GFFS


breads and flours. In fact, Dr Cave’s argument is not with providing support but rather with the way the NHS goes about it. He believes prescriptions are an inefficient and unnecessarily expensive way of supplying these essential foods. We agree that other ways such as voucher schemes may provide a better solution all round and have supported trials of this approach. But we deeply object to healthcare commissioners who find it easier to cut services rather than put in place alternatives which will maintain some level of service to patients. Thankfully Dr Cave does not believe the patient should pay the price of poor procurement.


‘For someone medically diagnosed with coeliac disease, there is no choice but to stick to a GF diet, day in day out for life, and so access to GF staples is critical, and is not as easy as you might think. The expansion of Free From aisles in large supermarkets masks the reality of very patchy provision. Research published in 2015 noted that budget supermarkets stocked no GF food, and that these stores tended to be frequented by people on lower incomes. Additionally, high prices make such products unaffordable for some.’


(Whilst GF food staples such as pasta, are three to four times more expensive than comparable gluten-containing products, gram for gram, GF bread is six times more expensive than regular gluten containing bread in the supermarket.)


‘People are feeling the negative impact of cuts,’ Sarah Sleet continued, ‘and we know that the most vulnerable are going without food when they can’t afford to support their diet.


‘The potential serious long-term health complications of not maintaining a GF diet include osteoporosis, infertility and, in some rare cases, small bowel cancer, conditions that could cost the NHS a lot more in the long run.’


Fortunately for coeliac patients in Scotland, GF prescribing is not only available on the NHS across the region, but, for the last couple of years, has been successfully managed by community pharmacy through the Gluten Free Food Service (GFFS).


Indeed, the Scottish Government’s review of the GFFS highlighted the service as an example of the positive role pharmacists can play in managing a long-term condition such as coeliac disease. The service, said the review,


makes optimum use of clinicians’ skills and - through the support provided by pharmacists - allows patients to actively manage their own condition without becoming a burden to the NHS.


Contractor, George Romanes, believes that GFFS not only brings benefits to the patient but to the NHS budget.


‘I currently have 16 patients in this branch,’ George told SP, ‘and I would have to say that, as with most community pharmacies, we’ve certainly seen our patients benefit from our pharmacy prescribing system.


‘Far from being a cost to the NHS, I would actually say that the system has brought financial benefits to the GF prescribing system.


‘For a start, the fact that the pharmacist can prescribe GF products means that the patient doesn’t have to present at the GP surgery, so there’s an immediate saving in GP costs. The fact that the healthcare system is currently under so much pressure in terms of workload means that the pharmacy prescribing GF process has immediate advantages in terms of taking the workload off GPs and frees them up for appointments.


‘Over the last couple of years, I’ve observed the way my GF patients use the formulary and I have to say that the system works extremely smoothly and well. For a start, rather than just choosing what they want each month – as used to happen – patients have reacted very positively to the formulary or menu card. The fact that they’re only allowed requisite amounts means that they not only have to think more carefully about what they want, but are also unable to ‘stockpile’ products as tended to happen before.


‘I find that most of my patients order once a month. This is useful for both them and my staff as it allows the patient to plan meals etc for the month and also allows us to keep a simple record of what they’ve ordered.


‘Rather than being a cost to the NHS, I would say that, in comparison with the old system whereby the GP was just asked for scrips for random products, this system is more structured and controlled and, in fact, some health boards in Scotland are actually reporting a decrease in GF products as, thanks to the controls, there isn’t as much waste.


‘Since the pharmacy prescribing


‘FAR FROM BEING A COST TO THE NHS, I WOULD ACTUALLY SAY THAT THE SYSTEM HAS BROUGHT FINANCIAL BENEFITS TO THE GF PRESCRIBING SYSTEM.’


service came in, there’s no doubt that the availability of GF foods in general has widened. Most supermarkets have at least one range of GF foods now and I find that my patients tend to get the ‘basics’ on scrip, and then buy their ‘luxury goods’ such as chocolate biscuits in supermarkets. Again, this is of no cost to the NHS.


‘Overall, I would say that the pharmacy prescribing GF service has been a great success all round. The patient is offered a structured service, the costs to the NHS have decreased and the pharmacist receives a payment of £125 per month. All in all, I’d say it’s a win-win-win situation!’


George’s sentiments are echoed by Fiona McElrea from Whithorn Pharmacy in NHS Dumfries & Galloway.


‘Our local GP passes on all coeliac patients to us and I definitely think this service has been a great success.


‘The fact that the patient has to come into the pharmacy on a regular basis means that we are able to easily carry out the annual pharmacy coeliac health check which is part of the specification for the Scottish Gluten- Free Food Service. This is a particularly good way for us to sit down with the patient on an informal basis – say, when they come in to collect a scrip - so that we can have a one-to-one consultation and carry out the health check.


‘We do have to be pretty proactive in monitoring when the six or twelve- month checks are due, but they’re very worthwhile since they enable us to track a patient’s progress and flag up any issues. If we do come across any issues or problems that the patient is experiencing, then we can refer them back to the GP, if necessary. The checks are especially useful for patients, who perhaps don’t see their GP very often. Once again, it’s the accessibility of the community pharmacist that facilitates these checks on an informal basis.


‘In terms of what’s available to patients, I think that they are given


a great range of products to choose from. The formulary gives a great variety of foods and I find that my patients tend to pick and choose from the entire list; ordering items like bread and rolls one month and then cereal or mixes the following month. Operating in this way allows them to take advantage of the full range of products.


‘When coeliac patients ordered from the GP, they tended to always choose the same items but now, the fact that they have to come into the pharmacy, means that we get the opportunity to talk to them about what they’d like or what they need. The fact that the products they order then go onto a repeat list means that it’s very convenient for them – and us!


‘The system is definitely much more structured than it previously was. Before, a patient would go to the GP and the GP would tell them to, for example, ‘have a loaf’. There was no regulation and no tabs were kept on what people were getting. I’m not saying that people were exploiting the system; it was more a case of many people didn’t order anything because they didn’t know what they were entitled to.


‘This system gives people more responsibility for their health but also gives them a wider variety and better recipes. GF bread, in particular, was notoriously bland and had the consistency of a brick. It really was quite unpalatable. The range of GF food that’s available now – not just through pharmacy, but in general – is excellent.


‘The only thing I would say is that everybody – pharmacists and GPs alike - should be prescribing from the same formulary. Recently, there have been cases of patients asking GPs to prescribe off formulary because the pharmacist wouldn’t do so and the GP has concurred. This totally goes against the ethos of the service.


‘Overall, however, I would say that the service is an excellent one that’s more cost effective for the NHS than previously.’ •


SCOTTISH PHARMACIST - 61


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