​​​​Changes to P​rescribing

In 2017, Croydon CCG made changes to some areas of routine prescribing:

  • Routine gluten-free food products stopped being prescribed on 28 February 2017
  • Prescribing for some specialist baby milks was reduced from April 2017
  • Vitamin D supplements for the prevention of deficiency are no longer provided from April 2017
  • Self-care medication prescriptions were reduced in a phased approach starting from April 2017

This followed an engagement process that ran from Friday 11 November 2016 to Friday 6 January 2017.

Throughout this engagement process, Croydon CCG engaged face to face with over 300 individual Croydon residents, patients and professionals at over 30 events, groups or locations. 

We received a total of 346 written responses through the online or paper survey.  The survey was run for the entirety of the engagement period.  Details of the survey can be found in the Patient and Public Engagement Report.

  • 71% of respondents agreed or strongly agreed that after reading the document they understood why the local NHS is proposing to stop prescribing some items which are now readily available or cheaper to buy directly

  • Prescriptions for gluten-free foods
    • 51% of respondents agreed or strongly agreed that the CCG should stop prescribing gluten-free food
    • 34% of respondents disagreed or strongly disagreed that the CCG should stop prescribing gluten-free foods
  • Prescriptions for vitamin D
    • 59% of respondents agreed or strongly agreed that the CCG should stop prescribing Vitamin D for maintenance
    • 34% of respondents disagreed or strongly disagreed that the CCG should stop prescribing Vitamin D for maintenance
  • Prescriptions for baby milks
    • 49% of respondents agreed or strongly agreed that the CCG should stop prescribing specialist formula baby milk
    • 34% of respondents disagreed or strongly disagreed that the CCG should stop prescribing specialist formula baby milk
  • Prescriptions for self-care medications
    • 70% of respondents agreed or strongly agreed that the CCG should stop prescribing self-care medication
    • 22% of respondents disagreed or strongly disagreed that the CCG should stop prescribing self-care medications

Following the engagement process, the Governing Body considered all of the feedback received throughout the engagement period at their public meeting on Tuesday 17 January 2017.  The Governing Body decided to develop detailed implementation plans to reduce routine prescribing of gluten-free foods, vitamin D, specialist baby milk, and self-care medications.

You can read the Governing Body papers, including the full engagement report of all the feedback, on page 93 of this pack.

Baby Milk

We developed detailed implementation plans and clinical pathways for each of these proposed changes and issued them to GPs and prescribers.  

The implementation plan and clinical guidelines for specialist baby milks were developed working closely with local specialists including paediatric dieticians, health visitors and paediatric consultants from Croydon University Hospital.

The clinical pathway for specialist infant formulas for babies with Cow’s Milk Protein Allergy (CPMA) means that Croydon CCG will continue to prescribe these baby milks up to the age of 12 months.  This is part of a locally agreed treatment pathway for the diagnosis and treatment of CMPA.

When babies reach the age of one, weaning should already be well underway and so they should be getting most their nutrients from other food sources, rather than milk.  At this age, they can also have alternative calcium-enriched cow's milk substitutes that are readily available from local supermarkets, such as soya, oat or coconut milks. This makes CMPA infant formulas less important in maintaining a balanced and nutritionally complete diet.

Weaning guidelines can be found on NICE (Recommendation 11) or NHS Choices.

You can read a number of documents about this engagement process below:

We sent the below letters and supporting materials to affected patients:

Gluten Free

Vitamin D