Introduction

Injectable weight loss management options and their prescribing in Primary Care (eg Semaglutide (Wegovy) and Tirzepatide (Mounjaro)

Injectable weight loss drugs have been brought to the UK market in the last few years including Semaglutide (Wegovy) launched in the UK on 4 September 2024 and Tirzepatide (Mounjaro) joining it a few months later. Both are available on the NHS as an option for weight management in line with NICE guidance, alongside a reduced-calorie diet and increased physical activity.

Patients are eligible for treatment within a specialist weight management service if they have a BMI of at least 35, or at least one weight-related comorbidity, such as hypertension or cardiovascular disease, and a BMI of 30 to 34.9, provided they meet the criteria for referral to specialist weight management services, including that conventional treatment has been unsuccessful. These guidelines may be different from area to area depending on local commissioning arrangements.

Semaglutide and Tirzepatide are injectable medications which are given once a week, and other options are likely to be released to the market over time. They can be delivered using a pen device normally used by the patient themselves.

NICE’s guidance on injectable weight loss drugs for managing obesity can be found here

Currently ICBs have strict prescribing criteria for injectable weight loss drugs and are mindful of potential cost implication. Examples used in some ICBs include ensuring patients have been taken all the way through the various tiers of weight loss services before the final tier (often tier 3) is reached and only at that point is a patient assessed for their suitability for the treatment.

Injectable weight loss drugs should not be prescribed in Primary Care (unless you are doing so under an enhanced service with a specific contract to do so).

Private Prescribing

There are many private medical and pharmacy companies who will assess patients and prescribe to those who want to receive the treatment. We have been made aware of GP Practices receiving letters from these private companies stating that their patient has been prescribed an injectable weight loss drug and the company is requesting that the GP make sure their patient does not have any contraindications.

This practice confers significant workload to GPs, and also effectively seeks to transfer some of the risk of prescribing to those GPs.

In line with Good Medical Practice guidance, it is the responsibility of the prescriber to make an assessment of the patient and judge their suitability to receive the prescription. DDLMC does not believe that it is acceptable for private providers to seek to transfer this responsibility to the patients NHS GP. Equally, provision of this type of information to a private organisation is not NHS work.

On the other hand, we do want our patients to receive safe treatment and not come to harm. Therefore, providing the information (ie detailed report) for a fee is an option. Alternatively, the patient could be provided with a simple computer summary of their key medical history and medications to share with the private provider (free of charge) or they could be signposted to access their medical information via the NHS app.

Patient facing information

DDLMC is aware that patients are often left wondering what happens next and will come to the practice to find out. We have devised the following information for patients that might help practices communicate with patients regarding their access to their medical information and these medications.