Head To Head

Should gluten-free foods be available on prescription?

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.i6810 (Published 10 January 2017) Cite this as: BMJ 2017;356:i6810
  1. Matthew Kurien, clinical lecturer in gastroenterology1 2,
  2. Sarah Sleet, chief executive3,
  3. David S Sanders, professor of gastroenterology1 2,
  4. James Cave, general practitioner4
  1. 1Academic Unit of Gastroenterology, Departments of Infection and Immunity and Cardiovascular Science, University of Sheffield, UK
  2. 2Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
  3. 3Coeliac UK, High Wycombe, UK
  4. 4Newbury, UK
  1. Correspondence to: D S Sanders david.sanders{at}sth.nhs.uk, J Cave jamescave{at}outlook.com

Prescriptions improve outcomes for people with coeliac disease, write Matthew Kurien and colleagues, but James Cave lambasts a costly system that frustrates patients and doctors alike

Yes—Matthew Kurien, Sarah Sleet, David Sanders

The NHS is facing unprecedented financial and operational pressures, with nearly two thirds of trusts in deficit.1 The UK’s healthcare spend as a proportion of gross domestic product is currently lower than that of its western European neighbours, exacerbating these pressures.2 The government has placed the onus of restoring financial balance with healthcare professionals by demanding improvements in productivity, efficiency, and rationing services.1

In this context prescription of gluten-free food might seem like an easy target for clinical commissioning groups (CCGs) trying to contain costs, but it unfairly discriminates against people with coeliac disease. In 2015, England annual prescriptions costs for gluten-free foods were £25.7m (€30m; $32m)—0.3% of the total NHS prescribing budget.3 Currently, about 40% of clinical commissioning groups are restricting or removing gluten-free food prescriptions,4 but Scotland, Wales, and Northern Ireland are not following suit.

Equality of access

A gluten-free diet is the only treatment for coeliac disease. Lifelong adherence to the gluten-free diet improves quality of life5 and reduces the risk of long term complications such as osteoporosis, vitamin D deficiency, iron deficiency, and (rarely) malignancy. Adhering to this diet is challenging and some evidence suggests it may be improved by access to gluten-free foods on prescription.6 Although gluten-free foods are available in supermarkets, they are often not found in local convenience or budget stores, disadvantaging poorer people and those …

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