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Variation in GP prescribing of gluten free foods ‘without clinical reason’

There is substantial variation in prescription rates of gluten free foods in general practice, which is not necessarily driven by obvious clinical factors.

This is the finding of a University of Oxford study, which said the variation may be driven by levels of deprivation and CCG policies.

The researchers looked at prescribing data from just over 7,600 general practices in England to analyse levels of gluten free food prescriptions across the country.

They found that there were 1.3m prescriptions for gluten free food in 2016/17, down from 1.8m in 2012/13. This represented a reduction of around £6.7m spent by the NHS on gluten free prescriptions in the last four years.

The researchers noted wide variation in the number of gluten free prescriptions given out per CCG, ranging from 0.1 to 55.5 per 1,000 patients.

The variation was associated with factors such as QOF scores and level of deprivation, with the most deprived practices prescribing at an 11% lower rate than the least deprived.

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The CCG that the practice fell under was also associated with the rate of gluten free prescribing.

The paper said: ‘We found CCGs to be a significant driver of variation, with a large variation in gluten-free prescribing at the CCG level, and a significant effect of CCG identifier within our mixed-effect modelling.

‘This is likely due to variations in CCG policies and therefore strongly suggests that practices are responsive to CCG prescribing guidance, at least on the issue of gluten-free food.’

The researchers added: ‘It is clear that the level of variation in gluten-free prescribing is very high, and that this variation appears to exist largely without good reason, being determined to a large extent by factors such as CCG.’

Following a public consultation, the Department of Health announced its intention in February to restrict the amount of gluten free products available for prescription.

BMJ Open 2018; available online 16th April


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