Gluten-Free Food on Prescription Michael Ellis Stakeholder Engagement Manager A presentation to inform the People’s Council of the gluten-free consultation across South Notts

Overview This presentation will provide and overview of the decision-making processes behind the decision for the South Notts CCGs to consider the options of the future of prescribing gluten-free (GF) foods on prescription Coeliac disease is a common digestive condition, triggered by the protein gluten which is found in wheat, barley and rye. Symptoms range from being mild to severe and can include abdominal pain, diarrhoea, nausea, weight loss, headaches and osteoporosis. There is no cure for coeliac disease, but switching to a GF diet can help GF foods are prescribed on the local NHS for adults and children with coeliac disease. Nationally the NHS spends £25m on providing gluten-free products on prescription such as bread, flour, pasta and cereal Across South Nottinghamshire the total annual spend is £245,000 with NNE spending £130,000. The NHS does not provide food on prescription for any other patients, such as diabetics, lactose intolerant or those with allergies. Over the past few years, GF have become widely available in supermarkets at more competitive prices compared to 30 years ago when choice was limited With an ageing population and greater demand for services, the NHS must act now to address the financial challenges that lie ahead and thus we going to consult with the public on future options about how we prescribe GF food

NNE Present Position In 2014 NNE CCG conducted a consultation with patients and the public We sought feedback about CCGs proposed plans to consider options available for managing the costs of prescribing GF food Overall respondents agreed that limiting units is an appropriate way of prescribing GF foods In 2015 NNE reduced the units for Coeliac patients as follows: 8 units of bread and/or flour only each month for all patients (1 unit of bread = 400g, 2 units of flour = 500g) Add 1 unit per month if in third trimester of pregnancy Add 4 units per month if a mother is breastfeeding

NNE Present Position Cont. Conducting a six month review of the new service NNE Primary Care Pharmacist working with Torkard Practice which is a large practice with patients Review will assess if patients affected by the new limits of quantity or range Any admissions to A&E due to bowel problems Increased visits to the GP related to the disease Report of results by end of July

South Nottinghamshire CCG Consultation Intelligence from the NNE consultation is being used to inform a planned joint consultation across South Notts Consultation Plan has been approved by the Overview and Scrutiny Committee (OSC) in July day consultation running between 3 rd August – 30 th October Feedback sought for three proposed options: 1 – Stop all prescribing of GF foods 2 – Limit to 8 units of bread and/or flour each month (current NNE service) 3 - Limit the products available to flour only (maximum of 4 units per month)

Consultation Approach Writing all patients with coeliac disease Drop-In sessions across Nottinghamshire (three in NNE) Online Survey Notices in GP Practices Voice for Health Events Press Releases Social Media Campaign

Outcome and Close With an ageing population and greater demand for services, the NHS must act now to address the financial challenges that lie ahead and thus we going to consult with the public on future options about how we prescribe GF food The presentation provides an overview of the decisions made and the supporting intelligence has resulted in the planned consultation. We would like the People’s Council feedback on current plans Any questions?