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Introduction 

NHS South Yorkshire Integrated Care Board (ICB) is seeking views from citizens of South Yorkshire, South Yorkshire health care professionals, and other local interested parties on proposals to review our current policy in relation to the prescribing of gluten-free products. 

To capture your views and feedback before any decision is made, a period of public involvement will run for twelve weeks from 28 July until 17 October 2025. 

If you would like this document in another format, please contact us. 

About this involvement document 

This document provides information about the services we currently commission and explains the reason why we are considering changing our policy on gluten-free prescribing. 

At the end of the document you will find a link to a survey which aims to capture your views and feedback.  

The survey also offers you the opportunity to share any significant information you think we should know before making a decision. 

About us 

NHS South Yorkshire ICB commission (buy) health services for patients in South Yorkshire, making decisions about local services. 

We have a budget to plan and purchase a range of health services including those provided in hospitals and in the community, including GP services. 

Our ICB Board oversees our work and sets our priorities and direction. 

We have four core purposes, they are: 

  • Improve outcomes in population health and health care 

  • Tackle inequalities in outcomes, experience and access 

  • Enhance productivity and value for money 

  • Help the NHS to support broader social and economic development 

Priorities 

The NHS has been asked to prioritise access to care, such as GP appointments in primary care, elective treatment in hospitals and to improve waiting times for urgent and emergency care, such as the length of time waiting in an accident and emergency department. 

Over the last few years our communities have told us that they want the NHS to prioritise access, agency and awareness. This is access to the types of care mentioned above, choice over their care, and the information to support people to make decisions about their care and that of their families. 

The NHS in South Yorkshire has a duty to be responsible with the money we have available and not spend more than we have each year. We also have a duty to secure the best investment for the funds that we have been allocated to provide high quality care for local people. 

Within this context, we are now reviewing some of our services and policies because we need to focus our resources on the services that matter to our communities the most. We have explored all areas of our commissioning in relation to our organisational priorities, the priorities of our citizens, cost effectiveness, clinical outcomes and essential services. One of the areas we have identified for review is the current arrangements for the prescribing of gluten-free products in South Yorkshire. 

Why are gluten-free products prescribed? 

In the UK, some gluten-free food can be prescribed on the NHS for individuals diagnosed with certain conditions such as coeliac disease and dermatitis herpetiformis. These conditions are lifelong autoimmune diseases caused by a reaction to gluten (a group of proteins naturally found in grains like wheat, barley, and rye). 

Once diagnosed, these conditions are treated by following a strict gluten-free diet for life. Prescriptions for some gluten-free products (bread and mixes) have been available to supplement a healthy diet. 

A nutritionally balanced gluten-free diet can be achieved without the need for specific manufactured products as many food items are naturally gluten-free, e.g. meat, fish, fruit and vegetables, rice &potatoes. If patients can’t easily access gluten-free products, this may increase the likelihood that they consume gluten, leading to medical complications. 

Since prescriptions for these products were first introduced, gluten-free options have increased in availability and range in supermarkets and other stores, however, we know that there is less availability of gluten-free products in food banks, and the cost of gluten-free products is generally higher than gluten-containing equivalents. 

How many people in South Yorkshire are prescribed gluten-free products? 

A total of 7,856 patients (0.5% of the population across South Yorkshire) have a diagnosis of coeliac disease. The total number of people with these conditions is likely to be double this.  

The percentage of patients affected who access prescriptions differs in each Place with 17% of Rotherham coeliac patients accessing gluten-free prescriptions to 23% in Barnsley. 

Currently, NHS South Yorkshire ICB has the 4th highest gluten-free prescriptions per 1000 patients compared to all other ICB’s across England. 

What do we currently provide in South Yorkshire? 

Prescribing of gluten-free products was standardised across South Yorkshire in 2023 based around the Coeliac UK recommended units below. 

How much does gluten-free prescribing cost? 

The total spend on gluten-free prescriptions last year across South Yorkshire was £443,847. The highest total spend was in Sheffield and the lowest spend was in Barnsley. 

What is the national guidance on prescribing gluten-free products? 

The Department of Health and Social Care carried out a consultation on gluten-free prescribing in 2018, the outcome of which was to restrict gluten-free prescriptions to certain bread and mixes, and the amount of units prescribed was reduced to those shown below. One unit is the equivalent of a 250g loaf or bread mix. 

