GPs ‘pressured’ into prescribing weight-loss drugs without ICB-commissioned services

GP practices across England are being ‘pressured’ into prescribing and monitoring weight-loss drugs without locally commissioned services, leaders have warned.

The BMA’s GP committee said that ICBs across the country are withdrawing locally commissioned services for prescribing and monitoring of tirzepatide, using the introduction of new QOF obesity indicators as an alternative form of provision.

In areas where the services are not commissioned, several LMCs also raised concerns that GPs are being ‘pressured’ into prescribing and monitoring the drug.

NHS England guidance from last year, when the phased NHS roll-out of the drug began, said that ICBs must meet the costs of funding access to the weight-loss injections in primary care settings, as per the NICE recommendation – but GPs raised concerns that ICBs have been slow to set up prescribing pathways. 

And this year’s GP contract saw weight-loss drug prescribing added to QOF, with GPs becoming eligible for up to 18 QOF points under new indicators for taking part in obesity management.

GPC England said that when the QOF points were introduced, it raised concerns that this would ‘likely impact’ the locally commissioned services, as ICBs ‘may look to utilise these indicators as an alternative form of provision’, allowing them to cut commissioning costs.

It added that ‘LMC intelligence’ has indicated that this has now happened in ‘several ICB footprints’ and the number is ‘growing’.

In a message to GPs, the GPC said: ‘We are extremely disappointed by reports from across England that ICBs have withdrawn locally commissioned services for prescribing and monitoring of tirzepatide following the introduction of these indicators, which we repeatedly highlighted and cited as a concern and possibility during the 2026/27 contract consultation on the proposed changes.

‘We have written to NHS England to raise these concerns and are continuing to discuss the situation.’

It added that QOF is voluntary rather than contractual and recommended that practices should ‘consider whether it is financially viable’ for practices to deliver the voluntary QOF indicator incentive target OB005.

Their guidance said: ‘Where you determine it is not financially viable, GPCE recommends that practices do not overtly attempt to chase the points available for QOF indicator OB005 and calls for NHS England to ensure that a properly costed and commissioned service is available in every ICB area to resource the associated workload.’

Leicester, Leicestershire and Rutland LMC said that its local ICB suggested they could ‘mandate general practices to prescribe’, however the LMC stressed that there is no contractual or other requirement for practices to provide any specific service, that it is a decision to be made by the practice.

It said: ‘We have previously made it clear to the ICB that if they do not commission a service from general practice, they cannot expect practices to prescribe tirzepatide for obesity.

‘Practices can choose to prescribe tirzepatide, but they would be doing so at the cost to the practice and only by diverting funds from other areas. The ICB have referred to the new QOF points.

‘One of the initial and enduring principles [of QOF] has been that practices can except patients when a local service is not being commissioned.

‘As a local service is not commissioned locally, it would seem appropriate for practices to exception report for these indicators.’

In North East London, the LMC also stressed that practices ‘should not feel pressured to deliver a service they are not commissioned to deliver’.

It said: ‘NEL LMCs are concerned about the developing position on weight management, GLP-1 prescribing and QOF. Practices may see QOF indicators linked to obesity and prescribing, but QOF is a voluntary incentive scheme and does not itself fund the clinical workload required to deliver a safe prescribing pathway.

‘The issue is broader than issuing a prescription. Safe weight management prescribing may require eligibility checks, monitoring, dose escalation, side-effect management, ongoing review and appropriate wraparound care.

‘There is also concern that secondary care may recommend medication and ask GPs to “do the necessary”, even where patients do not meet primary care criteria or where no local commissioned support exists.’

Pulse has contacted LLR and NEL ICBs for comment.

An NHS spokesperson said: ‘NHS England has issued clear guidance to support the rollout of tirzepatide for obesity and diabetes in line with NICE’s recommendations. 

‘Local systems have been given flexibility to choose from a range of implementation models to ensure services meet the needs of their patients, and NHS England is supporting them to deliver this with funding included in ICBs allocations.’

An investigation by Pulse’s sister title The Pharmacist revealed that some ICBs are imposing their own thresholds for prescribing tirzepatide through primary care that go further than the national thresholds.

MPs recently heard evidence collected by Pulse that weight-loss jabs are significantly adding to GP workload in a hearing of the Health and Social Care Committee on food and weight management.