GPs stopped from prescribing gluten free pizzas, cakes and biscuits

NHS England will today consider guidance to GPs about a ban on gluten free pizzas, cakes and biscuits and set out plans to curb other low priority items such as silk garments and bath oils in moves that could save almost £70 million a year.

NHS England has already ordered an end to the routine prescribing of 18 low value items such as homeopathy and products that are available over the counter, often at lower cost, to treat 35 minor conditions such as paracetamol and cough mixture. The initiatives could free up more than £200 million a year for reinvestment in frontline care.

As the NHS draws up its long term plan, it is important to ensure that every penny of investment is well spent so a new consultation will be launched into eight more products that cost the NHS more than £68 million.

NHS England is also issuing guidance to GPs on new regulations that come in to force next week restricting gluten free prescriptions to bread and gluten free baking mixes.

NHS England chief executive Simon Stevens, said: “The NHS is one of the most efficient health services in the world but, as part of the long term plan for the NHS, we’re determined to make taxpayers’ money go further and drive savings back into frontline care. It is essential the NHS should not be paying for anything which has been proven to be ineffective or where there are safer or cheaper alternatives.”

NHS administrative costs are already far lower than other comparable countries, with Organisation for Economic Cooperation and Development data show that the NHS only spends 2p in the pound on administration, compared to 5p in Germany and 6p in France.

NHS England is also undertaking further cost saving measures to ensure the NHS remains the most efficient health services in the world.

In 2017/18 the NHS saved over £200 million by using equally safe and effective ‘biosimilar’ versions of branded drugs and Simon Stevens has this week announced that the NHS is set to save a further record £300 million a year after NHS England negotiated deals with five manufacturers on low cost versions of the health service’s most costly drug, adalimumab.

NHS England has already published a first round of guidance which could save around £230 million a year by restricting such prescriptions for over the counter medicines for minor, short-term conditions, many of which will cure themselves or cause no long term effect on health.

These savings form a key building block of the NHS’s soon to be published long term plan and will be redeployed into frontline patient care.

Prescribing Gluten-Free foods

The new guidance, published today, follows extensive consultation by the Department of Health and Social Care and a change in the law – bread and gluten free ‘mixes’ remain available via NHS prescription.

The NHS began funding gluten free food for those with a gluten sensitivity in the late 1960s when availability was limited, but now a wide variety of foods are readily available in supermarkets.

‘Low priority’ prescribing

This latest consultation is asking for views on the following products that are deemed to be items of relatively low clinical effectiveness, items which are clinically effective but where more cost-effective items are available or items which are clinically effective but, due to the nature of the item, are deemed a low priority for NHS funding.

New items

  • Silk garments
  • Aliskiren – used to treat blood pressure
  • Amiodarone – used to treat abnormal heart rhythms
  • Bath and shower emollient preparations
  • Dronedarone – used to treat atrial fibrillation
  • Minocycline – used to treat acne
  • Blood glucose testing strips for type 2 diabetes
  • Needles for Pre-Filled and Reusable Insulin Pens for diabetes

The proposed recommendations on glucose testing strips and needles are focused on substitution for cheaper, but equally effective products, not a reduction in prescribing of these items. There are many different types of insulin pen needles available at a varying cost from £3.95 to £30.08 for 100 and strips range in price from £5.45 to £16.53 for 50. The aim is to ensure consistency across the country and encourage commissioners and prescribers to consider the more cost-effective options to release savings, while not affecting patient care.

Reviewed item

  • Rubefacients (excluding topical NSAIDs) it is proposed that guidance on rubefacients (excluding topical NSAIDS), initially published in November 2017, be updated to consider exclusion of capsaicin cream, in line with NICE guidance.

The consultation will run for three months from 28 November 2018 until 28 February 2019, after which joint commissioning guidance is expected to be published by NHS England and NHS Clinical Commissioners.