’t just eat substitute products but also eat rice and potatoes