GPs told they cannot prescribe Mounjaro as several ICBs fail to finalise service in time

GP in many parts of England are having explain to eligible patients that tirzepatide (Mounjaro) cannot be prescribed in primary care yet, despite the NICE deadline having now passed.

Commissioning guidance stated that tirzepatide for weight loss must be implemented in primary care by Monday this week (23 June), but several ICBs have told 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’, and Londonwide LMCs told Pulse that it is working with commissioners to ‘understand local arrangements’.

A spokesperson for Londonwide LMCs told Pulse: ‘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 and dietetic advice as a minimum, as well as access to behavioural change components.

‘We are working with local commissioners in the five London ICBs to understand local arrangements and will continue to support practices as they deal with patient enquiries.’

Hampshire and Isle of Wight ICB said that the drug will not be available locally ‘until the autumn’, and added: ‘Please don’t contact your GP just yet as they’re unable to help currently.’

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.

In Sussex, the ICB told patients that the process will be managed through practices ‘directly contacting people who are eligible’, but that this does not mean that prescriptions will be given out immediately.  

And Bath and North East Somerset, Swindon and Wiltshire ICB stated it is ‘currently working with colleagues in primary care’ to ensure this new treatment is offered to those patients who fulfil this criteria.

‘At this time, patients are kindly asked not to contact their GP practice with requests for weight loss treatment,’ it added.

Pulse has contacted NHS England for comment.

Provision of the weekly injection in primary care was initially recommended by NICE last summer, but NHSE made a request for a slower, phased rollout of tirzepatide in order to avoid overwhelming GPs. 

NICE accepted this request in its final guidance, and instructed the national commissioner to ensure the drug is made available via specialist weight management services within three months, and via primary care within six months. 

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.