THE gluten free food service (GFFS) enables all people in Scotland (except those in care homes) who have been diagnosed with coeliac disease or dermatitis herpetiformis to receive GF products without having to get a prescription from the GP practice.
The GFFS was introduced in 2014 as a pilot to investigate the feasibility of a community pharmacy-led supply. Following a review of this initial one-year pilot, in Autumn 2015, the Scottish Government announced that the GFFS would become a permanent aspect of the community pharmacy contract.
How does it work?
Patients diagnosed as having coeliac disease (or dermatitis herpetitformis) are given a referral form from their GP or dietitian, which confirms their eligibility to use the service.
The patient and pharmacist then sign the form and a patient care record (PCR) is created. The referral form is retained by the pharmacist for payment verification purposes. A new referral form is required where there is a change in units required, for example: age or pregnancy.
An annual health check should be completed by the pharmacists at registration and annually thereafter, using the PCR, which contains the patient assessment questions.
The person orders their GF products on the NHS Scotland GF food requirement order form, hands it in to the pharmacy and pharmacists use CPUS prescription forms to prescribe the GF products, ensuring that the CHI number is added. The GP cypher number is also added to the GP Reference Number box on the CPUS form. Contractors receive £125 per month for providing the service.
Where a significant proportion of CHI numbers are invalid or missing from contractors’ claims, a deduction to the fixed element of the payment will be applied. There is a deduction of £50 per month where the CHI capture is less than 90 per cent, or a £125 deduction where CHI capture is less than 50 per cent. This applies from November 1, 2016 until March 31, 2017 and is expected to be reviewed for 2017/18.
Pharmacists can register the patient for CMS, but this is not a requirement of the service. However, each pharmacy designates a named pharmacist to be responsible for the ongoing management and delivery of the scheme.
NHS Boards can choose to select a range of products from the national guidance to meet local needs of patients and publish a local formulary which should be adhered to.
Patients may order products from this local formulary up to the number of allocated units assigned to them. For information on the GFFS formulary in your health board, click here.
The review suggested a number of service developments, including:
- Alignment of Health Board formularies while still accounting for variations in local populations.
- Development and roll-out electronic prescribing forms for community pharmacy.
- Rollout of pre-printed GFF Order Forms with standardised data sets and online gluten-free service for patients.
- Inclusion of patients in care homes within the GFFS.
- Monitoring and further evaluation of the annual pharmacy coeliac health check to assess value to the patient.
The review also suggested that consideration should be given to applying the format of the service in other potential areas of prescribing where a similar service could improve patient access.
GFFS in England
By comparison, in England there is no national scheme for a gluten free food service and there appear to only be two CCGs providing gluten-free food services as listed on the PSNC database.
In fact, over recent months some CCGs have stopped prescribing gluten free products altogether, citing lack of funding, as they believe the money could be spent better elsewhere. According to Coeliac UK, over one-third of CCGs have now restricted or withdrawn access to GF foods.
However, considering the difficulties faced by people with coeliac disease, not to mention the health risks associated with the condition, and the exorbitant price of GF foods in supermarkets (making them unaffordable for some), is it really a false economy? In a recent debate in parliament, Parliamentary Under-Secretary of State for Health, David Mowat promised a review of the prescribing policies within the next six months.
In Scotland, the figures show that while volume has increased by 31.6% prescribing cost has only increased by 4.6%, and the cost per item decreased overall by 20%.
Avoiding foods containing gluten is the only treatment for this serious medical condition, and having the support of a healthcare professional is also an essential element, and while the many benefits of the pharmacy GFFS are obvious to people in Scotland, CCGs in England have chosen to disregard the impact of the disease and are turning their backs on sufferers. That needs to change.