Post by kickingfrog on Jan 12, 2017 10:54:05 GMT
Prescriptions: GMC's position.
Posted by Jane,Somerset on 11/1/2017...
GF board
I received this email yesterday. I emailed them during the consultation period so am being updated.
Might be useful for those in need.
SG/SJL
10 January 2017
Wynford House
Lufton Way
Lufton
Yeovil
Somerset
BA22 8HR
Tel: 01935 384000
Fax: 01935 384079
enquiries@somersetccg.nhs.uk
Dear Colleagues
Gluten Free Prescribing in Somerset
Further to our letter of November 2016 on this topic, we must remind colleagues that prescribe, of the General Medical Council’s position in respect of the change to Gluten Free prescribing in Somerset.
The GMC has said to us that:
“In our Duties of a doctor (see page 2 of Good medical practice), we say that doctors must make the care of their patient their first concern. This guidance also makes it clear that doctors must provide a good standard of care, provide effective treatments based on the best available evidence and take all possible steps to alleviate pain and distress. We also say that doctors must give priority to patients on the basis of their clinical need if these decisions are within their power. If inadequate resources or policies prevent doctors from doing this, and they feel that patient safety or comfort may be seriously compromised, they should put this right if possible and must raise their concern in line with our guidance and their workplace policy, making a record of the steps they’ve taken (paragraph 25b).
Our guidance on Raising and acting on concerns about patient safety provides further information on the steps we consider it reasonable for doctors to take if local developments are having an adverse impact on patient care. It would be for the doctor to
make a professional judgement about whether this is the case and to act accordingly. However, we do of course recognise that healthcare does not exist in a financial vacuum and that health systems in the UK have finite resources. Our core guidance
Good medical practice says that doctors must make good use of the resources available to them (see paragraph 18) and, in a recent article, our Chief Executive said that doctors should use NHS funds efficiently and follow reasonable guidance from commissioners. In our Leadership and Management guidance, we recognise treatment options that can be offered to patients may be affected by resource limits (paragraph 84). It might be
helpful to be aware that this guidance also sets out what we expect of all doctors and the additional duties of doctors who have extra responsibilities such as a role in commissioning services.”
We would point out in making any product non formulary Somerset CCG
recognises that prescribers retain their clinical freedom and when exercising their judgement, health professionals are expected to take the CCG formulary fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in the formulary are at the discretion of health
professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Yours sincerely
Shaun Green
Associate Director – Head of Medicines Management and Clinical Effectiveness
Appendix 1
Proposed changes to gluten-free prescribing in Somerset - your questions answered
From 1 December 2016 it is proposed that the prescribing formulary in Somerset will no longer recommend prescribing of gluten-free foods. Read on to find out more.
1. What exactly is proposed to change?
GPs in Somerset have historically prescribed gluten-free foods to some patients with coeliac disease. Somerset CCG, which is a membership organisation of all GPs in the county, is proposing to change its prescribing position and guidance to GPs. This means gluten-free foods will no longer be recommended on prescription.
2. When is this change proposed to take place?
The new position is proposed to be in place on 1 December 2016 and GP practices would then be recommended to stop prescribing gluten-free foods from that date.
3. Who will be affected by this proposed change?
People who have been diagnosed with coeliac disease and who have been receiving gluten-free foods on prescription will be affected by this change.
4. How common is coeliac disease?
Around 1% of the population is thought to be coeliac, although fewer have actually been tested and formally diagnosed.
5. How many people in Somerset will be affected by this proposed change?
We estimate there are approximately 1,000 people in Somerset currently being prescribed gluten-free foods, it is proposed to recommend that they no longer receive these foods on prescription.
6. Why are you proposing this change?
There are three broad reasons for proposing this change:
i. People with coeliac disease can follow a gluten free diet without needing to have specially formulated gluten free foods
ii. Specially formulated gluten-free foods are now widely available in supermarkets, restaurants and shops. Coeliac patients can find and buy gluten-free foods themselves and no longer need specially prescribed foods. All major supermarkets offer home deliveries which is important in a rural area like Somerset.
iii. The NHS has a limited prescribing budget and a duty to use its resources wisely. We feel that the money we are currently spending on prescribing gluten-free foods is not the best use of our budget. By implementing the proposal to stop these prescriptions, we estimate that we will save £350,000 per year in prescribing costs across Somerset.
