31 January 2025
The NHS in Leicester, Leicestershire and Rutland (LLR) is to end the prescribing of gluten-free foods from 1 February 2025.
The decision was taken by the LLR Integrated Care Board (ICB) at its meeting on 12 December 2024, following a lengthy engagement process including a public consultation, and discussions with patient representative groups and clinicians including GPs, dietitians and pharmacists.
The ICB fully appreciates the impact of any proposed change on people and their families. In reaching what is a very difficult decision regarding gluten-free products on prescription, we have carefully considered all the evidence from financial, clinical and patient perspectives.
The ICB decision will save the NHS more than £250,000 a year, at a time of significant financial pressure on the health service. This move within LLR is in line with other parts of the East Midlands that have taken similar decisions to remove gluten-free food prescribing.
The ICB has to carefully consider health expenditure for all conditions, balancing it with clinical risk and patient needs.
For coeliac disease, there is now a much wider range of specific gluten-free products available than previously, in addition to the wide variety of naturally gluten-free food including fresh fruit and vegetables, meat, poultry, fish, cheese and eggs.
It is possible to eat a gluten-free diet that follows the Eatwell Guide for balanced eating without the need for any specialist dietary foods, simply by choosing naturally gluten-free carbohydrate containing food as part of a healthy balanced diet.”
Sources of advice and guidance for people with coeliac disease include:
- Coeliac UK – www.coeliac.org.uk
- NHS – www.nhs.uk/conditions/coeliac-disease/
- The Association of UK Dietitians – www.bda.uk.com/resource/coeliac-disease-and-gluten-free-diet.html
This ICB decision does not affect the provision by local authorities for children who require a gluten-free diet at school.
Question and Answers
What is coeliac disease?
Coeliac disease is a condition where the immune system attacks the body’s own tissues when gluten is eaten. This damages the gut (small intestine) so the body cannot properly take in nutrients.
The NHS website has lots of information on symptoms, causes, diagnosis and treatment.
The Coeliac UK website has lots of additional information.
What is Dermatitis Herpetiformis?
Dermatitis herpetiformis is an autoimmune skin condition that can be linked to coeliac disease.
The NHS Inform website has lots of information on symptoms, causes, diagnosis and treatment.
Why is this change being made?
These changes are happening for a few reasons:
- The availability of gluten-free foods used to be limited, therefore foods were made available through a prescription. These products are now more widely available in some supermarkets and online.
- Awareness of Coeliac Disease and Gluten intolerance has improved and there is a general trend towards eating less gluten, so these foods have become more accessible in some supermarkets and online.
- Better labelling on foods means that people are better able to see whether ordinary foods are free from gluten.
- While gluten-free food is still more expensive than equivalent products containing gluten, the price paid by the NHS for gluten-free foods on prescription is still much higher than the supermarket or online prices.
The local NHS appreciates the impact this may have on patients; however, the health service has had to carefully consider health expenditure on gluten-free products along with support for all conditions, balancing it with the clinical risk and patient needs.
It has been a difficult decision to make but it will save the NHS more than £250,000, at a time of significant financial pressure on the health service.
What is happening elsewhere in the country?
This move within LLR is in line with other parts of England including Derbyshire, Nottinghamshire and Northamptonshire in the East Midlands who stopped the provision of gluten free products in prescribing some years ago.
Where can people buy gluten-free food?
Most major supermarkets and many other retailers now stock gluten-free foods, as well as other special diet alternatives, both online and in-store. In addition, improved food labelling now means people are better able to see whether ordinary food products are free from gluten. Further information on labelling can be found on the Gov.uk website.
What support is available for people with coeliac disease from the local NHS?
For children and young people under the age of 16
Support is provided by the University Hospitals of Leicester (UHL) dietetics department, with consultant gastroenterologist input if there are any concerns. Patients are seen on an individual basis to support with dietary/lifestyle changes. Children are usually discharged back to their GP once they reach 16 years.
