BAPEN was delighted to interview Alison Jones, the driving force behind the UK’s first gluten-free subsidy card scheme, launched in Hywel Dda Health Board and now expanding across Wales. Have a read of the below as Alison shares her motivations and insights into the project’s success.

Can you tell us about your motivations for this project?

Gluten free food has been available on prescription in Wales since the late 1960s. Patients were allocated units of gluten‑free (GF) food each month, but any change meant another GP visit. That isn’t how most of us shop – we try things, we want variety and flexibility. Once people with coeliac disease understand their diet, they’re generally well and shouldn’t need to keep going back to the doctor just to switch a product. There’s a grey line between “food as medicine” and “food as food”; the card was my way of crossing that line – giving people the means to buy the food that’s critical to them without medical gatekeeping.

The old system wasn’t a good use of clinician time and, because of variable stock, it led to lots of prescribing errors. Meanwhile, GF products were increasingly available in supermarkets, and it felt like the right moment to move away from prescriptions that were no longer necessary for access. In Wales prescriptions are free, so the aim was to cover the extra costs of GF food so people aren’t disadvantaged because of their condition.

What were the main pain points with gluten‑free prescriptions?

The previous system for accessing gluten-free food through NHS prescriptions was fraught with difficulties for everyone involved. Patients were required to order in bulk, often without the opportunity to try new foods first, which meant they were stuck with limited choices and sometimes had to invest in extra freezers just to store their supplies. For GPs, the process was confusing and time-consuming, with frequent errors arising from the subtle differences between products – such as prescribing spaghetti instead of penne – which led to unnecessary appointments and administrative headaches.

Community pharmacies faced their own challenges, struggling to store bulky stock that often arrived with short use-by dates, resulting in complaints and significant out-of-pocket expenses. Financially, the system made little sense: the NHS frequently paid far more for gluten-free products on prescription than they would cost in shops, for instance two pizza bases to the NHS were three times the price of the cost in a supermarket.

There was also growing pressure from policy changes in England, where prescriptions had been restricted to bread and flour mixes, raising concerns that Wales might follow suit and further disadvantage people with coeliac disease. All these factors combined to make the old prescription model inefficient, costly, and frustrating for patients, clinicians, and pharmacists alike.

Beyond the system itself, what barriers do people with coeliac disease face?

GF food is more expensive and less available in smaller shops, with far less variety. Cross‑contamination is a genuine risk in outlets that don’t fully understand coeliac disease. That uncertainty creates food insecurity and social exclusion – people worry about eating out, or fear being seen as making a “lifestyle choice” rather than managing a medical necessity. There’s still a lack of public understanding; comments like “it’s only a bit of gluten” show how little people appreciate the seriousness of the condition.

How did you get the pilot scheme off the ground?

When the idea for a gluten-free subsidy card first took shape, I knew that vouchers weren’t the answer – they risked stigmatising people at the supermarket checkout. I spoke to my manager, who was incredibly supportive and willing to take a calculated risk on something new. Together, we set out to find a card provider, and were fortunate enough to secure one willing to supply the cards free of charge for the pilot phase.

Of course, launching the scheme wasn’t as simple as handing out cards. We had to navigate a maze of data privacy requirements, equality and quality impact assessments, and fraud risk checks. Only after jumping through these hoops could we move forward. We identified 197 people in 9 selected GP practices in Hywel Dda University Health Board who were receiving gluten-free prescriptions and invited them to take part; 123 agreed to join the six-month pilot. During this time, we paused their prescriptions and instead gave them the card to use for their gluten-free food shopping.

The pilot’s success quickly became apparent, and it was clear we needed to bring in a wider team. We involved the multidisciplinary team and the Health Board, setting up task-and-finish groups focused on finance, quality, and evaluation to ensure every aspect of the scheme was robust. This collaborative approach allowed us to address challenges as they arose and keep the project moving forward. By 2022, after a period of careful planning and teamwork, the scheme had been fully adopted across the Health Board, laying the groundwork for its eventual national roll-out.

How successful was the project, and what did the evidence show?

It was very successful. After six months, 86% of participants didn’t want to go back to prescriptions. My funded research – interviewing a subset of the 123 – showed the card gave people more choice, flexibility, and access to GF food, and helped them feel more “normal.” It de‑medicalised dietary management and supported a healthy GF diet.

We now support about 80% of people with coeliac disease or dermatitis herpetiformis in the Health Board. The Chief Pharmaceutical Officer requested a piece of research into the scheme, interested in identifying ways to reduce pharmacists’ workloads and products in pharmacies. This research highlighted our model as a way to reduce workload in community pharmacy, and Health and Care Research Wales’ work found strong appetite across Wales. In July 2025, the Cabinet Secretary announced Wales‑wide roll‑out of the gluten‑free subsidy card.

Ultimately, the card supports patients, costs the NHS less, and is appreciated by patients, GPs, and pharmacists alike.

What were some factors that contributed to the project’s success?

When you hit an idea that’s a no‑brainer, the challenge is making it happen.

• Talking and collaboration were everything – listening to patients, GP practices, and community pharmacy, and working with medicines management, pharmacy, dietetics, prescribing support teams, Coeliac UK, industry, patient groups, and government.
• Leadership buy‑in mattered – my manager backed the vision and was willing to take measured risks.
• Research and evaluation – we had structured, approved research alongside transparent, ongoing evaluation.
• Faith and tenacity – believing this was right for patients and the NHS, and sticking with it through the hard yards.

What challenges did you face, and what did you learn?

Transparency was always a guiding principle throughout the project – I made sure to report outcomes openly and clearly demonstrate how decisions were reached. Continuous evaluation proved essential, helping us stay on track and adapt as circumstances changed.

Organisation was also critical; maintaining a clear strategic vision and a lessons-learned log enabled us to monitor progress and avoid repeating mistakes. Early identification of risks, paired with robust mitigation strategies, helped us navigate challenges effectively.

It would be remiss to not mention teamwork – tasks were delegated according to people’s strengths and task-and-finish groups were set up to address specific issues. Managing my own time was a challenge, as leading a project of this scale can easily become all-consuming, so I learned to ask for help when needed.

Seeking legal advice was also vital, especially to clarify that providing money in lieu of prescriptions was about supporting people to purchase medically necessary food, not supplementing their income.

Are there plans to expand the scheme outside of Wales, to the rest of the UK?

Not that I’m aware of at present. Wales‑wide adoption is underway, and I think Coeliac UK would be keen to see it considered elsewhere, but there are no plans I know of beyond Wales right now