Practice letter to patients who require a biopsy

Letter to patients who need a positive diagnosis of coeliac disease and get
GFF on prescription
Dear xxxx (patient)
NHS Vale of York Clinical Commissioning Group (CCG) is responsible for
commissioning your healthcare.
Commissioning in the NHS involves making decisions about local need, the
allocation of resources, the purchasing of services as well as their monitoring and
review. The CCG has a duty and responsibility to commission safe and effective
services that deliver the best affordable care within the resources available.
As part of its review of the prescribing process in the Vale of York, the CCG has
recently analysed the prescribing of gluten free foods for patients diagnosed with
coeliac disease. The analysis was based upon guidance from the National Institute
for Health and Care Excellence (NICE) and local prescribing information. The
guidance states that in order for patients to be diagnosed as having coeliac disease
they must have a recognised blood test and a biopsy of the gut.
It appears that some people in the Vale of York have been diagnosed as having
coeliac disease without a biopsy to confirm the diagnosis, therefore potentially
restricting the patient’s diet unnecessarily.
As your diagnosis of coeliac disease was based upon the results of a blood test. It is
important to make sure that you are diagnosed with coeliac disease by doing a
biopsy. The biopsy is also necessary to be prescribed with gluten free foods.*
What happens next?
If you would like to have the biopsy that will confirm your diagnosis, please contact
the surgery so we can organise this. Please bear in mind that you will have to
resume a ‘normal’ diet (containing gluten) in the short term prior to the biopsy test.
If you do not want to undergo this procedure, it will not be possible to confirm a
diagnosis of coeliac disease and this will affect your eligibility to receive gluten free
foods on prescription in the future.
Gluten free foods on prescription*
Prescribing without a biopsy may mean that patients are unnecessarily restricting
their diet. It can also lead to unnecessary prescribing spend.
The CCG has reviewed the prescribing of gluten free food in other areas and used
this information to shape its decision to limit gluten free prescribing to bread and flour
from the 1 September 2014. Other gluten free products will no longer be available on
Please see the recommended amounts of units prescribed below. (NB: A 400g loaf
of bread accounts for 1 unit and 500g bread flour accounts for 2 units)
To be referred for a biopsy please contact Dr xxxx at the surgery.
If you have any queries about this change in prescribing, please contact
Recommended amounts per month:
Yours sincerely
Age and sex
child 1-3 years
child 4-6 years
child 7-10 years
child 11-14 years
child 15-18 years
male 19-59 years
male 60-74 years
male 75+ years
female 19-74 years
female 75+ years
Higher level of physical
activity (any age or sex)
3rd trimester pregnancy
Number of units
add 4
add 4
add 1