North Tyneside CCG News

Update on prescribing changes

Thu 01st October 2015

From 19 October 2015, NHS North Tyneside Clinical Commissioning Group (CCG), the organisation responsible for planning and buying healthcare and health services, will stop funding some gluten-free foods.

This is one of a number of areas of medication that it prescribes across the borough that provide opportunities for optimising safe, cost effective and appropriate medicines use.

These include:

  • Looking at steps to consider the appropriate reduction in the use of proton pump inhibitors (stomach medicine), a powerful medicine for dyspepsia which is a stomach related condition, for which over recent years there has been increasing concern regarding long-term use. The review will balance the continued need for its use with the risk of possible serious adverse drug reactions.
  • Reviewing the use of and prescribing the most cost effective number of capsules for the management of some specific chronic pain conditions.
  • Ensuring patients receive the correct quantity of painkillers needed for their condition, which means we are able to reduce oversupply and cut out waste. It also means that it reduces the risk of harm to others in having large quantities of painkillers in households.
  • Swapping to a consistent brand for strong pain medication in order to reduce confusion over different brands and their strengths, therefore helping to reduce waste and potential harm from mistakes.
  • Support for medication reviews for patients in nursing and residential homes and the way medicines are managed in nursing homes to make them as safe and efficient as possible, again helping to reduce avoidable waste and to ensure residents are getting the best out of their medications for their needs.
  • Providing staple foodstuffs for patients diagnosed with coeliac disease, but not items that the national campaign for healthy eating does not support – and that are also available for sale.
  • Considering the use of a more cost effective moisturising cream that has less risk of skin irritation and reduces unnecessary expenditure.
  • Reducing unnecessary expenditure on products that have less proven clinical benefit for patients such as muscle rubs and shower gels that are also available to purchase over the counter.
  • Promoting the use of more clinically effective and cost efficient forms of medicines for particular conditions such as fungal nail infections and irritable bowel syndrome.

In recent years the variety and accessibility of gluten-free products in supermarkets has improved dramatically. The vast majority of foods are naturally gluten-free; however, we do recognise that some specialist gluten-free products cost more than the equivalent gluten-containing items. We have therefore looked at ways in which we can minimise the financial pressures rather than stop prescribing altogether.

We have decided to limit prescribing of gluten-free foods to staples that are more expensive to buy as a gluten-free product in the supermarkets, i.e. bread and flour.

Why are you prescribing only bread and flour?

The decision was taken to fund bread as bread is considered to be a staple food in the UK and the gluten-free breads are more costly than the gluten-containing equivalents in the supermarkets. The addition of flour (including multipurpose flour and bread mixes) allows people to cook or bake other foods. This is in line with national guidelines.

Why are only some brands of bread and flour included?

We have included all brands that are available as a stock item to local pharmacies from the majority of local wholesalers without restrictions on minimum order. We have excluded products that have additional administration charges, delivery or other charges added to the list price as these costs will be incurred by the NHS and mean that the single products end up being significantly more expensive to the NHS than if they were purchased from a supermarket.

Why have you now included fresh bread?

We appreciate that many people prefer fresh bread and many gluten-free suppliers have now removed the substantial surcharges that were associated with fresh bread.

Why can’t I get my gluten-free products from the supermarket on prescription?

It would be nice if we could do this – unfortunately the way the NHS works means that only pharmacies or dispensing doctors’ practices are able to dispense NHS prescriptions.

Why are you no longer funding biscuits, cakes, etc.?

It is generally accepted that these products are treats and not part of an everyday healthy diet. To prescribe items on the NHS considered treats would be at odds with national healthy eating messages.

Why are you not funding pizza bases and pasta on prescription anymore?

There are various naturally gluten-free foods that can be eaten in place of pasta, such as potatoes, rice, rice noodles, etc. Also gluten-free pizza bases and pasta are available from supermarkets at a reasonable cost and are similarly priced to the equivalent gluten-containing products.

Some areas have set up schemes allowing people to get their gluten-free products straight from their pharmacy without a prescription – why can’t you do this?

We could do this but it would not save any money. We would still have to pay the pharmacies for the items provided. The Prescription Pricing Authority currently arranges payments to pharmacies on our behalf. However, if we were to stop using prescriptions and supply straight from the pharmacy we would have to set up administration locally to deal with the payments, which would actually add to the cost. We do not currently have the resources locally to set this up.

Cost of gluten-free products to the NHS

Gluten-free products are more expensive than gluten-containing products but it is still unclear why the NHS is charged so much for gluten-free products. There is no obvious reason as to why prescribable items cost more than double the supermarket price of similar items.

Are there no other ways in which the NHS could save money?

We are constantly looking for ways to save money without impacting on patient care. This means that we have to look at how we can do things differently and every little helps. The aim of this policy is not to penalise those who suffer from coeliac disease, but to provide some support towards the increased cost of maintaining a gluten-free diet so that their average weekly food bill is similar to that of non‑coeliacs.

Coeliacs are not alone – there are frequently restrictions on the range of items that can be supplied under the NHS both on prescription and other items. Examples of other areas where this applies include the provision of a synthetic wig (but not a real‑hair wig), dentures, crowns and bridges (but not dental implants), basic spectacle frames (but not necessarily fashionable ones).