Gluten Free Food Prescribing? Gluten free food has been in the headlines across the UK for some time now, most notably for the reduction in availability on prescription, as departments seek to cut costs. But as a non-Coeliac, dispensing gluten free food, you may be surprised by the options and opportunities when serving Coeliac customers.

For those pharmacists seeing a reduction in gluten free prescribing, this may be due to your local CCG or GP service. Some CCGs have issued a restrictive gluten-free prescribing policy, while others have stopped the service altogether.

A map of availability can be found on the Coeliac Society UK website, along with directions on campaigning against the removal of gluten free food from prescription.

In January, following a meeting with the Patient and Client Council, Gluten Free Ireland and the Northern Ireland Health and Social Care Board (HSCB), the HSCB issued a notice to GP surgeries, reiterating that gluten free food is to remain available on prescription.

In Scotland, the Gluten-free Food Service allows diagnosed patients to routinely visit their community pharmacies without the need to revisit their GP. Registration forms for patients are available through GP surgeries and dietitians.

Diagnosis For those newly diagnosed, the route to obtaining gluten free food through your pharmacist is not a straightforward one. The first step is a blood test but this is usually only carried out where Coeliac disease is suspected and not a matter of routine.

Many people will also try to self-diagnose the condition by opting for a gluten free diet but to get positive results in a blood test and subsequent biopsy, they must return to eating gluten, potentially making themselves sick again until they are formally diagnosed.

With a blood test completed, the GP may then refer the patient to a gastroenterologist to perform a biopsy to confirm the condition. Even with a negative blood test, the patient may still be referred, if Coeliac-like symptoms persist.

Patients suffering from the rarer Dermatitis Herpetiformis form of Coeliac disease, may also undergo a skin biopsy. Coeliacs are also prone to anaemia due to iron deficiency and may be further tested for several vitamin or mineral deficiencies.

It is generally advised that diagnosed patients also see a dietitian but this does not always happen.

Gluten Free Food on Prescription With a diagnosis confirmed, the next step is the selection of foods. These are decided by the Advisory Committee on Borderline Substances (ACBS) and are defined as staple foods:

 bread
 pasta
 cereals
 biscuits or crackers
 cakes and pastries
 pies
 gravies and sauces

The point system will allow patients to choose their staple requirements with brand availability varying by supplier and pharmacy.

Coeliac UK publish a list of commercial brands available on prescription here:

Supporting Coeliacs As a pharmacy, there are number of ways you can support Coeliacs in your community. Patients with Coeliac disease are loyal to the brands they like as some products are seen as being very poor quality, particularly with regard to bread and biscuits.

This is more acute among newly diagnosed patients versus those diagnosed in childhood where a more recent comparison with regular bread is made.

A wide range of gluten free foods that are frequently partnered with the prescribed foods are now available, such as pizza toppings, jams, spreads, ready meals and breakfast cereals. This gives your pharmacy the opportunity to cross sell a range of products while providing a one stop shop for Coeliacs.

Shopping for gluten free food is often a challenge with gluten free products mixed throughout supermarket shelves, resulting in what the gluten free community refer to as “the treasure hunt”.

A complete list of gluten free food is published annually by Coeliac UK for members and a free list of gluten free foods in UK supermarkets is published by Gluten Free Ireland, updated bi-monthly.

Gluten free events are also very popular. Utilising the database of patients, providing dietitians for advice and offering a range of products for sale, local events have seen turn outs of over 100 people to small events, simply because they are exclusively gluten free.

There are also strong links between Coeliac disease and vitamin deficiency as well as lactose intolerance, opening up further opportunities to provide a range of products which are well suited to providing much appreciated support for the physical and mental well-being of the patients.

In Northern Ireland, Gluten Free Ireland has run a number of free events through local pharmacies and see large turn outs along with an increase in product awareness and excellent patient feedback for the pharmacy.

You can find out more at Gluten Free Ireland!