Formulary for Gluten-Free foods for Adults and Children
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1 Formulary for Gluten-Free foods for Adults and Children Why have the prescribing guidelines changed? The cost of gluten-free (GF) items at the supermarket is much lower than the price the NHS is charged. The range and price of GF foods available from shops is constantly improving. The NHS is spending around 24.7 million a year on GF (epact data April to June 2014). WHCCG total Gluten Free Spend Aug14 to July15 Non-preferred products ( luxury items such as biscuits, pastries, breakfast cereals Breads and Flours Pasta Crackers, bread rolls and pizza bases 314,000 (100%) 28,700 (9%) 175,700 (56%) 34,600 (11%) 75,000 (24%) As a result it has been proposed that bread (including fresh), flour and pasta continue to remain on prescription. Surcharges were one of the problems faced when fresh bread was added onto prescription; however, this has now been resolved. GF bread and pasta remain more expensive for the consumer than their non GF equivalent. What is Coeliac Disease? Coeliac disease is an autoimmune disease triggered by gluten. Treatment is to follow a gluten free diet for life. Diagnosis: Coeliac disease should be diagnosed with a positive blood result (tissue transglutaminase TTG) and confirmed by a duodenal biopsy, taken while the patient is still consuming gluten Referral: On diagnosis referral should be made to a Dietitian for dietary input Review: Yearly by a health professional, as per NICE guidelines GF diet and recommended units of GF staple foods Gluten is a protein found in Wheat, Barley and Rye. Wheat is the most widely consumed cereal in the UK. The GF diet requires the elimination of staple foods including bread, flour and pasta. Gluten is also found in cakes, pastries and biscuits and also in foods that you may not expect, such as some sauces, soups, ready meals and sausages. Elimination of wheat, barley and rye-containing ingredients from the diet results in the removal of a number of staple foods. This can result in a restricted and potentially unbalanced nutritional intake. The amount of gluten-free staple food recommended as units is based on: People with coeliac disease including naturally GF staple foods (e.g. potato and rice) as well as GF specialist staple foods (e.g. GF bread and pasta) A review of consumption data from the National Diet and Nutrition Surveys to establish a benchmark for the reasonable amount of GF food on prescription Consideration of the Eatwell Plate model for balanced eating. Foods that can be prescribed on patient s request (7-13 units depending on age&gender see appendix for examples) Bread / Fresh bread, Flour, Pasta Foods that can be purchased by patients directly from supermarkets/online retailers (unless requested by a specialist health professional) Crackers, Crispbreads, Rolls, Breakfast cereals, Pizza bases GF foods are ACBS approved for the established sensitive gluten enteropathy including Coeliac Disease and Dermatitis Herpetiformis to help with the compliance of these conditions. These products should not be prescribed for Wheat intolerance. Consequences of non-compliance with a GF diet can lead to severe health conditions such as osteoporosis and lymphoma.
