Bid to ease burden of coeliac disease

Mercede Pannozzo, who has ceoliac disease, prepares some gluten-free penne pasta. Picture: Phil Wilkinson
Mercede Pannozzo, who has ceoliac disease, prepares some gluten-free penne pasta. Picture: Phil Wilkinson
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A NEW service allowing patients who are intolerant to wheat to access specialist foods more easily is being launched in Scotland.

In a year-long trial, people with coeliac disease will be able to get foods such as bread, flour and pasta from their pharmacy without having to keep going to their GP for a prescription.

It is hoped the pharmacist-led service will help free up doctors’ time as well as simplify the process for patients.

But doctors’ leaders have called for the pilot service to go even further, passing more responsibility to dietary
experts to decide what a patient needs.

Coeliac disease is a lifelong autoimmune disorder which is caused by the immune system reacting to gluten – a protein found in wheat, rye and barley.

Once diagnosed, the only treatment for coeliac disease is a gluten-free diet. When products containing gluten are removed from the diet, patients start to feel better. Gluten-free products are available to buy, but staple products – such as bread, pasta and flour – can be prescribed by the NHS.

Patients can currently access these by getting a prescription from their GP.

But in efforts to make the process simpler for patients and free up GP time, a Gluten Free Foods Service is being launched in Scotland so pharmacists take over the provision of products.

Once the service launches in February, eligible patients will no longer have to request individual prescriptions for gluten-free items from their GP.

Instead they will be able to register their condition with a community pharmacy of their choice who will dispense the products they agree they need.

While basics such as bread and pasta may be prescribed, more “luxury” items such 
as cakes are normally not 

Pharmacists will be the first port of call for patients needing products, as well as offering advice and referring them for medical or dietary advice when needed. But GPs will still be involved in deciding how many items they should 

The success of the service will be assessed after 12 months to see whether it has clinical benefit for the patients and is cost effective for the NHS compared to the previous set-up.

Dr Andrew Buist, deputy chairman of the British Medical Association’s Scottish general practitioners committee, said: “The BMA has welcomed plans to move responsibility for prescribing gluten-free products as a step in the right direction towards reducing unnecessary workload from general practice. However, as the guidance is currently 
written, there is still a requirement for the GP to decide how many units a patient should receive.

“We believe this is a more appropriate role for dietary specialists such as gastroenterologists or dieticians and we have raised this directly with the Scottish Government. We hope that the guidance will be amended accordingly.”

A Scottish Government spokeswoman said: “The Gluten Free Food Service is being provided for a 12-month trial period.

“It is intended to improve convenience for patients, give patients and their community pharmacist control over the precise items to be dispensed within a locally set formulary, make better use of pharmacist and dietician input and make optimum use of GP time.”

“The new arrangements do not change the criteria for eligible patients nor the scope of items which may be accessed on prescription.”

Case study: ‘I prepare my own meals and carry them around’

MERCEDE Pannozzo, 26, a neuroscience PhD graduate from Edinburgh, was diagnosed with coeliac disease 18 months ago, as was her mother in the past year.

She said: “I’d been to the doctors with recurring complaints, mostly a sore stomach and also a rash on my arm. Later they tested me for diabetes several times because I felt run down and faint.

“The actual diagnosis can be quite complicated. I knew bread and wheat didn’t agree with me so the fact I had cut down on those already meant it didn’t show up in my blood when tests where taken.”

Mercede said when she was eventually diagnosed she had to alter her diet to alleviate her symptoms and ensure that lasting damage was not done to her gut.

She said: “Being from an Italian family we used to have pastries for breakfast so that had to go, and now I prepare my own meals and carry them around, rather than dash out to somewhere at lunch like I used to.

“It has become a lot easier to get gluten free food, though. Starbucks and Costa both offer several products whereas they didn’t a few years ago.”

Mercede said that gluten- free staples, typically bread and pasta, were expensive if bought at the supermarket – around £3 for a small loaf of bread – making the prescription products handed out by GPs necessary for most.

Mercede welcomed the

trial, saying: “I’ve had issues with some pharmacies where you put your prescription in, it takes a week to ten days for the bread or pasta to arrive, and then it’s out of date by the time you get it.

“The number of points that GPs hand out and what they get you also seems to vary a lot between surgeries; it’s never clear what my 12 points will buy me. The trial is welcome and will save people going to their GPs, but pharmacies will have to be ready for the changes.”

She added: “The food on offer from GPs isn’t very nutritious, and it changes frequently. A year ago you could get cereals like muesli, bread and biscuits, but now it’s mainly bread and pasta, along with the flour they provide.

“I tried to make a lot of things myself to know what is going into my food but often the flour is very absorbent and you need to add a lot of saturated fat like butter. Each slice is far more calorific than regular bread.

“It will improve though. It is a learning curve for the companies developing the foods.”

Disorder: Cereals act as poison

COELIAC disease is caused by a reaction of the immune system to gluten – a protein found in wheat, barley and rye. When gluten is eaten, the immune system reacts by damaging the lining of the small intestine.

Symptoms can include bloating, diarrhoea, nausea, wind, constipation, tiredness, headaches, mouth ulcers, sudden weight loss, hair loss, anaemia and osteoporosis. It affects around one in 100 people although only 10 to 15 per cent have been diagnosed.

Edinburgh University in September found the rate of children being diagnosed rose from 1.7 in 100,000 in 1990-1994 to 11.8 per 100,000 in 2005-2009. It was partly linked to better diagnosis but also to an increase in the incidence of related autoimmune conditions – including Type 1 diabetes.