Routine gluten-free food prescriptions to end in Luton as health policy aligned across Bedfordshire and Milton Keynes

Routine gluten-free food prescriptions in Luton are set to end under a health decision to match policy across Bedfordshire and Milton Keynes.

A ten-week public consultation was held into three areas where services varied between the legacy clinical commissioning groups (CCGs) of Luton, Milton Keynes and Bedfordshire, which covered Bedford and Central Beds.

"BLMK CCG reviewed policies which required alignment," according to a report to its governing body, which met on March 29.

Gluten-free food prescribing, fertility services and the Milton Keynes pharmacy first minor ailment scheme were the topics under review, explained the report.

There were 851 individual replies overall, as well as formal responses from various stakeholder organisations, such as local Healthwatch groups and Bedfordshire local pharmaceutical committee.

"The feedback received focused on ensuring anyone on a low income can access gluten-free bread and flour within the NHS system to protect the most vulnerable and reduce health inequality," said the report.

"Those at risk of dietary neglect should include people with a diagnosis of coealic disease or dermatitis herpetiformis on an income assessed benefit, such as Universal Credit."

BLMK CCG director of commissioning, contracting and transformation Richard Alsop told a governing body meeting: "We ran the consultation genuinely wanting to hear the thoughts of stakeholders and the public, so we ultimately reach the best decision possible."

Bedfordshire and Milton Keynes have aligned policies limiting gluten-free foods on prescription to "exceptional circumstances, where patients could be at risk of dietary neglect". Luton currently provides gluten-free foods (bread and flour) on prescription.

"The service covers about 100 patients in the former Luton CCG area," added the report.

"It's noted that prevalence is higher than the number of people accessing the gluten-free foods, indicating some patients are choosing to buy theirs already.

"Stopping gluten-free prescribing in Luton means a cost efficiency of about £50,000. If extended across BLMK, there would be an increase of £174,303 per year."

Healthwatch Luton described the policy alignment as a "levelling down" for the town's residents, saying: "This alignment for coeliac residents locally won't provide an equal access."

The CCG's associate director of medicines optimisation Fiona Garnett said: "BLMK integrated care system (ICS) has a process to an agreed formula on which items are approved for prescribing. We felt the option to cease routine gluten-free foods was reasonable.

"Given the strong opinion of stakeholders regarding the impact on our most vulnerable patients during the Covid pandemic, it's important those people on limited income or at risk of dietary neglect should continue to access these foods for a gluten-free diet."

Luton GP and CCG strategic lead for long-term conditions Dr Chirag Bakhai said: "Other than aligning, which is moving downwards really, what's changed from three to four years ago in Luton when the CCG decided there was a reason to go this way?

"We're being asked to approve something directly contrary to that."

Ms Garnett replied: "We're now one CCG and we can't have different policies. We must align. I hadn't realised Milton Keynes has areas with even worse deprivation than in Luton.

"We felt the best way forward was to stop routine provision to all, but ensure all patients on low income or are vulnerable have access."

CCG lay member for audit and governance Saqhib Ali suggested it should be "a levelling up, not a levelling down", referring to the cost estimate "of £200,000 in the context of a budget of £1.6bn".

The governing body voted nine-one to withdraw the gluten-free prescription availability in Luton, while ensuring patients at risk of dietary neglect can still access this when appropriate, in line with Bedfordshire and Milton Keynes.