2 Age and gender GF staple monthly units recommendation Prescribable monthly units (about 75%) Child Child Child Child Child Male Male Male Female Female Breastfeeding Add 4 extra 3 3 rd trimester pregnancy Add 1 extra - High physical activity level Add 4 extra - See examples of Units allocation in Appendix 1 Unit is: 250g of Pasta 250g flour mix 400g bread/fresh 200g crackers / crispbreads 250g rolls/baguettes/naan 250g pizza base (2 bases) 300g breakfast cereals 500g of oats List of GF products available on prescription - Pasta Pasta Company name Pack Price / Price / GF / WF / DF/MF/Mzsize (g) pack ( ) Unit ( ) F* Buckwheat Penne / Spirals GF WF Barkat Animal Shapes / Alphabet shapes / GF WF Macaroni / Spirals / Tagliatelle / Spaghetti Spirals / Grains / Sagnette / Penne / GF Mixed Bi-Alimenta Gnocchi GF Tubetti GF Dietary Specials Penn / Fusilli / Spaghetti Lasagne / Macaroni / Shells / GF WF, SF, MF, Mz-F Ener-G Spaghetti GF WF, SF, MF, Mz-F Vermicelli GF WF, SF, MF, Mz-F Lasagne / Tagliatelle GF Glutafin Penne / Shells / Spirals / Spaghetti GF Fibre Spaghetti GF Fibre pasta spirals GF Lasagne GF Juvela Tagliatelle GF Macaroni / Fusilli / Spaghetti GF Penne (fibre) GF Orgran Lasagne GF Spirals GF Rizopia Fusilli / Penne / Spaghetti GF Lasagne GF
3 List of GF products available on prescription Bread and flours Company name Breads (Not Fresh) Pack size (g) Price / pack ( ) Price / unit ( ) DF/GF/MF/Mz-F* /SF/WF* Lifestyle Un / Sliced: Brown / White / High fibre GF Dietary Specials Multigrain loaf (white) GF WF Ener G Six flour loaf GF WF, SF, MF, Mz-F Barkat Wholemeal sliced GF WF Juvela Unsliced/sliced - Fibre & White GF Juvela Fibre Part Baked GF Glutafin Sliced Fibre / White GF WF Juvela White Part Baked GF Proceli Brown rice GF WF Ener G Six flour brown loaf (sliced) GF WF, SF, MF, Mz-F Proceli Sandwich rice GF WF Livwell Sliced White / Seeded GF Ener G Brown or white rice bread GF WF, SF, MF, Mz-F Barkat Sliced Rice Brown / White GF WF Barkat Multigrain sliced GF WF Proceli Sandwich GF WF Proceli Sliced White GF WF Fresh Bread Company Pack Price / Price / DF/GF/MF/Mz- name size (g) pack ( ) unit ( ) F/SF/WF* Brown / White Original (sliced) GF WF DF Genius Brown /White Original (unsliced) GF WF DF Brown / White Sandwich Bread (sliced) GF WF DF Warburtons Sliced Brown / White GF WF Fresh (Brown / White) or Glutafin GF Sliced (Fibre / White) Select Sliced seeded loaf GF Juvela Sliced fibre GF Gluten-Free Sliced white GF Above companies are the delivery details and contact numbers Genius - Fresh bread only No charge if ordered directly from (via Alliance wholesalers) Glutafin Available from UDG with no delivery charge Juvela - Fresh bread only Available from UDG with no delivery charge Warburtons Available from UDG with no delivery charge
4 When considering the prescription of bread flour it is generally recommended to choose basic flour as first line as it is more cost effective and versatile for use. Although bread mix or multipurpose are commonly preferred as it contains sugar and milk powder which help the bread to rise. 1 st line - Bread mix / Flour 2 nd line - Bread mix / Flour Company Price / Price / DF/GF/MF/Mz- Pack size name pack ( ) Unit ( ) F/SF/WF* Brown rice flour 500g GF WF, SF, MF, Mz-F Potato flour 500g GF WF, SF, MF, Mz-F Innovative White rice flour 500g GF WF, SF, MF, Mz-F Solutions Tapioca flour 500g GF WF, SF, MF, Mz-F (Pure Gluten Free) Gluten-free blended flour 1kg GF WF, SF, MF, Mz-F Teff brown flour 1kg GF WF, SF, MF, Mz-F Teff white flour 1kg GF WF, SF, MF, Mz-F Tobia Teff White / Brown 1kg GF Proceli White flour 1kg GF Company Pack Price / Price / DF/GF/MF/Mz- name size pack ( ) Unit ( ) F/SF/WF* Barkat Bread mix 500g GF WF Flour 750g GF WF Finax Fibre bread mix 1kg GF Flour mix (regular/coarse) 900g GF Glebe Farm Pizza mix 375g GF Glutafin Select Bread mix, fibre, multipurpose mix (Fibre / White) 500g GF Glutafin Bread mix, fibre, multipurpose mix Gluten- Free (Fibre / White) 500g GF WF Heron Foods Bread mix 500g GF Hi-fibre/Bread and cake mix 500g GF WF Juvela Gluten- Free Mrs Crimble s Fibre / White / Harvest 500g GF Bread 275g GF Pastry 200g GF Orgran Pizza and Pastry 375g GF PK Foods (low protein) Flour mix 750g GF Tritamyl White bread/flour 2kg GF Brown bread 1kg GF Ultra GF Flour mix 1kg GF Wellfoods Flour plain 1kg GF WF DF
