The Mounjaro mismatch – patient expectation versus GP reality

Emma Wilkinson speaks to GPs across England as they raise the alarm over a chaotic rollout of weight-loss drug Mounjaro on the NHS this week

All week, patients have arrived expecting access to tirzepatide (Mounjaro), only to find services are not in place and practices have been told not to prescribe.

Since Pulse first reported on the issue this week more GPs have come forward to describe the strain on surgeries, warning that managing patient expectations is taking up significant practice time while many integrated care boards (ICBs) are yet to finalise tirzepatide prescribing plans.

Under national commissioning guidance, tirzepatide for weight loss was due to be implemented in primary care from Monday 23 June. But in many areas, local services have not been set up, and there is confusion over how the rollout will work. Even when services are commissioned, areas have only budgeted for tiny numbers and many patients are likely to be disappointed, GPs have said.

The rollout is being phased to manage demand, starting with patients who have a BMI of 40 or more and at least four weight-related comorbidities. In year two, eligibility is expected to expand to those with a BMI of 35-39.9 with four comorbidities, and in year three to people with a BMI of 40 with three comorbidities, including those from ethnic groups with lower thresholds. NHS England has said the full rollout could take up to 12 years to reach all 3.4 million potentially eligible patients.

But this has not been effectively communicated to patients, according to GPs Pulse has spoken to.

Dr Samuel Finnikin, a GP in Sutton Coldfield, says: ‘Here [in Birmingham and Solihull], we have been instructed not to prescribe and instead [the ICB] are setting up ‘locality clinics’, although I don’t know what they look like yet.’

He says the ICB has funding for just 477 patients in cohort one, which is not a lot of people spread over the region. 

‘I’ve no idea how the service will work or how it will prioritise patients or who will provide the require wraparound support,’ he adds.

In Liverpool, LMC secretary Dr Rob Barnett says GPs have been asked not to prescribe tirzepatide until commissioning arrangements have been sorted. 

‘Cheshire and Merseyside ICB is currently discussing the commissioning arrangements with each Place in the ICB. 

‘The option is likely to be either a PCN, on behalf of probably all PCNs in a Place or an existing Tier 3 weight management service. 

‘I expect it will be a few weeks before this is sorted. It is very unfortunate that the press has given out information suggesting that it will be available, without being clear on the criteria stipulated by NHS England. 

‘For Liverpool, we have been told that there will be funding for approximately 250 patients in the current financial year, so not everyone who thinks they need it will qualify. I know that patients have been contacting practices regarding tirzepatide.’

It is the same in Lancashire and Cumbria, says LMCs chief executive Dr Adam Janjua.

‘In Lancashire and South Cumbria, they have told our GPs to not initiate for weight loss as there is no active LES in place and they are looking at various options.

‘Despite this GPs have been flooded with queries and this is putting a huge strain on GP resources including phone lines and appointments.’

In North East North Cumbria they are working on a LES proposal for practices to sign up to, he says.

But there has also been confusion about what happens with patients eligible for the drug because of type 2 diabetes.

‘Our view is that if there is a type 2 diabetes patient who has an uncontrolled level of HbA1c and they would be eligible for escalation of their medication regime with say a GLP-1 then they would be fine to have a GLP-1 started.

‘Weight loss is a desired side effect of the medication and will only be of benefit to the patient and the NHS.

‘Type 2 diabetes patients who may be obese but have a well-controlled HbA1c should not be started on GLP-1s at present as its not indicated,’ he added.

Three weeks before the planned rollout, Pulse could only find eight ICBs that could confirm which model they would be using to provide tirzepatide in primary care.

Other areas where there are no services in place yet include South Yorkshire where GPs are not able to prescribe until wraparound support is in place.

‘Tirzepatide for weight management is currently traffic lighted RED and will stay red until we have developed the appropriate primary care pathways and have the required wrap around support in place,’ a letter to practices from the ICB said.

‘Engagement with key stakeholders is commencing on the possible primary care models and we are also considering the knock on impact on other services.

‘We are mindful of the huge pressure that high patient expectations are already placing on primary care and also aware that the majority of patients will be disappointed as they will not meet the initial priority cohorts.’

Dr Peter Smye, medical director of Suffolk LMC confirms they are in the same boat as many places around the country.

In Suffolk and North East Essex, GPs have not been commissioned to provide tirzepatide for weight loss.

‘Instead, the local NHS has chosen a Community Outreach service model.

‘Access is only available through a specialist NHS weight management service. This is not currently operating at present,’ a message to practices from the LMC said.

Meanwhile, GPs in Kent and Medway, Mid and South Essex, Hampshire and the Isle of Wight, and Humber and North Yorkshire are also still waiting for services to be put in place.

For now, practices across the country continue to face a rising tide of patient demand, without the tools, funding or frameworks in place to meet it.

ICB Area	Rollout Status
Kent & Medway	GPs instructed not to prescribe. Awaiting BSOP service setup. No right-to-choose prescribing. National messaging described as ‘incredibly unhelpful’.
Essex	Initial access via Tier 3 only. Primary care rollout expected later in 2025. Practices told to manage expectations.
Cheshire & Merseyside	Prescribing paused. Commissioning arrangements under discussion. Model likely via PCNs or Tier 3 services.
Humber & North Yorkshire	Still finalising model and support. Patients told not to contact GPs/pharmacies yet.
South Yorkshire	Not yet live. Prescribing blocked until care pathways and support are in place.
South West London	Not yet available. Plans for general practice delivery via LES confirmed, but rollout not started.
Bedfordshire, Luton & Milton Keynes	Model is in place. Local arrangements active; referrals through community-based service.
Dorset	Rollout expected autumn 2025. ‘Please don’t contact your GP just yet as they’re unable to help currently.’
Nottingham & Nottinghamshire	Model is in place. Patients referred via established provider hub. Pathway operational.
Staffordshire & Stoke-on-Trent	Not yet available. Still developing Tier 3 service; no primary care access at present.
Suffolk & North East Essex	Not commissioned. Specialist outreach model planned but not operational. GPs not funded to prescribe.
North East & North Cumbria	LES proposal in development. Discussions ongoing; final model not yet confirmed.
North West London / Londonwide	Mixed availability. GPs advised that the drug may not yet be available in all areas.
Sussex	Not immediately available. Eligible patients will be contacted directly; GPs not initiating prescribing.
BANES, Swindon & Wiltshire	Working with primary care. GPs told not to prescribe; planning under way.
Surrey	Model in place. Service operating via specialist weight management, but not all eligible patients will have immediate access.

Source: Pulse research into the developing picture of weight-loss prescribing in primary care