7. How did you make the decision to recommend stopping prescribing gluten-free foods?
Somerset GPs explored the options and implications of gluten-free prescriptions as part of the Somerset Clinical Commissioning Group, which is a membership organisation of all the GP practices in the county. Their decision to propose recommending stopping the prescribing of gluten-free foods was informed by the following factors:
i. Their view was that patients with coeliac disease could continue to safely manage their condition and their diet without prescribed foods
ii. Somerset CCG reviewed how similar actions had already been taken in other parts of the country and had been implemented successfully
iii. Somerset CCG believes its proposal to recommend stopping the prescribing of gluten free foods supports its long term strategy of empowering and activating patients to increase self-care for their long term conditions.
8. Do you still recommend prescribing foods for any other groups of patients with other conditions?
We are continuing to prescribe foods for a small number of patients with rare metabolic disorders, such as phenylketonuria. This is because following a diet for a rare metabolic disorder without access to prescription products is currently considered much harder than following a gluten free diet. These products also tend not to be widely available in supermarkets.
9. What are the risks of the proposal to recommend stopping the prescribing of gluten-free food?
We understand that there are always risks associated with any change and that we need to minimise the risks.
By proposing to recommend stopping the prescribing gluten-free foods, there is a risk that some patients, particularly people with learning disabilities, dementia or mental health problems, may have difficulty managing their coeliac condition and may experience health problems as a consequence. It is important that carers for such patients understand the importance of following a gluten-free diet and are supported to do so.
When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
10. Will you be offering extra support and help for people with coeliac disease who it is proposed will no longer receive gluten-free foods on prescription?
We will continue to support, advise and monitor patients diagnosed with coeliac disease through our GP practices, community dietetics services and gastroenterology departments.
We will prepare GPs, dieticians and gastroenterologists for this proposed change so that they are particularly alert to any potential risks to vulnerable patients.
We encourage patients with coeliac disease who are having difficulty maintaining a gluten-free diet to seek advice and support from Coeliac UK -
www.coeliac.org.uk/home/
11. Is the NHS in Somerset following national prescribing guidance?
We will continue to monitor and advise that coeliac patients are annually reviewed in line with the NICE (National Institute for Clinical Excellence) guidelines, which can be found at www.nice.org.uk/guidance/ng20?unlid=3818974220162201535
12. If, following the proposal, I no longer get gluten-free foods on prescription, how will I manage my coeliac condition?
Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. In addition gluten-free foods are widely available in supermarkets and shops, so you can continue to buy and eat appropriate food. You can also seek advice and support from your GP, community pharmacy and dietician. Check out the information and resources on the Coeliac UK website: www.coeliac.org.uk/home/
13. If I struggle to maintain a gluten-free diet without prescribed foods, what should I do?
If you are having difficulty maintaining a gluten-free diet, please seek advice and support from your GP, community pharmacy and dietician. Coeliac UK also has a lot of useful resources, information, recipes and contacts on their website: www.coeliac.org.uk/home/
14. I cannot afford to buy gluten-free foods as I am on a low income. Is it proposed that I will continue to receive gluten-free foods on prescription?
The recommendation applies to everyone with coeliac disease. Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. You can seek advice from the community dietetics services or your GP practice.
When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
You can also find recipes and tips for managing a gluten-free diet on the Coeliac UK website - www.coeliac.org.uk/home/
15. Is it proposed that children with coeliac disease will continue to receive gluten-free foods on prescription?
The recommendation applies to children as well as adults. Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. In addition to the resources on their website - www.coeliac.org.uk/home/ - Coeliac UK also offers specific support and advice for parents and families. You can also seek advice from the community dietetics services or your GP practice.
When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
16. My family member has a condition (e.g. learning disability / long term condition / dementia / mental health problem) which will make it difficult for them to maintain a gluten-free diet. Is it recommended that they continue to receive gluten-free foods on prescription?
The recommendation to stop prescribing gluten-free foods applies to everyone with coeliac disease. Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. We do recognise that this change may have a disproportionate impact on some vulnerable people, including those with learning disabilities, dementia, a mental health problem or another long term condition.
You can seek advice from the community dietetics service or your GP practice. When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
17. How will this proposed change affect people who have coeliac-type symptoms but have not been tested or diagnosed?
This proposed change will not directly affect people who have not been diagnosed as the NHS should not be prescribing gluten free foods for patients without a confirmed diagnosis of Coeliac disease. This proposed change will only apply to people who have been diagnosed with coeliac disease and who are already receiving prescriptions for gluten-free foods.
It is proposed that patients who are diagnosed as having coeliac disease in the future will not receive prescriptions for gluten-free foods.
Posted by Jane,Somerset on 11/1/2017...
