Coeliacs in Warwickshire are set to lose access to gluten-free ingredients through NHS prescriptions – and "serious financial pressure" could see other services chopped.

General practitioners (GPs) currently have scope to prescribe gluten-free flour and bread for patients with coeliac disease but the Coventry & Warwickshire Integrated Care Board (ICB) – the body that makes decisions on how NHS cash is spent – is nearing the end of a process to cease availability.

The ICB rolled out a new prioritisation process to assess the things it pays for in March 2025 and this was the first to reach the decommissioning stage.

'We can't afford to buy everything'

Rachael Danter, deputy chief executive and chief transformation officer of the ICB, told Warwickshire County Council's adult health and social care overview and scrutiny committee that money had to be used "in the best way possible" with the plan focused on evidence-led decisions, where the greatest health needs are and tackling inequalities. 

Citing "serious financial pressure", she said it was "really important that we get the greatest benefit from where we direct our money" and admitted: "That does mean that over the next few years we will have to make some tough choices about the services that we buy. We can't afford to buy everything." 

Promising a "fair and consistent" process, she said that "all contracts that are coming up for renewal" would be assessed alongside all new service proposals. Ongoing services will be scrutinised "over time".

Each element could be expanded where possible, kept as is or subjected to a service review "both in terms of money and access".

Ms Danter continued: "Where services can show some benefit but the evidence is either weak, incomplete or indirect, we will work with the provider to do one of four things – look to negotiate a better price, work the provider to improve the efficiency or productivity, restrict access, so the threshold to get that service is harder to get, or we will request stronger evidence from the provider."

From there, services will be reassessed with those unable to show value moved towards decommissioning where they are "unable to provide data to show benefit or that the cost of the service is not warranted in terms of value for money".

Panel chair Cllr Jo Barker said the plan was "completely logical" and seemed "extremely robust", although Cllr John Holland raised the lack of discussion around preventative measures. 

"The best way of treating sick people is to prevent them from getting sick in the first place. I didn't hear anything about reducing ill health," he said. 

Ms Danter replied: "This process is not for prevention, it is for schemes already in place.

"If a new scheme was put forward around prevention it could be taken through this process and would probably score quite highly on the first set of criteria, in terms of how it fits with strategy, the national direction of travel and meeting inequalities.

"Many of the schemes we are assessing are short-term non-recurrent pilots that have been given small amounts of money but are not in a substantive budget.

"We are trying to assess whether or not they should continue because giving the budget recurrent status would immediately put financial pressure on the system."

Gluten-free decision

Having been introduced to the process, the committee was asked whether it felt the ICB had done enough engagement on the gluten-free cuts or should go out to a full public consultation. 

Rose Uwins, the ICB's head of communications, said that approximately 1 in 100 people in the UK are coeliac with 1,401 patients, including 219 children, receiving gluten free products on prescription at the discretion of their GP across the ICB area.

She stressed that it was not a treatment or medicine with "no significant adverse outcomes" emerging from the other areas that have axed availability. 

A digital-only survey yielded 232 responses with more than half raising the issue of increased food shopping bills and more than a third saying the move could prevent people from sticking to a gluten-free diet.

In a public post on social media, Coeliac UK "strongly" opposed the plan, adding: "Removing this support would put extra pressure on people with coeliac disease, particularly vulnerable individuals and families already facing rising food costs."

The ICB's own report acknowledged the feedback "suggests that a significant share of prescription recipients are living with limited financial flexibility".

"By contrast, those who did not receive prescriptions were more likely to describe their situation as comfortable. A larger proportion of this group reported having more than enough for necessities, with either a little or a lot spare for extras and leisure. 

"While some respondents in this group also reported financial strain, the overall pattern shows that non-recipients are more financially secure compared to those who rely on prescriptions."

The ICB says it spends £240,000 per year on gluten-free prescriptions and that products are now more readily available in supermarkets, estimating the increased cost of replacing the bread and flour to be between £11 and £14 per month.

Cllr Barker said: "I am perfectly content that you've engaged with a quarter of the affected population which is huge. Statistically, I think you've cracked it."

She added she was "pretty sure we know" what the wider population would say and cited the alternatives – potatoes and rice – and the products and advice available through foodbanks, including the one she helps to run.

It was unanimously agreed by councillors not to ask for a full consultation, meaning the ICB can progress the decision to decommission. 

Cllr Barker concluded: "We've had a good debate, you've given us good information, we are going to be getting more and more difficult decisions to make."