5 List of manufacturers of gluten free fresh bread with reduced delivery charges Company Delivery charges Contact nber Barkat Innovative solutions (Pure Gluten Free) Lifestyle Orgran Procelli Wellfoods Delivery charge ranges from 6.50 to 10 depending on the size of the package. Pharmacists are able to order directly and will be charged via their main wholesaler (AAH/Unichem/Phoenix) Do not use mainstream wholesalers. Can be ordered directly from company. Delivery charges: >500g = g to 10kgs = kgs 25kgs = Online order delivery charge: 6 items = 3.95, 12 items = 3.45, 18 items = items or more there is no delivery charge. Direct order from pharmacies. For the first 6 months, the pharmacy has to use one of their recommended special wholesalers. After this period, the pharmacy can open an account with Lifestyle. Orders for less than 8 items will incur a delivery charge of 7.75 Available to order from Naturally Good Food. Delivery cost for order weight of up to 1kg is 3.15 Delivery cost for order weight above 1 kg is 6.50 All orders go through Ambe Medical (main wholesaler) Delivery charge from Ambe is 10 for orders below 75. Next day delivery. Flexible ordering arrangements Available via Unichem and AAH as a special order (with high carriage charges) or can be ordered directly from the company. Cost when ordered directly: Free for orders of 6 units or more Delivery charge of
6 Appendix: Example of monthly unit allocation for various patient groups adapted from CoeliacUK Age Group (years) Monthly units Recommendation 1 to to to Male Male Male Female Female Breast feeding 3 rd Trimester pregnancy Add 4 units Add 1 unit Monthly units to prescribe (about 75% of recommendations) 6 units of bread (2400g) or mix suitable for making bread (1500g) 1 unit of pasta (250g) 6 units bread (2400g) or mix suitable for making bread (1500g) 3 units of pasta (750g) 5 units of pasta (1250g) 5 units of pasta (1250g) 4 units of pasta (1000g) 7 units bread (2800g) or mix suitable for making bread (1500g) 1 unit of bread (440g) Purchasable monthly units (supermarket/online retailers) 2 units of breakfast cereal (600g) 1 unit of crackers (200g) 2 units of breakfast cereal (600g) 1 unit of pizza bases (250g) 1 unit of pizza bases (250g) 2 units of GF oats (1000g) 2 units of pizza bases (500g) 3 units of breakfast cereal (900g) 2 unit of crackers (400g) 3 units of breakfast cereal (900g) 2 units of pizza bases (500g) 2 units of GF oats (1000g) 2 units of GF oats (1000g) 2 units of breakfast cereal (600g) 1 units of GF oats (500g) 1 unit of crackers (200g) 1 unit of crackers (200g) References 1. NICE clinical guidelines 86 Coeliac Disease Recognition and assessment of coeliac disease May Coeliac UK ACBS - Department of Health as Borderline Substances and may be prescribed at NHS expense for established gluten enteropathy with or without co-existing established wheat sensitivity. 4. British Society of Gastroenterology 5. NHS PrescQIPP - NHS PrescQIPP - Gluten Free Prescribing
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Class 30 Coffee, tea, cocoa and artificial coffee; rice; tapioca and sago; flour and preparations made from cereals; bread, pastry and confectionery; edible ices; sugar, honey, treacle; yeast, baking-powder;