GF board
I received this email yesterday. I emailed them during the consultation period so am being updated.
Might be useful for those in need.
SG/SJL
10 January 2017
Wynford House
Lufton Way
Lufton
Yeovil
Somerset
BA22 8HR
Tel: 01935 384000
Fax: 01935 384079
enquiries@somersetccg.nhs.uk
Dear Colleagues
Gluten Free Prescribing in Somerset
Further to our letter of November 2016 on this topic, we must remind colleagues that prescribe, of the General Medical Council’s position in respect of the change to Gluten Free prescribing in Somerset.
The GMC has said to us that:
“In our Duties of a doctor (see page 2 of Good medical practice), we say that doctors must make the care of their patient their first concern. This guidance also makes it clear that doctors must provide a good standard of care, provide effective treatments based on the best available evidence and take all possible steps to alleviate pain and distress. We also say that doctors must give priority to patients on the basis of their clinical need if these decisions are within their power. If inadequate resources or policies prevent doctors from doing this, and they feel that patient safety or comfort may be seriously compromised, they should put this right if possible and must raise their concern in line with our guidance and their workplace policy, making a record of the steps they’ve taken (paragraph 25b).
Our guidance on Raising and acting on concerns about patient safety provides further information on the steps we consider it reasonable for doctors to take if local developments are having an adverse impact on patient care. It would be for the doctor to
make a professional judgement about whether this is the case and to act accordingly. However, we do of course recognise that healthcare does not exist in a financial vacuum and that health systems in the UK have finite resources. Our core guidance
Good medical practice says that doctors must make good use of the resources available to them (see paragraph 18) and, in a recent article, our Chief Executive said that doctors should use NHS funds efficiently and follow reasonable guidance from commissioners. In our Leadership and Management guidance, we recognise treatment options that can be offered to patients may be affected by resource limits (paragraph 84). It might be
helpful to be aware that this guidance also sets out what we expect of all doctors and the additional duties of doctors who have extra responsibilities such as a role in commissioning services.”
We would point out in making any product non formulary Somerset CCG
recognises that prescribers retain their clinical freedom and when exercising their judgement, health professionals are expected to take the CCG formulary fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in the formulary are at the discretion of health
professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Yours sincerely
Shaun Green
Associate Director – Head of Medicines Management and Clinical Effectiveness
Appendix 1
Proposed changes to gluten-free prescribing in Somerset - your questions answered
From 1 December 2016 it is proposed that the prescribing formulary in Somerset will no longer recommend prescribing of gluten-free foods. Read on to find out more.
1. What exactly is proposed to change?
GPs in Somerset have historically prescribed gluten-free foods to some patients with coeliac disease. Somerset CCG, which is a membership organisation of all GPs in the county, is proposing to change its prescribing position and guidance to GPs. This means gluten-free foods will no longer be recommended on prescription.
2. When is this change proposed to take place?
The new position is proposed to be in place on 1 December 2016 and GP practices would then be recommended to stop prescribing gluten-free foods from that date.
3. Who will be affected by this proposed change?
People who have been diagnosed with coeliac disease and who have been receiving gluten-free foods on prescription will be affected by this change.
4. How common is coeliac disease?
Around 1% of the population is thought to be coeliac, although fewer have actually been tested and formally diagnosed.
5. How many people in Somerset will be affected by this proposed change?
We estimate there are approximately 1,000 people in Somerset currently being prescribed gluten-free foods, it is proposed to recommend that they no longer receive these foods on prescription.
6. Why are you proposing this change?
There are three broad reasons for proposing this change:
i. People with coeliac disease can follow a gluten free diet without needing to have specially formulated gluten free foods
ii. Specially formulated gluten-free foods are now widely available in supermarkets, restaurants and shops. Coeliac patients can find and buy gluten-free foods themselves and no longer need specially prescribed foods. All major supermarkets offer home deliveries which is important in a rural area like Somerset.
iii. The NHS has a limited prescribing budget and a duty to use its resources wisely. We feel that the money we are currently spending on prescribing gluten-free foods is not the best use of our budget. By implementing the proposal to stop these prescriptions, we estimate that we will save £350,000 per year in prescribing costs across Somerset.
7. How did you make the decision to recommend stopping prescribing gluten-free foods?
Somerset GPs explored the options and implications of gluten-free prescriptions as part of the Somerset Clinical Commissioning Group, which is a membership organisation of all the GP practices in the county. Their decision to propose recommending stopping the prescribing of gluten-free foods was informed by the following factors:
i. Their view was that patients with coeliac disease could continue to safely manage their condition and their diet without prescribed foods
ii. Somerset CCG reviewed how similar actions had already been taken in other parts of the country and had been implemented successfully
iii. Somerset CCG believes its proposal to recommend stopping the prescribing of gluten free foods supports its long term strategy of empowering and activating patients to increase self-care for their long term conditions.
