Factsheet for Healthcare Providers on the new Gluten-free Food Service by NHS Bedfordshire:

Transcription

1 Factsheet for Healthcare Providers on the new Gluten-free Food Service by NHS Bedfordshire: INTRODUCTION Gluten-free foods are allowable on NHS prescriptions for people with a confirmed diagnosis of gluten enterophathy, the most common being Coeliac Disease. Coeliac disease is a hereditary malabsorption disorder caused by sensitivity to gluten, a protein found in wheat, rye, barley, and oats. Currently patients requiring gluten-free products have to see their GP for a prescription, which is then taken to their community pharmacy (or the dispensing doctor) to be issued. With the rising costs of prescribing gluten-free products and increasing GP workload, it is important to find a more efficient way of managing this provision. The recent NICE Guideline 86 on the Recognition and assessment of Coeliac disease has raised more awareness of the disease and is likely to result in an increase in the number of patients with confirmed diagnoses. PROPOSAL The proposal is to introduce a Gluten-Free Food Supply Service which will enable patients to receive a supply of their gluten-free products directly from their chosen pharmacy (or dispensing doctor) without the need of a prescription. Patients will be allowed to select products from an approved list and within their allowable quantity; based on criteria set by the PCT following national guidance. The service fits well in the Medicines Management QIPP agenda, and fulfils the criteria for one of the Directed Enhanced Services proposed by the Department of Health to be commissioned from Community Pharmacists. Patients requiring regular supplies of gluten-free food will benefit from a more simplified, efficient system for ordering their products and from improved access. This service will also make it easier for patients to benefit from a wider choice of Gluten-free products with increased flexibility in trying various products. OBJECTIVES The service will ensure: o Reduced cost of prescribing gluten-free food o Improved access to products suitable for patients needs

2 o Improved patient support and information from healthcare professionals o Better assessment of the dietary requirements of individual patients, to be reflected in their allowable quantities of gluten-free products. METHODOLOGY Step 1 GP practices will identify all patients eligible for this service and inform them of the new ordering system by sending to the patient a: Patient Referral letter to be taken to a pharmacy of their choice / dispensing doctor NHS Bedfordshire Gluten-free foods Patient Leaflet Where a patient has been newly diagnosed, Step 1 will be completed by the Hospital Dietitian who will also advise the patient s GP of this referral. Step 2 The Patient will have to identify a community pharmacy of their choice from which to access this service. Dispensing patients will be asked to use the Practice dispensary as usual to order their gluten-free food. The process for completing registration at the pharmacy or dispensing doctor is as follows - on receipt of the referral letter: Pharmacist / Dispenser and patient agree maximum units of gluten-free food allowable within PCT guidelines (based on Coeliac UK guidance). Pharmacist / Dispenser completes registration form to be faxed to the GP. A record of the registration is made on the Patient s medication records (PMR) in the pharmacy/dispensary. A record is made of patient s review date at their surgery. Pharmacist / Dispenser offers healthy lifestyle advice as appropriate. Pharmacist / Dispenser provides a gluten-free food product booklet. Patient completes monthly order form to place first order. On collection of the ordered products, the patient is given an order form for the following month s order. Order requests should be submitted only when items are required in order to reduce waste. Individual patient concerns which cannot be resolved by the pharmacist or dispenser should be referred to the GP, where appropriate the GP will refer the patient to a dietitian. Step 3 Annual Patient Review - patients will be required to see their GP / dietitian for a review on an annual basis. The surgery will arrange these appointments the date for the first appointment will be stated in the initial patient referral letter. A patient s failure to attend an annual review will result in the termination of the supply of gluten-free food.

3 The surgery will inform the pharmacist / dispenser once the review has taken place and re-authorise the supply of gluten free food until the next review date usually after 12 months. TIMESCALE The Gluten-free food supply service is expected to be rolled out across Bedfordshire between April and June The service will be launched to community pharmacies and dispensing doctors in March The launch programme will include a training session on management of Coeliac Disease and guidance for supporting patients. EVALUATION The information gathered on patient s order forms should provide the PCT with the necessary data for assessing the service to ensure that it is fit for purpose. The service will be evaluated after 6 months and again after 12 months and changes made to the service specification where necessary. Contact details: For further information, contact the Medicines Management team on or by to belinda.ekuban@bedfordshire.nhs.uk.

