How much to prescribe /Prescribing guidelines

[kickingfrog]

From CUK -GF items in scrip:

How much to prescribe

Prescribing guidelines have been produced to based on:

Consumption data from the National Diet and Nutrition Surveys (1)
The Balance of Good Health model
Gluten-free prescribable foods providing 15% total energy (total CHO should provide 50% total energy which includes naturally gluten-free foods such as rice potatoes and breakfast cereals, intrinsic and milk sugars as well as gluten-free prescribable foods)
The guidelines provide a minimum monthly amount of gluten-free food, calculated in units, based on requirements of different ages and sexes.

Gluten-free foods have been given a unit value (see tables below).

Additional amounts are added for high activity levels, breastfeeding and 3rd trimester of pregnancy.

Age and sex
number of units

child 1-3 years 10
child 4-6 years 11
child 7-10 years 13
child 11-14 years 15
child 15-18 years 18
male 19-59 years 18
male 60-74 years 16
male 75+ years 14
female 19-74 years 14
female 75+ years 12
breastfeeding add 4
3rd trimester pregnancy add 1
high PAL add 4


food item


number of units

400g bread/rolls/baguettes 1
500g mix 2
200g biscuits/crackers 1
250g pasta 1
2 x 110-180g pizza bases 1

Example:

Male aged 15-59 years requires 18 units per month.
This could be made up of:

10 x 400g loaves of bread (=10 units)
1 x 2 pack pizza bases (=1 unit)
1 x 500g pasta (=2 units)
2 x 200g crackers (=2 units)
1 x 200g sweet biscuits (=1 unit)
1 x 500g flour mix (=2 units)


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[kickingfrog]

What can be prescribed on NHS Prescriptions?


Subject to the prescriber having the appropriate prescribing rights, any food, drug, toiletry or cosmetic may be prescribed on an NHS prescription unless the product is listed in Part XVIIIA of the Drug Tariff (the ‘Blacklist’) or the criteria set out in the Tariff for prescribing products listed in Part XVIIIB of the Drug Tariff (the Selected List) is not met.

Medical devices (appliances) can only be prescribed on NHS prescriptions if the product is listed in Part IX (Appliances section) of the Drug Tariff.

The Blacklist
The ‘Blacklist’ can be found in Schedule 1 to the NHS (General Medical Services Contracts) (Prescription of Drugs etc.) Regulations 2004 which is reproduced in Part XVIIIA of the Drug Tariff.

Any food, drug, toiletry or cosmetic may be prescribed on an NHS prescription unless the product is listed in Part XVIIIA of the Drug Tariff. For example, whisky is not on the blacklist, so a prescription for this item would be passed for payment by the NHSBSA Prescription Services. The prescriber may however be questioned by their Primary Care Trust (PCT) about the appropriateness of prescribing this item at NHS expense.

…..
Borderline Substances List
Part XV of the Drug Tariff is known as the ‘Borderline Substances’ list. In certain conditions, some foods and toiletry preparations have the characteristics of drugs. A board known as the Advisory Committee on Borderline Substances (ACBS) advises on the circumstances in which these products may be regarded as drugs. Part XV of the Drug Tariff is split into two lists:


List A is an alphabetical index of the approved borderline products and the conditions they may be prescribed for.

List B is an alphabetical index of medical conditions and related approved products for managing those conditions.

Prescribers should endorse prescriptions with the endorsement ‘ACBS’ if they are issuing the prescription in accordance with the Committee’s advice.

If the ACBS endorsement is missing for a product on the borderline substances list, pharmacy contractors can still dispense the prescription and it will be passed for payment by the NHSBSA Prescription Services.
However the prescriber may be asked by their PCT to justify why the product has been dispensed at NHS expense. Pharmacy staff should not add the ACBS endorsement.




www.psnc.org.uk/pages/allowed_disallowed_items.html

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[kickingfrog]

PCSG CUK guidelines GF prescription food

From CUK Guidelines




Coeliac disease is unique among gastrointestinal disorders in that an effective dietary treatment is available that will restore almost all patients to full health, and help to protect against the development of complications.

The best way to ensure good health is for patients to adhere to a strict gluten-free diet for life. Adherence to the diet however, is often perceived to be irksome and restricting and many patients find strict compliance difficult. Difficulties however, can mostly be overcome by skilled, sympathetic and well-informed GPs, consultant gastroenterologists, consultant paediatric gastroenterologists, paediatricians, dietitians (and paediatric dietitians), nurses and pharmacists who can provide patients with good, sensible, and appropriate practical advice.

It has been clearly shown that good dietary compliance is aided by the ease with which patients can obtain suitable amounts of gluten-free products on prescription. Coeliac disease is a disorder readily treated by diet and every effort should be made to ensure that patients understand this and have easy access to gluten-free products suitable for their needs and so reap the benefits of good health and well-being.

It is also apparent that those patients who are regularly reviewed adhere much better to their gluten-free diet than those who are left to their own devices.

This website provides an indication of the amounts of prescribable gluten-free products that are appropriate for a range of people with coeliac disease. Wide consultation among healthcare professionals and patients has been undertaken in their formulation. It is hoped that it will be of value to all those who offer medical and dietetic support to patients with coeliac disease.

