Mounjaro primary care plans not yet finalised despite looming deadline

Exclusive Many areas in England have not yet finalised plans for tirzepatide (Mounjaro) delivery in primary care, despite the NICE deadline being less than three weeks away.

In response to a Pulse request to all 42 ICBs, only eight areas could confirm which model they will use to implement the NICE recommendation for tirzepatide prescribing in primary care. 

A further eight ICBs are still developing their plans, with one ICB saying it will not meet the NICE deadline due to delays with NHS England’s ‘wraparound service’. The remaining 26 areas did not respond at all. 

GPs have also raised concerns about the increasing demand on practices due to patient queries about Mounjaro, despite the fact it is not yet available in primary care.

Around 220,000 patients will be eligible for the weight-loss injections in primary care over the first three years, and NICE agreed to a phased approach to implementation following concerns from NHS England that the initial recommendation would have overwhelmed general practice.

At the end of March, NHS England set out ‘interim commissioning guidance’ which stipulated that ICBs must meet the costs of funding access to the weight-loss injections in primary care settings from 23 June, as per the NICE recommendation.

The national commissioner set out the criteria for determining eligible patients in the first three years, as well as the four possible models for delivery, which included general practice.

It also clarified that NHS England will be responsible for providing ‘centrally funded wraparound care services’, which NICE said is essential alongside the weight-loss injections.

NHSE told Pulse that local systems ‘have been given flexibility to choose from a range of implementation models’ and that the set up for primary care Mounjaro prescribing will vary across the country. 

Of the eight ICBs that confirmed their delivery model, three told Pulse that GP practices will be involved (see table).

Surrey Heartlands and South West London ICBs said GP practices will be funded to provide the drug via a locally commissioned service. Meanwhile, Staffordshire and Stoke-on-Trent said it will take a ‘community, GP-led’ approach, but could not confirm if practices will be funded. 

The ICB areas where local commissioners said they had not yet finalised plans included:

• South East London
• Shropshire, Telford and Wrekin
• North East and North Cumbria
• Humber and North Yorkshire
• Hertfordshire and West Essex
• Derby and Derbyshire
• Black Country
• North West London

South East London ICB told Pulse it is still working through the primary care pathway, but expects to implement a ‘community/ local based model’ with some support provided by specialist weight management services. This means initiation and stabilisation of Mounjaro will not happen at individual GP practice level. 

However, local commissioners in SEL said: ‘We do not expect to meet the June 23 timeline, in part because we don’t believe the national NHSE-commissioned wraparound service will be available at that time and that is crucial for supporting any Primary Care pathway.’ 

Many areas had not yet decided whether GP practices will be funded for involvement in Mounjaro delivery. North East and North Cumbria ICB said it is ‘in active discussions with the Local Medical Committee’ but is ‘not ready to share any plans’ at this stage.

All ICBs have received a funding allocation from NHS England which is based on both the drug costs and the expected workload of setting up the new service within primary. 

Medical secretary for Mid Mersey LMC Dr Ivan Camphor said that in his area ‘nobody’s really sure how it will work’ in primary care. Cheshire and Merseyside ICB did not respond to Pulse’s request.

But he said he is currently dealing with patients coming to the practice who have been prescribed Mounjaro by pharmacies.

He told Pulse: ‘Patients are coming in and telling us that they’re on Mounjaro, and we’re not really getting any information from the pharmacists about the drug itself. 

‘It’s a bit of a disaster really, because the advice given nationally is “it is available, the pharmacists can prescribe it”, but general practice can’t prescribe it because we don’t have the dietary, overarching service around it to sustain it.’

Dr Camphor also said he is not aware that there is ‘any specific funding available’ for GP practices to take on tirzepatide prescribing, warning that it would be ‘nigh on impossible to provide’ without funding. 

‘In June it will be available and we need to get our act together to figure out how this is going to be available, because there certainly is a huge demand for it from patients everywhere, and a huge amount of interest,’ he added.

Similarly, Greater Manchester ICB did not provide a response to Pulse, and the LMC confirmed that the model for Mounjaro primary care delivery has not yet been finalised. 

Association of Greater Manchester LMCs chair Dr Amir Hannan said the ICB is ‘working through the numbers of people’ that would qualify for the injections and ‘making sure there’s enough capacity in the system’. 

He told Pulse: ‘I think it is massively up in the air. There are certain [ICB] areas that have said that they’re going to provide payment for the actual delivery of the service. 

‘Greater Manchester hasn’t yet announced whether there is going to be a payment or not. They have to deliver a service, they just have to work out what the best way is of actually delivering it. So I’ve not got clarity in terms of what it will be.’

Despite having less than three weeks to prepare for the implementation, Dr Hannan pointed out that a ‘much, much bigger problem’ is the national press coverage of Mounjaro which has told patients they can soon get hold of the injections.

‘The consequence of that, the bigger impact for us, is that lots of patients are then contacting GP surgeries asking for Mounjaro injections, and that’s putting added pressure on a system that’s already pressured, because clearly we’re still waiting for guidance. So that’s the bigger challenge we’ve got at the moment.’ 

Dr Hannan said he would be open to GP practices delivering the drug, but that there should be a central system for informing patients about Mounjaro and its eligibility, rather than practices taking this on. 

‘We can’t have the public constantly ringing the surgeries to say “we want Mounjaro” because all of our appointments will just get filled with explaining to people what the criteria is,’ he told Pulse. 

A spokesperson for NHS England said: ‘NHS England has issued clear guidance to support the rollout of tirzepatide (Mounjaro) for obesity in line with NICE’s recommendations, which require access from 23 June.

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

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. 

A recent study warned that weight-loss drugs cannot be seen as short-term solutions by the NHS, and GPs will inevitably need to engage with obesity management as the medicines are rolled out. 

Last month, the Tony Blair Institute concluded that the rollout of weight-loss drugs in England could be dramatically sped up by making use of existing private providers and a ‘digital first’ approach.