8. Do you still recommend prescribing foods for any other groups of patients with other conditions?
We are continuing to prescribe foods for a small number of patients with rare metabolic disorders, such as phenylketonuria. This is because following a diet for a rare metabolic disorder without access to prescription products is currently considered much harder than following a gluten free diet. These products also tend not to be widely available in supermarkets.
9. What are the risks of the proposal to recommend stopping the prescribing of gluten-free food?
We understand that there are always risks associated with any change and that we need to minimise the risks.
By proposing to recommend stopping the prescribing gluten-free foods, there is a risk that some patients, particularly people with learning disabilities, dementia or mental health problems, may have difficulty managing their coeliac condition and may experience health problems as a consequence. It is important that carers for such patients understand the importance of following a gluten-free diet and are supported to do so.
When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
10. Will you be offering extra support and help for people with coeliac disease who it is proposed will no longer receive gluten-free foods on prescription?
We will continue to support, advise and monitor patients diagnosed with coeliac disease through our GP practices, community dietetics services and gastroenterology departments.
We will prepare GPs, dieticians and gastroenterologists for this proposed change so that they are particularly alert to any potential risks to vulnerable patients.
We encourage patients with coeliac disease who are having difficulty maintaining a gluten-free diet to seek advice and support from Coeliac UK -
www.coeliac.org.uk/home/
11. Is the NHS in Somerset following national prescribing guidance?
We will continue to monitor and advise that coeliac patients are annually reviewed in line with the NICE (National Institute for Clinical Excellence) guidelines, which can be found at www.nice.org.uk/guidance/ng20?unlid=3818974220162201535
12. If, following the proposal, I no longer get gluten-free foods on prescription, how will I manage my coeliac condition?
Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. In addition gluten-free foods are widely available in supermarkets and shops, so you can continue to buy and eat appropriate food. You can also seek advice and support from your GP, community pharmacy and dietician. Check out the information and resources on the Coeliac UK website: www.coeliac.org.uk/home/
13. If I struggle to maintain a gluten-free diet without prescribed foods, what should I do?
If you are having difficulty maintaining a gluten-free diet, please seek advice and support from your GP, community pharmacy and dietician. Coeliac UK also has a lot of useful resources, information, recipes and contacts on their website: www.coeliac.org.uk/home/
14. I cannot afford to buy gluten-free foods as I am on a low income. Is it proposed that I will continue to receive gluten-free foods on prescription?
The recommendation applies to everyone with coeliac disease. Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. You can seek advice from the community dietetics services or your GP practice.
When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
You can also find recipes and tips for managing a gluten-free diet on the Coeliac UK website - www.coeliac.org.uk/home/
15. Is it proposed that children with coeliac disease will continue to receive gluten-free foods on prescription?
The recommendation applies to children as well as adults. Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. In addition to the resources on their website - www.coeliac.org.uk/home/ - Coeliac UK also offers specific support and advice for parents and families. You can also seek advice from the community dietetics services or your GP practice.
When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
16. My family member has a condition (e.g. learning disability / long term condition / dementia / mental health problem) which will make it difficult for them to maintain a gluten-free diet. Is it recommended that they continue to receive gluten-free foods on prescription?
The recommendation to stop prescribing gluten-free foods applies to everyone with coeliac disease. Following a gluten free diet can be achieved without resorting to specially formulated foods on prescription, by avoiding foods which naturally contain gluten. We do recognise that this change may have a disproportionate impact on some vulnerable people, including those with learning disabilities, dementia, a mental health problem or another long term condition.
You can seek advice from the community dietetics service or your GP practice. When exercising their judgment, GPs are expected to take the CCG formulary fully into account, alongside each individual's needs. The application of the formulary is at the discretion of each GP. The formulary does not override the responsibility of a GP to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
17. How will this proposed change affect people who have coeliac-type symptoms but have not been tested or diagnosed?
This proposed change will not directly affect people who have not been diagnosed as the NHS should not be prescribing gluten free foods for patients without a confirmed diagnosis of Coeliac disease. This proposed change will only apply to people who have been diagnosed with coeliac disease and who are already receiving prescriptions for gluten-free foods.
It is proposed that patients who are diagnosed as having coeliac disease in the future will not receive prescriptions for gluten-free foods.