4 Criteria for allocating maximum units of gluten-free food allowable per patient group: Age and sex Points/Units per month 1-3 years years years years years 18 Male Male Male Female Female Breastfeeding + 4 Third trimester of pregnancy + 1 High physical activity level + 4 The points values are as follows: Food item Points/Units 400g bread/rolls/baguettes 1 250g flour/cake/bread mix 1 200g biscuits/crackers/crisp breads 1 250g pasta 1 2 pizza bases 1

5 Guidance for implementation Patient Selection: Gluten-free food is allowable on the NHS as a Borderline substance. The Advisory Committee on Borderline Substances (ACBS) state that these foods may be prescribed where there is established gluten-sensitive enteropathies including steatorrhoea due to gluten-sensitivity, coeliac disease and dermatitis herpetiformis. Only patients with documented evidence of diagnosis of gluten enteropathy should be selected for referral to the pharmacy / dispensing doctors LES. Any patients currently receiving gluten-free food but not meeting the stated requirements (for example in the management of autism) must be called for a review and prescribing discontinued where appropriate. Where a decision is made to discontinue prescribing, the practice is encouraged to arrange a dietetic appointment for the patient to ensure they receive further support. Prescribing of gluten-free products for patients with PKU or other inborn errors of metabolism should remain with the GP. Patients notes should be read-coded when referred to the Gluten-free food supply service. The following read-codes may be used: Coeliac disease XE0bK; Dermatitis Herpetiformis M140. All practices will receive an initial allocation of 15 Patient Information Leaflets practices requiring more copies should contact the prescribing team. All eligible patients should be sent a referral letter and an information leaflet. The pharmacy / dispensary will provide further details of the service at the time of registration including a copy of the Gluten-free product list. Please ensure once a patient is transferred to the new service, that their active repeat medication records are amended to exclude all gluten-free food. Following their registration at a community pharmacy (for people using community pharmacies) a copy of the registration form (sample attached) will be sent to the GP. Practices must record in the patient s notes, detail of their selected pharmacy. Pharmacies may only supply gluten-free products to patients registered with them for this practice. This will ensure that people do not collect gluten-free food from more than one pharmacy / dispensary. Change of Pharmacy patients are required to inform their GP should they need to change their pharmacy. GPs should at this stage provide a new referral letter for the patient to take to the new pharmacy and the alert the old pharmacy of the change. Pharmacists will only be able to sign a patient on when they present with a referral letter.

6 Newly diagnosed patients Following a confirmed diagnosis of gluten enteropathy (coeliac disease) by a gastroenterologist, the hospital dietetic team will refer the patient directly to the gluten-free food supply service. The GP will be informed of this referral and will be expected to take on the annual assessment once the patient is discharged from secondary care. Annual Reviews All patients referred to the Gluten-free food supply service must be recalled by the practice for an annual review. The PCT guidance Managing patients with coeliac disease (attached) should be followed to ensure appropriate assessment of all patients. Referral letters going out to patients informing them of the service and of the registration procedure (template attached) should include a date for their first review. The date for the first review appointment should be determined by the practice as seen appropriate. Follow-on appointments should be planned annually. (If a patient is due for a medical review within the next three months, it is advisable to wait until this date before referring them on to the dispensary.) Patients who fail to attend their annual review will not be given further supplies of gluten-free food beyond the review date. The surgery will be required to inform the pharmacy / dispensary once the review is completed by sending them a Reauthorisation form (template attached). Service evaluation Data collected from the monthly patient order forms will be used to evaluate the service to ensure that the objectives are being met. In addition to this, patient experience surveys will be carried out 6 months into the service and then on an annual basis. Practices are also encouraged to feed back any concerns as well as share good practice / experiences to the prescribing team. This information will be included in the evaluation process. Encl: Gluten-free Food Supply Service flowchart Patient referral letter - template Patient registration form - sample Patient re-authorisation form - template Patient information leaflets x 15 Patient Order form - sample Gluten-free Product Booklet - sample