Resources provided include:
- Coeliac UK – ‘coeliac disease and me’ booklet
- Coeliac UK school pack
- UHL coeliac disease in children leaflet
- Information on dietary calcium and iron intake
- Leicester City Council / Leicestershire County Council school meals form (if applicable)
- Leicestershire Coeliac UK group flyer
- Free sample cards for various gluten-free brands and product
For further information on referral, diagnosis and support, please visit the UHL website.
Where can I find further information about Coeliac Disease and my diet?
Further information about Coeliac Disease and how to manage symptoms can be found by visiting – www.nhs.uk/conditions/coeliac-disease/www.nhs.uk/conditions/Coeliac-disease
There is a lot of information on the Coeliac UK website at www.coeliac.org.uk that you can access if you want advice about your diet including:
- Home of Gluten free recipes
- Diet and health workshops
- Food and drink information
- Gluten-free food on a budget
The Association of UK Dietitians also have a range of support and information – www.bda.uk.com/resource/coeliac-disease-and-Gluten-free-diet.html
The BBC Good Food website also contains top 10 tips for a gluten free diet www.bbcgoodfood.com/health/special-diets/top-10-tips-gluten-free-diet
Patient Webinars are also available to view on Overview of Coeliac Disease – patientwebinars.co.uk
If you require specific advice, please ask your GP if you can be referred to a dietician.
What support is offered if I can’t afford to buy gluten-free products?
There is local advice and support available on the cost of living from local authorities:
- Leicester City Council – Household support fund
- Leicestershire County Council – Cost of living support
- Rutland County Council – Cost of living support
What is the cost difference between NHS gluten-free foods on prescription versus supermarket costs?
It is complex to put together an average difference in cost between supermarkets and prescription costs, however, below are some examples of the variations:
Costs at end of December 2024
From Asda – Asda Free from White or Brown sliced Load (535g) = £1.90 (35.5p/100g)
From Asda – Warburtons GF white or seeded sliced loaf (300g) = £2.15 (71.7p/100g)
Asda Sliced Wholemeal Tin Load 400g £1.15 (28.7p/100g)
From Asda- Asda GF plain/ SR flour £1.10/kg
Costs at end of December 2024
From Tesco – Warburtons white bread sliced (800g) = £1.40 (17.5p/100g)
From Tesco – Warburtons Gluten free white bread sliced (300g) = £2.20 (73p/100g)
Available on prescription – Warburtons Gluten free white bread sliced (400g) = £3.34 (83.5p /100g)
Costs at end of December 2024
From Tesco – Juvela gluten free fresh fibre loaf sliced (400g) = £3.00 (75p/100g)
Cost at end of Dec 2024
From the Co-oP Free From Brown/ White sliced bread 500g £2.10 (42p per 100g)
Available on prescription – Juvela gluten free fresh fibre loaf sliced (400g) = £3.80 (95p/100g)
There are also hidden costs that the NHS has to pay, which supermarkets don’t, such as costs associated with the time it takes a GP practice to generate a prescription and sign it. Also, the cost of the pharmacy ordering the stock and processing the prescriptions and then the pharmacist checking it. All these activities are funded either directly or indirectly by the NHS.
How can patients get in touch with the local NHS?
People can contact the LLR ICB:
- Email: llricb-llr.beinvolved@nhs.net
- Telephone: 0116 295 3405
- Write: Leicester, Leicestershire and Rutland Integrated Care Board, Room G30, Pen Lloyd Building, Leicestershire County Council, Leicester Road, Glenfield, Leicester LE3 8TB
How can patients complain about the decision regarding gluten free products?
Please contact the local Integrated Care Board rather than your GP practice should you wish to complain about the decision or the process.
- Email: llricb-llr.beinvolved@nhs.net
- Telephone: 0116 295 3405
- Write: Leicester, Leicestershire and Rutland Integrated Care Board, Room G30, Pen Lloyd Building, Leicestershire County Council, Leicester Road, Glenfield, Leicester LE3 8TB