Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps his Department is taking to update guidance to Integrated Care Boards (ICBs) on the need to offer gluten free staples on NHS prescription for people with coeliac disease.

NHS England has no plans to update the guidance. The Department undertook a national consultation in 2017 on the prescribing of gluten-free (GF) foods in primary care. The rationale for this was the increased availability of these products in supermarkets and other food outlets at a time when the annual cost to the National Health Service of prescribing such items was £15.7 million. The first of these proposed changes to prescribing arrangements resulted in the Government’s decision to restrict NHS prescribing of such foods to only bread and mixes.

NHS England’s guidance, Prescribing Gluten-Free Foods in Primary Care, was developed to communicate to local commissioners, now integrated care boards (ICBs), the changes in legislation. Wording is included in the guidance which states that commissioners may further restrict the prescribing of GF foods by selecting bread or mixes only, or may choose to end the prescribing of GF foods altogether if they feel this is appropriate for their population, whilst taking account of their legal duties to advance equality and provided they have regard to reducing health inequalities. In NHS England’s guidance, there are no limits on the amount of bread or mixes that can be prescribed. This guidance is available at the following link:

https://www.england.nhs.uk/wp-content/uploads/2018/11/prescribing-gluten-free-foods-primary-care-guidance-for-ccgs.pdf

Decisions about the commissioning and funding of local health services are the responsibility of local ICBs. NHS England’s guidance should be taken into account when ICBs formulate local policies, and prescribers are expected to reflect local policies in their prescribing practice. The guidance does not remove the clinical discretion of prescribers in accordance with their professional duties.