Age and sex 

Number of units 

Children under 10 years 

8 

Children over 11-18 years 

12 

Female 19 years and older 

8 

Males 19 years and older 

12 

Women in 3rd trimester of pregnancy 

9 

Breastfeeding 

13 

Many other areas across the country have, or are currently considering, reducing or stopping the prescribing of gluten-free products. 

What are we proposing? 

Option 1 

Stop providing gluten-free prescribing (except for the most at risk of becoming malnourished by not adhering to a gluten-free diet)* 

Prescribing of gluten-free food is not recommended. Prescribers can apply discretion in exceptional circumstances where they are sufficiently convinced that there is a genuine risk that a vulnerable individual is, or will become, undernourished if they do not prescribe gluten-free products. 

Option 2 (current offer) 

Provide gluten-free breads and mixes to Coeliac UK guidelines for England 

Prescribing of gluten-free bread and mixes to Coeliac UK recommended units per month: 

  • Children under 10 years - 8 units 

  • Children over 11-18 years - 12 units 

  • Female 19 years and older – 8 units 

  • Male 19 years and older – 12 units 

  • Women in third-trimester of pregnancy – 9 units 

  • Breastfeeding women – 13 units 

Option 3 

Provide gluten-free breads and mixes to 75% Coeliac UK guidelines (except for the most at risk of not adhering to a gluten-free diet)* 

Prescribing of bread and mixes to a volume below Coeliac UK guidelines adjusted for the additional costs needed to purchase gluten-free bread and mixes: 

  • Children under 10 years – 6 units 

  • Children over 11- 18 years – 9 units 

  • Female 19 years and older – 6 units 

  • Male 19 years and older – 9 units 

  • Women in third-trimester of pregnancy – 10 units 

  • Breastfeeding women – 9 units 

Option 4 (preferred option) 

Provide gluten-free breads and mixes to Coeliac UK guidelines for England for those under 18 years only. 

Prescribing of gluten-free bread and mixes to Coeliac UK recommended units per month: 

  • Children under 10 years - 8 units 

  • Children over 11-18 years - 12 units 

  • Women in third-trimester of pregnancy – 9 units 

  • Breastfeeding women – 13 units 

* In such exceptional circumstances, prescribing quantities should be limited to those recommended by Coeliac UK 

Why is option 4 our preferred option? 

Option 4 is our preferred option because we know adherence to a gluten free diet can be harder for children and young people. Research shows children and young people want to follow diets as close to their friends as possible. When we’ve done previous engagement with South Yorkshire residents about gluten free prescribing, people have told us that they believe supporting children and young people should be a key priority for us. 

How much money could be saved by reducing gluten-free prescriptions? 

A summary of the estimated cost and potential savings for all four options is provided in the table below. 

Option 

Baseline 

Cost 

Saving 

Option 1 

£443,847 

£110,962 

£332,885 

Option 2 

£443,847 

£443,847 

£0 

Option 3 

£443,847 

£332,885 

£110,962 

Option 4 

£443,847 

£72,125 

£371,772 

 

Our duty to involve 

We have a legal duty to involve patients and the public in our work in a meaningful way to improve health and care services. This duty is relevant to designing and planning services, decision making and proposals for changes that will impact on individuals or groups and how health services are provided to them. 

Where public involvement is required, we must make the best possible judgement on what is a fair and proportionate approach. As a public body, we are mindful of our responsibility to involve local patients and the public on this proposed change. 

A significant amount of public involvement has previously taken place to discuss the prescribing of gluten-free products in South Yorkshire. This insight will be considered alongside new feedback received to this involvement period. A full report on the engagement that has taken place previously can be found on our website at www.southyorkshire.icb.nhs.uk/get-involved.  

How to get involved 

You can feedback in several different ways to suit you: 

What will happen with your feedback? 

Feedback from the involvement period will help to inform the NHS South Yorkshire Integrated Care Board to make a decision on the future prescribing of gluten-free products in South Yorkshire at its meeting on Wednesday 5 November 2025. The Board meets in public. 

We will publish the outcome of the involvement period on our website, through social media, and via the press and media.