The BMA has set out advice for the time and costs for GPs in setting up locally commissioned services to provide tirzepatide (Mounjaro) weight loss injections on the NHS.
NICE interim commissioning guidance states that tirzepatide for weight loss must be implemented in primary care by 23 June 2025.
ICBs have been tasked with getting services in place for the rollout which will be supported by a centrally-funded, wrap-around digital support service of psychological, nutritional and exercise advice.
NHS England has set out plans for a phased rollout starting with those with a BMI ≥ 40 and at least four comorbidities before widening eligibility in subsequent years.
Earlier this month, Pulse exclusively revealed that many areas in England have not yet finalised plans for tirzepatide delivery in primary care, despite the NICE deadline looming.
And, in a primary care bulletin sent today, NHS England said ‘clinicians will need to await details from their ICB on the weight management pathway in the community’.
‘This will include pathways for prescribing as well as referring into a “wraparound’ offer”. Access routes and services will differ across each ICB.’
In advice to GPs, the BMA said the time commitment included six hours of training time, initiation and titration of the medicines, which requires monthly checks equating to 110 minutes per patient, and six-month and annual review of 20 minutes each.
Practices or local medical committees should take this into account when determining if an enhanced service offer is cost effective, the BMA said.
The guidance also contains a template letter for practices to push back against requests from private providers of weight loss medicines for patient information.
Indemnity providers have warned that GPs could be at medico-legal risk if they completely ignore requests from online prescribers.
It has been estimated that there are 1.5 million users of weight loss jabs in the UK, mostly through private providers.
It is recommended that private providers encourage patients to share their online records with them to obtain a full medical history, including observations, rather than requesting this information directly from the GP.
The letter notes that requests for medical information to enable private prescriptions of weight loss drugs is non-contractual work for which GPs do not have the capacity.
‘As per General Medical Council and General Pharmaceutical Council guidance, the responsibility for ensuring access to medical information and verification through examination, lies with the prescriber,’ it states.
‘We advise that you encourage your patient to share their on-line medical records with you in the interests of patient safety.
‘If they are unable to do this, they can request a printed medical summary from the practice, but this will be managed as a routine administrative task which we will complete when capacity allows.’
The letter also flags that women wishing to start a GLPI-1 agonist for weight management should be advised about interactions with hormonal contraception.
Practices may also wish to consider sending out a bulk text message to all women of childbearing age, ‘to highlight the importance of a medication review if they are started on GLP-1 analogues in the private sector’ and questions on this should also be part of HRT or contraception annual reviews, the BMA noted.
This issue was recently raised by the Medicines and Healthcare products Regulatory Agency who said women should be informed they will need to use effective contraception which in the case of tirzepatide includes condoms in addition to oral contraception they may be taking.
Any medications prescribed outside of the practice should be added to a patient’s medication record as an ’external prescription’, so that drug interactions and safety alerts may be triggered, the BMA added.
‘Tirzepatide represents a new therapy for weight management which can be delivered in primary care, but requires structured implementation, appropriate monitoring, and clarity around responsibilities.
‘GPs should engage in prescribing where clinically appropriate and safely resourced to do so,’ the BMA concluded.
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NICE and NHS seem confused about what is Primary Care, what is Secondary Care, and what is Contracted GP care.
GPs can refer any patient, regardless of BMI to the Secondary Care weight management service which will be centrally provided, acording to NHS, so is a secondary care service and not Primary Care.
The Clinician deciding must issue the prescriptions. If this is a digitally provided service, then a secondary care NHS doctor must issue AND SIGN those prescriptions. This is OUTSIDE the normal experience and clinical expertise of the average GP, hence the centralised service, and GPs do NOT have to sign prescriptions for this service.
Only fools would take this on, as patients are not going to, in the main, comply with the need to engage with the psychosocial aspects of the ‘pathway’, as shown by their interaction with the private system. They will be like the fat lazy glutton in the TV ad (I thought direct-to-patient advertising was illegal in UK??) who just wants to be entitled to get injections so that she can go on eating constantly, like she does in the TV video!
A genuine NHS scandal.
Several million would potentially benefit, with a modest but consistent reduction in risk of morbidity and mortality.
But the NHS plans are for a fraction of that number to be offered GLP 1 drugs.
How can anyone defend the NHS in the context of this huge failure?