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Should patients with coeliac disease pay for their treatment?
  1. John W Puntis1,
  2. Mark Peter Tighe2
  1. 1 Department of Paediatric Gastroenterology, The General Infirmary at Leeds, Leeds, UK
  2. 2 Department of Paediatrics, Poole Hospital, NHS Trust, Poole, UK
  1. Correspondence to Dr John W Puntis, 6 The Avenue, Roundhay, Leeds LS8 1DW, West Yorks, UK; john.puntis{at}yahoo.co.uk

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A strict gluten-free (GF) diet is the only effective treatment for patients with coeliac disease (CD) and is a lifelong requirement in order to prevent adverse health outcomes. In the UK for the past 50 years, those with a firm diagnosis of CD have had food staples such as GF bread, pasta and flour available on prescription from their general practitioner (GP); children are among those exempt from payment. GF food prescribing is now under threat in England because of a drive to save money, confusion between CD and gluten intolerance, and the increasing avoidance of gluten as a ‘lifestyle’ choice. This should concern paediatricians when, according to the Royal College of Paediatrics and Child Health (RCPCH), one in five children in the UK is currently living in poverty (State of Child Health Report, 2017), for without free prescription of GF food some low-income families will simply be unable to afford to follow a GF diet. Clearly there is the potential to cause harm by reducing dietary compliance resulting in complications and ultimately increasing costs to the healthcare system.

GF products have recently been included by National Health Service (NHS) England in a list of ‘low value’ prescriptions,1 and Clinical Commissioning Groups (CCGs) are consulting on whether these should no longer be freely available. CCGs are NHS bodies responsible for planning and commissioning health services for a population on average of 250 000; collectively they manage an annual budget of around £74 billion, including the prescribing costs of GPs. CCGs are tasked with getting the best possible health outcomes by assessing local needs and deciding priorities and strategies. The concept of abandoning ‘low value’ prescriptions has been explained as ‘allowing local clinical leaders to make the best and …

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