Unnecessary or over-expensive prescribing is a traditional battleground between the NHS, the pharmaceutical industry and patients. For many years the main NHS target was to get doctors to prescribe generic rather than branded drugs – same efficacy but as much as seven times cheaper.
Now the NHS is introducing more initiatives to shift the cost of treatments onto patients.
Commissioning is about prioritising and sometimes that’s tough
Already GPs have been asked to minimise prescription of paracetamol, ibuprofen and aspirin – all available over the counter significantly more cheaply than the NHS can supply them. Now it’s gluten-free foods for people with coeliac disease, a permanent auto-immune condition exacerbated by eating gluten. Up to 1% of the population may be affected to some degree. The gluten connection was not firmly established till the 1950s and the NHS negotiated with suppliers to make gluten-free items available on prescription.
Prescribing is now generally limited to staples (e.g. breads, flour, oats, pasta). Over the years dietary awareness has led to much greater demand for gluten-free products, now more widely available at lower prices than previously. So should they still be prescribable?
Around 50 local Clinical Commissioning Groups (CCGs) have already introduced varying restrictions despite frequent local opposition.
Now Sheffield CCG wants (reluctantly) to join them although the results of a national consultation are still awaited. Local people have until 20 th October to comment on a proposal to cease funding gluten-free staples for people over 18 other than in exceptional circumstances. The aim is to save £30,000 this year and £100,000 thereafter. The CCG says its research indicates that most people can buy what they need at a reasonable cost.
Cuts in prescribing pain killers have been tolerated because the cost is generally occasional and limited. But Coeliac disease patients risk health damage if they don’t eat the right things. In January local gastroenterologist Professor David Sanders told the Daily Telegraph that stopping prescription of gluten-free food “unfairly discriminates against people with Coeliac disease...there will be long term costs in terms of patient outcomes.”
People with the condition say that gluten-free foods are not as widely available as the CCG thinks, especially in disadvantaged areas. Shelf products may be three times as expensive and bread may contain extra sugar. An individual’s weekly diet could cost an additional £10 (Coeliac UK).
The CCG is trying to manage ‘financial challenge’ because of its reduced allocation.
“Commissioning is about prioritising and sometimes that’s tough.” said CCG Chair Dr Tim Moorhead last week, suggesting that savings could be used for knee and hip replacements.
But this way of looking at it sets patient against patient. What about the £535,000 spent by the CCG on management consultancy last year?
Someone with Coeliac Disease told me “The CCGs should fight with the producers and suppliers to reduce their costs and not merely target patients as an easy option. This is absolutely money driven.” The biggest danger is that we are all being sweetened up for more and more charges. These little changes affecting people with a chronic illness look like the thin end of the wedge. Accepting them means that more will be proposed. Respond to the CCG Consultation at http://www.sheffieldccg.nhs.uk/get-involved/consultation- on-prescribing- gluten-free-
foods-for- adults.htm For information about local campaigning see www.sheffieldsaveournhs.co.uk