1. Medicines and Self Care Gill Stead Head of Prescribing WLCCG

2. Challenges facing prescribing Demand for NHS services continues to increase GP and urgent care settings under pressure The gap between resources and funding over the next 5 years

3. What is Coeliac disease? Gluten is found in wheat barley and rye In Coeliac disease, the immune system reacts to gluten. People who are affected must have a gluten free diet.

4. Self Care and Gluten Free (GF) Food The NHS has prescribed GF foods to patients for the past 30 years. Many CCGs have now stopped or limited prescribing of GF products because of the cost to the NHS and also a wide range of products are available to buy in supermarkets. Leicestershire spends £650,000 each year on GF products on prescription

5. Dietary support and advice People with Coeliac disease in Leicestershire are offered dietetic counselling with a dietitian. Coeliac UK paid membership offers ongoing support with recipes, shopping,going on holiday, eating out etc.

6. What the CCG is proposing This proposal is a change to what a specific group of patients have been able to access historically. The proposal recommends and supports GPs to no longer prescribe or limit gluten-free food of prescription and the CCG wants to hear your views.

7. Self care and minor ailments Consultations for minor ailments takes up one hour per day of GP’s time The cost to the NHS £2 billion per year Viral infections and hay fever are the most common minor ailments seen by the GP Both of these common conditions could be suitable for treatment with over the counter medication.

8. Paracetamol Four times more expensive on prescription than if bought over the counter. Widely available from shops and pharmacies at a very low cost. You can buy up to 96 tablets under the discretion of a community pharmacist.

9. Proposal-options Patients buy paracetamol for minor ailments Patients by all medicines minor ailments

10. Prescribing medicine In order to test public opinion, we have designed a questionnaire in conjunction with HealthWatch to understand the impact of removing certain medicines and products which are available to buy in community pharmacy or supermarkets. We want your feedback on the questions we are going to ask to make sure that we are asking patients the right things

11. The questions we want to ask If gluten free foods available on prescription were limited to 6-8 units of bread and/or flour per month, how would this affect you? If gluten free foods were no longer available at all on prescription, how would this affect you ? Is there anything else which the NHS can do to help those who suffer from coeliac’s disease?

12. The questions we want to ask If the NHS in Leicester, Leicestershire and Rutland decided to stop prescribing paracetamol for self-limiting illnesses (illnesses which normally get better on their own such as headaches, migraines, sore throat, aches and pains), how would it affect you? If paracetamol in liquid form (often sold over the counter under the brand name of Calpol and used for children to help with teething and fever) was no longer available on prescription for these self-limiting illnesses, how would this affect you? Paracetamol can be prescribed to people who don’t need it every day, but take it now and again for ongoing pain management. How would it affect you if prescription of paracetamol was stopped for these purposes? If paracetamol was no longer available on prescription for any kind of illness, including chronic pain as part of a pain management plan, how would this affect you ?

13. On your tables discuss: There are many other medicines currently available on prescription which can also be bought over the counter from community pharmacists, including more expensive items such as anti-histamines, anti-fungal creams and other pain killers such co-codamol. If the prescribing of these more expensive medications was stopped, how would this affect you?

14. Thank you