Agenda item

Report of the Vice Chairman of the Joint City and County Health Scrutiny Committee (Nottinghamshire County Council)

Hazel Buchanan, Director of Operations, Nottingham North and East Clinical Commissioning Group (CCG), and Jonathan Bemrose, Director of Finance, Nottingham North and East Clinical Commissioning Group (CCG), introduced the report on Maximising the Use of Our NHS Resources, highlighting the following points:

(a)  patients generally prefer to access services in primary care settings;

(b)  pathways of care are being redesigned to ensure there is better access to GP practices, care is provided closer to home, hospital admissions are avoided and there is better sharing of information across primary and secondary care;

(c)  patient and public engagement in  NHS services is key to build intelligence and plan for the future;

(d)  medicine management must ensure evidence based choice and patient safety;

(e)  the gap between funding and the care costs will be around £140 million by 2018/19 if current trends continue;

(f)  coeliac disease is a common digestive condition and triggers by intolerance to protein gluten found in bread and many processed foods;

(g)  the south CCGs (Rushcliffe, North and East and North and West) spend approximately £250,000.00 providing gluten free products on prescription;

(h)  gluten free products are now widely available in supermarkets and restaurants and coeliac patients can eat a wide range of foods including rice, potatoes, fruit and vegetables;

(i)  the south CCGs are planning a 90 day consultation between August and October 2015 with key stakeholders, patients and public. Nottingham City CCG colleagues have been involved in dialogue regarding the consultation proposal. The three options for consultation are:

·  stop all prescribing;

·  restrict prescribing to bread and flour (Rushcliffe and Nottingham West);

·  restrict prescribing to flour only;

Following discussions with the committee the following additional points were noted:

(j)  children under 5 with multi-intolerances are to excluded from the consultation regarding gluten-free prescribing;

(k)  Healthwatch Nottingham voiced concern that the report was not more explicit regarding key local public health messages, but it was confirmed that public health colleagues were involved in discussions and consultation detail;

(l)  additional dietetic support would be available to support coeliac patients;

(m)  pharmacists are working with GP practices to improve medicines management in this area;

(n)  in order for behaviour change to take affect there needs to be better relationships between GPs and patients and application of shared decision making;

(o)  it was requested that the consultation should be available online in order that anyone could contribute to the consultation exercise not just those targeted groups;

(p)  as yet, there hasn’t been any feedback on NHS Nottingham North and East  CCG restricted prescribing of gluten free products to bread and flour in December 2014 restrictions put in place.  A clinical audit following the restrictions is taking place and Committee members felt this should be included in the consultation material.

RESOLVED to:

(1)  note the report;

(2)  agree to a 90 day consultation between August and October 2015 regarding gluten free prescribing with key stakeholders, patients and public. The three options for consultation are:

1.  stop all prescribing

2.restrict prescribing to bread and flour (Rushcliffe and Nottingham West)

3.restrict prescribing to flour only;

(3)  the consultation should be available online for any member of the public to contribute to;

(4)  be advised of the outcome from the consultation exercise at a later date.