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Gluten-free Prescribing Guidance
Research undertaken by Coeliac UK suggests that access to GF food on prescription is viewed as the most important factor for people with coeliac disease
(CD) in terms of adherence to a GF diet. It is recognised that gluten-free (GF) foods are more expensive: practitioners are encouraged to prescribe adequate
quantities to ensure patients are not financially disadvantaged. The guidance provides advice on the amounts of GF food required by individuals with glutensensitive enteropathies.
It is important to make patients aware that naturally occurring gluten-free food e.g. potatoes, rice, fresh vegetables and fruits (which can be purchased by
the patient) are essential and should form the basis of their regular diet, in line with the nutritional recommendations for a healthy well balanced diet.
Products included
Bread, rolls, baguettes; bread mix, flour mix, pastry mix
Pasta
Crispbread
Products to be prescribed on the advice of a dietician, to meet individual patient needs:
Crackers, savoury biscuits, pizza bases, breakfast cereals
Products not included
Biscuits, sweet
Cakes, cake mix
Items not in the ‘products included list’
Non-essential items such as sweet biscuits and cakes are considered to be low priority for prescribing on the NHS and are not included in the formulary.
GF products, including brands that are not approved for NHS prescription, are widely available in supermarkets/pharmacies: it is accepted that (commercial)
GF foods are more expensive in comparison to equivalent gluten-containing products.
Age and sex
1-3 years
4-6
7-10
11-14
15-18
Male 19-59
Male 60-74
Male 75+
Female 19-74
Female 75+
Breastfeeding
3rd trimester of pregnancy
High physical activity level
Monthly amount of units
prescribing recommended
10
11
13
15
18
18
16
14
14
12
Add 4 units
Add 1 unit
Add 4 units
Number of units represented by prescribable gluten-free food items
Item
400g
100-250g
250-500g
500g
500g
250g
200g
100g
150g
300g
2 x 110-180g
Bread
Rolls/baguettes
Rolls/baguettes
Bread mix/flour mix
Pastry mix
Pasta
Crispbread
Crackers/savoury biscuits
Crackers/savoury biscuits
Breakfast cereals
Pizza bases
Units
1
0.5
1
2
2
1
1
0.5
0.75
1.5
1
Monthly amount of units do not have to be fulfilled as patient’s are encouraged having a healthy, well balanced diet through the consumption of naturally GF foods.
Prescribing Advice
1. Before newly prescribing a patient gluten-free items, diagnosis should be confirmed through a positive serological test followed by endoscopy/biopsy by
gastroenterologist for coeliac disease (CD) and skin biopsy by a dermatologist for dermatitis herpetiformis (DH). All patients should be read-coded in
medical notes for CD or DH. It is important that the diagnosis is made by a suitably qualified medical practitioner and not by self-testing kits.
2. Gluten-free foods vary from brand to brand. What may be suitable and taste good to one patient will not necessarily suit another. On initial diagnosis, it is
best for the patient to be issued with a small quantity as an acute prescription so that they can try a range of products. Inform patients that they can also
contact manufacturers directly, who will give them information on their range of products and are usually happy to send out samples. Signpost the patient
to Coeliac UK. Once patient’s preferences have been established relevant items can be issued as a repeat prescription.
3. Having agreed a list of gluten-free foods on prescription, regular reviews are important. The patient still needs the flexibility to change items as dietary
needs vary throughout life. As the patient improves so will their appetite and quantities may need to be adjusted accordingly.
4. Only gluten-free Items on a GP clinical system should be prescribed as this ensures all items are Advisory Committee on Borderline Substances (ACBS)
approved; handwritten prescriptions should not be issued. ACBS supports the prescribing of gluten-free foods for patients with established gluten
enteropathy. ACBS annotation notifies the NHSBSA Prescription Pricing Division that the item is being prescribed for an appropriate condition. GPs are
not expected to prescribe outside the ACBS recommendations.
5. Quantities of food are difficult to estimate; it is necessary to assess how much gluten containing foods e.g. bread, pasta, flour, cakes, biscuits and
pastries were consumed on a monthly basis before the patient started experiencing symptoms. Does the patient have the skills or facilities to cook or
bake? It is also important to consider that quantities differ i.e. one loaf of standard sized bread is not equal to a gluten-free loaf. Use the monthly
amount of units prescribing guide.
6. Supply should usually be limited to 4 weeks at a time for all patients. All requests for large quantities of foods should be checked because they may be
difficult to store and become out of date.
7. People with coeliac disease in England do not receive prescriptions free of charge, unless they are exempt for another reason. Patients will usually need
to pay a separate prescription charge for each item of GF food. Patients who have to pay for more than three prescription items in three months, or 14
items in 12 months, could save money by buying a pre-payment certificate, which covers the cost of all items on prescriptions (including medications).
Information regarding current pre-payment certificate costs and forms can be obtained from a pharmacy or from the NHSBSA website.
Resources
British Society of Gastroenterology
Primary Care Society for Gastroenterology
Coeliac UK
The Association of UK Dieticians
British Society of Paediatric Gastroenterology, Hepatology and Nutrition
http://www.bsg.org.uk/
http://www.pcsg.org.uk/
http://www.coeliac.org.uk/
http://www.bda.uk.com/
http://www.bspghan.org.uk/
Written by: NHS Doncaster CCG Medicines Management Team, Martin Deakin, Senior Acute Team Dietician, Dietetic and Nutrition Service, DRI
Date of Preparation: May 2014 Approved by: Medicines Management Committee
Date of approval: May 2014
Review date: May 2016