Weight Loss Injection Prescribing Prescriptions for Primary Care
We appreciate the frustration of those who would like to access GLP1s for weight loss on the NHS. Due to financial constraints of the NHS, despite NICE guidelines, the NHS then has to adapt guidance to fit the funding available so you may not be able to access GLP1 on the NHS. You can access free weight loss support on the NHS here: Free Weight Loss Service | One You Surrey You can access support for the whole family, particularly thinking about helping children who may weigh a bit more than they should here Be Your Best Surrey
These guidelines are due review in June 2025 but the guidance for your GPs on prescribing can be found here: Profile : Tirzepatide - Weight management in adults
A patient information leaflet has been created by Surrey Heartlands here: Tirzepatide for overweight & obesity - Information for patients - April 2025.pdf
We are aware that many patients are chosing to access Mounjaro and Wegovy privately. Such prescriptions remain the responsibility of the prescriber but we would like to raise awareness that it is important that all those who are at risk of becoming pregnant must ensure they are using reliable contraception as there are concerns that these drugs can harm a developing pregnancy.
There have been alerts produced for those on oral contraception or oral progesterone as part of their HRT that Mounjaro and Wegovy can reduce effectiveness of their medication so could put you AT RISK OF PREGNANCY.
Those on oral contraception should consider switching to an intrauterine method of contraception (e.g Mirena / copper IUD) / Nexplanon. Depo can be used but can be associated with weight gain so may not be wished in this instance. Patient-information-GLP-1-agonists-and-contraception.pdf
Those on an oral progesterone for HRT should switch to mirena IUS ideally, especially as we know that those who are living with obesity are at higher risk of endometrial cancer and mirena is very effective at protecting the lining of the womb from this. Other options for HRT include switching to a combined/sequential patch or, off licence, taking the micronised progesterone, at the same dose, via vagina rather than orally. Nexplanon is not used for endometrial protection for HRT. HRT does not protect you against pregnancy so contraception is needed if you are under 55. 23-BMS-TfC-Use-of-incretin-based-therapies-APRIL2025-C.pdf
We insert intrauterine contraception and nexplanons at the surgery. We offer local anaesthetic for all our intrauterine insertions in a supportive environment.
Side effects on Mounjaro commonly include nausea, constipation and diarrhoea, indigestion, vomiting, headache, loss of hair and dizziness. Rarer side effects include gallbladder disease, pancreatitis, cardiovascular events, liver problems, cancer, kidney issues and changes to the mood. It is important that if you are unwell and are taking any privately prescribed medication, you inform your clinician so that they can consider if that could impact their diagnosis and ensure you get the care you need.
The following is the patient information leaflet from Surrey Heartlands ICB to outline their rules that we must abide by regarding Mounjaro/Wegovy prescribing and referrals.
Information for Patients
Surrey Heartlands Integrated Care Board (ICB) in line with National Institute for Care and Excellence (NICE)
and NHS England guidance is working towards ensuring we have a sustainable and equitable weight
management programme in place across our local area.
As part of this work tirzepatide, also known as Mounjaro will be available to people who are within the highest
risk group and who have been assessed in line with national criteria to have the most urgent clinical need.
Initially, from the end of March 2025, individuals can be referred to the specialist weight management service
at Ashford & St Peter’s Hospitals NHS Foundation Trust (ASPH) providing they meet the criteria set out
below. The team at ASPH will be able to discuss treatment options available such as bariatric surgery and
medical options, including tirzepatide for weight loss. GPs and health care professionals in primary care will
currently not be able to prescribe tirzepatide.
People who meet the criteria will have the following:
A Body Mass Index (BMI) of 35 kg/m2 or above (-2.5 kg/m2 for ethnic minorities) and one of the following:
• Precancerous or cancerous condition in which weight loss would aid access to therapies
• Patients requiring urgent weight loss for organ transplant
• Idiopathic intracranial hypertension (IIH) requiring frequent lumbar punctures under neurology
specialist and/or with visual compromise
• Patients awaiting surgery for life limiting conditions, where high BMI is the primary barrier to surgery and
weight loss would be beneficial
• Weight loss required for assisted conception in women currently not eligible for fertility treatment and
have been advised to lose weight
• Proven genetic cause of obesity and not eligible for setmelanotide (Imcivree®)
• Severe Obstructive Sleep Apnoea
As work progresses around the establishment of our weight management programme, including establishing a
service delivering care in the primary care setting from the end of June 2025, the criteria will be reviewed and
updated. NHS England has advised that in the first year individuals with the most urgent clinical need to be
prioritised for treatment in primary care as detailed below:
- BMI ≥40 and ≥ 4 qualifying comorbidities:
- Atherosclerotic Cardiovascular disease: Ischaemic Heart Disease, cerebrovascular disease,
peripheral vascular disease, heart failure
- Hypertension: established diagnosis of hypertension and requiring BP lowering therapy
- Dyslipidaemia: treated with lipid lowering therapy or with LDL ≥4.1mmol/L or HDL <1.0mmol/L
for men or HDL <1.3mmol/L for women, or fasting TG ≥1.7mmol/L
- Obstructive sleep apnoea (OSA): established diagnosis of OSA (sleep clinic confirmation via
sleep study) and treatment indicated
- Type 2 diabetes mellitus (T2DM): established T2DM