Practices have been getting requests to review the notes for patients before the private provider prescribers weight loss drugs.
Tirzepatide & Semaglutide
These weight loss drugs are currently ‘Blue’ on the local formulary and can not be prescribed on the NHS.
A ‘Blue’ classification is for drugs where there has been new NICE guidance issued but this has not been worked thorugh locally into the necessary pathways, and therefore prescribing is not permitted until this is done.
In practical terms for general practice this is the same as a drug being ‘Black’ (or Red – hospital only) and GP’s should not be prescribing this drug for managing obesity.
In terms of requests from private providers
It is not your responsibility to check the medical record for a private provider. This is the responsibility of the prescriber.
The prescriber has a responsibility to ensure they have all the information they need to safely be able to prescribe the drug. If the private provider feel they need additional information to do this then they should ask the patient to provide a copy of their medical record (via the NSH App or a SAR request). The GP should not take on responsibility by checking the record for them.
The patient also has a responsibility to ensure the information they give the private provider is accurate.
That being said if you are aware of a reason why it would be unsafe for the patient to receive the medication (that the patient has a known eating disorder, or their weight is definitely not of a level that would indicate weight loss drugs were safe (i.e anorexic, bulimic)) or if you are aware that the patient has provided inaccurate information, then there is a general duty of care to the patient. In these situations we would suggest considering informing the provider and raising it with the patient either by booking a review with the patient / highlighting the issue to their specialist.
If they do prescribe then consider adding the drug to the clinical system as a drug being prescribed elsewhere so that any alerts and contraindications will come up for any medications you look to prescribe. If there are existing contraindications with medications you are already prescribing then you can let the patient know and they will need to consider which to stop.
Bear in mind that patients may not think to disclose that they are on the medication and in some situations it may be advisable to ask specifically if they are being prescribed any medications by other health providers/OTC/Online so that these can be take into consideration as part of your diagnostic differential.
Please find a draft letter to the left that you can utilise if you wish.
Background
Injectable weight loss management options and their prescribing in Primary Care (eg Semaglutide (Wegovy) and Tirzepatide (Mounjaro)
Injectable weight loss drugs have been brought to the UK market in the last few years including Semaglutide (Wegovy) launched in the UK on 4 September 2024 and Tirzepatide (Mounjaro) joining it a few months later. Both are available on the NHS as an option for weight management in line with NICE guidance, alongside a reduced-calorie diet and increased physical activity.
Patients are eligible for treatment within a specialist weight management service if they have a BMI of at least 35, or at least one weight-related comorbidity, such as hypertension or cardiovascular disease, and a BMI of 30 to 34.9, provided they meet the criteria for referral to specialist weight management services, including that conventional treatment has been unsuccessful. These guidelines may be different from area to area depending on local commissioning arrangements.
Semaglutide and Tirzepatide are injectable medications which are given once a week, and other options are likely to be released to the market over time. They can be delivered using a pen device normally used by the patient themselves.
NICE’s guidance on injectable weight loss drugs for managing obesity can be found here
Currently ICBs have strict prescribing criteria for injectable weight loss drugs and are mindful of potential cost implication.
Injectable weight loss drugs should not be prescribed in Primary Care
Useful links
BMA – General Practice responsbility in responding to private healthcare
MDU – Advice on disclosing information for patients’ weight loss medication
N&W ICB TAG Prescribing Guidance and Bulletin – Tirzepatide (please note their interpretation of your actions for private providers are different from ours and GPC’s if in doubt please check)