People with coeliac disease: minimum monthly gluten-free food prescription requirements

Age group Suggested no. units per month* Example minimum monthly prescription
(items can be interchanged e.g. bread mixes can be interchanged with rolls or loaves)

Child 1-3 years 10
4 x 400g loaves of bread (or 2 x 500g mix suitable for making bread)
1 x 500g pasta
2 x 200g biscuits
1 x 500g flour mix

Child 4-6 years 11
4 x 400g loaves of bread (or 2 x 500g mix suitable for making bread)
2 x (2 x 110/180g) pizza bases
3 x 200g biscuits
1 x 500g flour mix

Child 7-10 years 13
6 x 400g loaves of bread (or 3 x 500g mix suitable for making bread)
1 x 500g pasta
1 x (2 x 110/180g) pizza bases
2 x 200g biscuits
1 x 500g flour mix

Child 11-14 years 15
6 x 400g loaves of bread (or 3 x 500g mix suitable for making bread)
2 x (2 x 110/180g) pizza bases
3 x 200g biscuits
1 x 500g flour mix
1 x 500g pasta

Child 15-18 years 18
6 x 400g loaves of bread (or 3 x 500g mix suitable for making bread)
2 x (2 x 110/180g) pizza bases
4 x 200g biscuits
2 x 500g flour mix
1 x 500g pasta

Male 19-59 years 18
10 x 400g loaves of bread (or 5 x 500g mix suitable for making bread)
1 x (2 x 110/180g) pizza bases
1 x 500g pasta
2 x 200g crackers/ crispbreads
1 x 200g sweet biscuits
1 x 500g flour mix

Male 60-74 years 16
10 x 400g loaves of bread (or 5 x 500g mix suitable for making bread)
1 x 500g cake mix
1 x 500g pasta
1 x 200g crackers/ crispbreads
1 x 200g sweet biscuits

Male 75+ years 14
8 x 400g loaves of bread (or 4 x 500g mix suitable for making bread)
1 x 500g cake mix
1 x 500g pasta
1 x 200g crackers/ crispbreads
1 x 200g sweet biscuits

Female 19-74 years 14
8 x 400g loaves of bread (or 4 x 500g mix suitable for making bread)
1 x (2 x 110/180g) pizza bases
1 x 500g pasta
2 x 200g crackers/ crispbreads
1 x 200g sweet biscuits

Female 75+ years 12
6 x 400g loaves of bread (or 3 x 500g mix suitable for making bread)
1 x 500g cake mix
1 x 500g pasta
1 x 200g crackers/ crispbreads
1 x 200g sweet biscuits

Breastfeeding
Add 4 units
1 x 500g pasta
1 x 200g crackers/crispbreads
1 x 400g loaf of bread

3rd trimester pregnancy Add 1 unit 1 x 200g sweet biscuits

High physical activity level
Add 4 units
1 x 500g pasta
1 x 200g sweet biscuits
1 x 200g crackers/ crispbreads


*Gluten-free prescribable items have been allocated a ‘unit’ value based on their carbohydrate and energy content and their cost (see table below).

Number of units represented by the prescribable gluten-free food item
Prescribable food item
No. of units
400g bread 1
400g rolls/baguettes 1
500g bread mix/flour mix/pastry mix/cake mix 2
100g sweet/savoury biscuits/crackers 1/2
150g sweet/savoury biscuits/crackers 3/4
200g sweet/savoury biscuits/crackers/crispbreads 1
250g pasta 1
500g pasta 2
2 x 110g-180g pizza bases 1


www.pcsg.org.uk/

Put 'coeliac disease' in search box


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[kickingfrog]

Gluten-free foods: a prescribing guide

This is an informative booklet. Norma McGough (dietitian for CUK & a coeliac herself) helped to compile it.
I think this is the information that CUK said it was going to send to GPs.
If you send your name & address you will receive a free copy.

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New Guidance Available for Prescribing Gluten-Free Foods

An expert panel have produced a new document entitled ‘Gluten-free foods: a prescribing guide’.

These guidelines have been approved by the British Dietetic Association (BDA), the coeliac disease working group of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN), the Primary Care Society for Gastroenterology (PCSG), and Coeliac UK to assist general practitioners, dietitians, pharmacists and practice nurses in the decision making process when prescribing gluten-free foods.

The guide includes background information about coeliac disease, as well as stating the minimum recommendations and advice when prescribing the quantities and varieties of gluten-free foods available on prescription.

The guide is not intended to replace a full dietetic assessment but to provide an example of the minimum requirements for those needing a gluten free diet.

To receive a copy of ‘Gluten-free foods: a prescribing guide’, please email [e-mail] at Good Relations Healthcare or telephone [phone].



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[Silly Yak]

Posted by Christine from Northants on 12/2/2011, 18:44:28

[kickingfrog]

Also please see:

www.mims.co.uk/Drugs/nutrition/gluten-sensitivity/

[kickingfrog]

From CUK


www.coeliac.org.uk/gluten-free-diet-and-lifestyle/prescriptions/