Mounjaro: Are GPs able to prescribe it?

GP in many parts of England are having to explain to eligible patients that tirzepatide (Mounjaro) cannot be prescribed in primary care yet, despite the NICE deadline having now passed. So do private providers still have a role to play?

NHS availability... is it what it appears?

Commissioning guidance stated that tirzepatide for weight loss must be implemented in primary care in June 2025, but several Integrated Care Boards (ICBs) have told GP practices that plans for the rollout are still being finalised and the drug cannot yet be prescribed.

In some areas, the service is not expected to be in place until the autumn, Pulse has learned.

GPs are reporting getting large numbers of patient requests amid the media attention that the rollout has received. Some ICBs have put out statements asking patients not to contact their GP practices about accessing the drug, but acknowledged that this situation ‘may be difficult for practices to explain to patients’.

And LMC leaders have told Pulse that the discrepancy between the national message and the reality locally has left GPs to manage expectations which are impossible to meet.

It comes after Pulse revealed earlier this month that less than three weeks before the rollout was meant to commence, only eight out of 42 ICBs could confirm which model they were going to use to implement the NICE recommendation.

Earlier this year NHS England stipulated that ICBs must meet the costs of funding access to the weight-loss injections in primary care settings from 23 June, for patients with a BMI of 40 or higher, and four or more weight-related comorbidities.

In a message to practices this week, Kent ICB said: ‘Although it has been announced that it will become available in primary care settings from Monday, 23 June (for a specific patient cohort) arrangements are being made to mobilise a provider of the necessary Behavioural Support for Obesity Prescribing (BSOP) that is specified in the NICE guidelines.

‘Until this service is in place in Kent and Medway, it is not possible to prescribe tirzepatide in primary care. Please also note there is no provider of tirzepatide available under right to choose. We are aware that this situation may be difficult for practices to explain to patients.’

Kent LMC medical director Dr Caroline Rickard told Pulse that the mismatch of national messaging and local reality is ‘incredibly unhelpful’ for GPs, who are left to manage expectations that cannot be met.

She said: ‘Like many areas across the country the reality for GPs in Kent and Medway is that a commissioned pathway to provide all the needs patients require to access weight loss services with Mounjaro (tirzepatide) is currently not in place.

‘Kent and Medway ICB have advised GP practices that we are not able to prescribe this medication at the moment. The mismatch of national messaging and local reality is incredibly unhelpful for GPs working in practices who are managing additional requests with expectations that cannot be met.’

In Essex, the ICB said that access to tirzepatide ‘will initially be through Tier 3 weight management services only’, with a rollout in primary care settings ‘planned for later in 2025’.

It advised practices to publish a message on their websites indicating that the national rollout ‘does not mean all people will be able to get a prescription for tirzepatide on this day’.

North West London ICB advised patients that tirzepatide ‘may not yet be available in all areas’. A spokesperson for Londonwide LMCs stated ‘GPs engage in prescribing where clinically appropriate and safely resourced to do so, and prescribing medication such as Mounjaro requires structured implementation, appropriate monitoring, and clarity around responsibilities. It also needs to be accompanied by wrap-around support incorporating nutritional advice as a minimum, as well as access to behavioural change components'.

Similarly, in Chesire and Merseyside the drug still cannot be prescribed, with the ICB telling patients not to contact practices about it until a new community-based weight management service is established.  Humber and North Yorkshire ICB said it is ‘still finalising the details of the prescribing model’ and wraparound care that will be introduced as part of the rollout.

‘In the meantime, people should not ask their GP practice or pharmacy about getting tirzepatide on the NHS via prescription until the new community service has been brought in,’ the ICB added in a statement.

An NHS England spokesperson said: ‘NHS England has published guidance for ICBs to support the rollout of tirzepatide to treat obesity – and, the treatment will start to become available nationally for eligible patients, based on the highest healthcare need.'

As it stands, around 220,000 patients will be eligible for the weight-loss injections in primary care over the first three years.

Last week, the BMA set out advice for the time and costs for GPs in setting up locally commissioned services to provide the weight loss injections on the NHS. The demand is there but unfortunately the provision is not yet in place.

This is where private providers continue to play a role in ensuring patients receive the treatment they need in a timely manner. Whilst GPs do have a wealth of knowledge in the general medical field as General Practitioners, it can be difficult to get the right support unless your GP surgery has a specialised dedicated service for weight loss, such as a Clinical Nurse Specialist or a suitably qualified alternative (e.g. on site pharmacist, nutritionist etc.).

Having a team that specialises in the area of weight loss can be of several benefits due to their knowledge & experience within that particular field. Patients need professionals who can identify suitability, help with common issues, give advice and continuing support to ensure the patient not only reacts well with the medication but starts to see their weight loss goals achieved through nutrition, exercise and the necessary support to enable positive changes.

We are proud to specialise in weight loss and have the ability to offer tailored advice to each patient. Should you wish to discuss treatment options or have a review of your treatment regime, please let us know.

Thanks for reading,

The AJ Hill Team