Gluten-free foods scheme – Operating Manual (2008 version)
Prescribers
In future, rather than having to itemize gluten-free foods on a prescription, prescribers will be able to issue an order for a maximum number of points per month for up to a year. The existing Repeat Dispensing Scheme does not allow different items to be issued each time, so practices are being issued with dedicated stationery.
Which patients are eligible?
Any patient can join, but neither the GP practice, the pharmacy nor the patient is compelled to do so. If any one opts out, normal FP10 prescribing continues. Note that because a charge equal to a prescription charge must be collected for each item from any patient who pays for their prescription, it is likely that only patients who do not pay will take part.
How much should be prescribed?
There are national recommendations for minimum quantities per month. These are:
Age and sex
/ Units per month1-3 years / 10
4-6 years / 11
7-10 years / 13
11-14 years / 15
15-18 years / 18
Male 19-59 / 18
Male 60-74 / 16
Male 75+ / 14
Female 19-74 / 14
Female 75+ / 12
Breastfeeding / + 4
3rd trimester of pregnancy / + 1
High physical activity level / + 4
Patients are not obliged to join the scheme, and may not do so if their prescription would be reduced. We recommend that prescribers should average the last three prescriptions to calculate an acceptable level. A ready reckoner is available to assist in this (GF Ready Reckoner.xls).
The maximum length of a prescription is 12 months. If you prescribe in quantities greater than a month, please note this on the order card to avoid misunderstanding.
What about folic acid and vitamins?
At present, these will continue to be issued on FP10.
How do prescribers complete the order card?
Simply write the patient’s name, the number of points per month and the number of months for which the prescription is to run. If you normally prescribe 2 months at a time, write the number of months as, e.g., 6 x 2 months. Sign the card and give it to the patient.
Each time the patient presents for dispensing, the dispenser exchanges their card for a new card with one month less on it.
What if the patient wants to change pharmacy?
The card given by a pharmacy will be prestamped with their details. If they want to change pharmacy they will bring the unwanted card back to the surgery to be exchanged for a new one. We hope that this will be a rare occurrence.
What data will be available to prescribers?
The reimbursement of dispensers is being done by the PCT, so gluten-free foods will no longer appear on PPD reports. However, equivalent data will be collected by the PCT and returned to practices at intervals.
Do we have to take part?
No. Participation is voluntary, but the general response has been that this will significantly reduce practice workload with increased patient satisfaction. Patients are not compelled to join in either, so some may prefer to continue with existing systems, at least for the present. The scheme is a voluntary partnership between prescriber, dispenser and patient.
Dispensers
Do we have to join the scheme?
No. If you are approached by a patient with an order card and do not wish to take part, please signpost to another dispenser.
What are the points values for each type of food?
Since this scheme is outside the FP10 route, we are not restricted entirely to ACBS products. However, to be permitted within the scheme a product type will need a point value. We cannot accept the supply of pre-prepared meals, but there may be good reasons to allow some food currently not allowed. For example, at Christmas we are prepared to allow one pack of mince pies, and we will permit some wrapped bars for packed lunches. The guiding principle is that these must not be a significant part of the whole mix, for nutritional reasons.
The points values are as follows:
Food item / Points400g bread/rolls/baguettes / 1
500g flour/cake/bread mix / 2
200g biscuits/crackers/crispbreads / 1
250g pasta / 1
2 pizza bases / 1
1 pack of 6 mince pies / 2 (max. of 1 pack per month)
2 bars not exceeding 90p in cost / 1
We are prepared to consider additions to the list on request. As a general rule, where items cannot be related to this list we provisionally allocate 1 point for every £3 or part of £3 cost price (i.e. £3 = 1 point, £4 = 2 points, £6 = 2 points) and contact dispensers afterwards with a final points value. Where we do this, we honour this temporary guidance on the first occasion.
How do we decide what items to issue?
This is negotiated with the patient. Patients are being told that dispensers cannot be forced to accept any particular item, but we hope you will be as flexible as possible. The management of the patient is now shared between prescriber and dispenser, and we would expect dispensers to help patients make healthy choices to ensure a balanced and adequate diet.
How often can patients have supplies?
Generally, the rules for Repeat Dispensing apply. Adjust supply dates for convenience and allow double supplies prior to holidays. Where the custom is for prescriptions to be issued for 2 months, this can be continued.
Are prescription charges still payable?
Yes. One charge is payable for each type of food e.g. bread, rather than for each brand. The vast majority of patients are either exempt on other grounds or have prepayment certificates, and they will need to renew these when the time comes. If a prescription charge is received, please annotate the card to show it.
How are we reimbursed?
Please endorse the order card just as you would have done for an FP10. There is no need to list brands, except where prices differ. It helps us if you can endorse the purchase price. Reimbursement will be calculated by the PCT.
What dispensing fees will we receive?
There is no dispensing fee as such. Instead you will receive a patient management fee of £10 per patient dispensed for, per month, paid against the completed card. This fee is not related to the amounts dispensed, but is a flat rate management fee. It incorporates any out-of-pocket expenses incurred in obtaining the food, so there may be items that you may wish to exclude from this scheme if the carriage costs are high. Patients have been told that this may happen.
What happens if the patient does not want all the items at one time?
You can negotiate splitting of the supply, but please ask the patient to sign for each batch collected. One fee will be payable, however many collections there are.
Can a patient carry unused points forward?
No.
How will we know what the patient wants?
Patients will have pads of gluten-free shopping lists, which they can forward to dispensers in the same way as a repeat prescription request.
When does the scheme start?
Dispensers will be invited to training evenings and can start the scheme immediately after completing the training successfully.
Whom do we approach with any queries?
The PCT prescribing team at Sedgemoor (tel. 01726 627845) or Camborne (01209 886565)
A copy of the information sheet for patients is attached.