Weight Management Medication in Primary Care

Background

NHS England and NICE have approved the use of tirzepatide (Mounjaro®) for weight management. When this was first introduced in 2025, responsibility for assessment, prescribing, and ongoing monitoring sat with specialist weight management services. General practice was primarily involved in identifying and referring eligible patients.

Current Position and Key Change

For 2026/27, this position has changed significantly following the introduction of new QOF indicators and associated commissioning decisions.

This guidance follows communication from local weight management services, advising that they will no longer be prescribing tirzepatide (Mounjaro) to eligible patients and that prescribing responsibility is being transferred to general practice.

QOF Requirements

This change follows the introduction of the new QOF indicators for 2026/27, in particular OB005:

Percentage of eligible patients (as defined by NICE TA1026 Funding Variation cohorts, accounting for ethnicity and comorbidity status) who have a recorded shared decision-making discussion about the management of obesity and are offered NICE-approved pharmacotherapy for use in a primary care setting, alongside referral to a suitable behavioural support programme, within the preceding 12 months.

Alongside this, OB004 requires practices to identify patients living with obesity and refer them to an appropriate weight management service within 90 days of BMI recording, reinforcing the broader shift of obesity management into primary care.

Whilst OB005 does not explicitly require practices to issue prescriptions, it has been widely interpreted nationally by many ICBs as indicating that funding and responsibility now sit within primary care via QOF. This has led to commissioning decisions across England in line with the position now being seen locally.

Local Arrangements (Cambridgeshire & Peterborough)

We have been in discussion with Central East ICB colleagues and have highlighted the potential for this to create significant workload pressures for practices, both in terms of managing eligible patients requiring prescribing and responding to enquiries from those who do not meet the criteria. We have also asked for clearer communication to both practices and patients to support consistent implementation.

At the time of writing, the local formulary has been updated to permit prescribing of tirzepatide in primary care for a defined cohort of patients. This represents a clear shift from previous arrangements, where prescribing and monitoring were undertaken by specialist weight management services such as Healthy You.

Eligibility criteria

• BMI of 35kg/m2 or more (reduced by 2.5kg/m2 for people with South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds) AND at least 4 of the following 5 qualifying co-morbidities:
• Established atherosclerotic cardiovascular disease.
• Hypertension requiring treatment
• Dyslipidaemia treated with lipid-lowering therapy, or with low-density lipoprotein (LDL) ≥ 4.1 mmol/L, or high-density lipoprotein (HDL) <1.0 mmol/L for men or HDL<1.3 mmol/L for women, or fasting (where possible) triglycerides ≥1.7 mmol/L.
• Obstructive sleep apnoea (sleep clinic confirmed) meeting criteria for continuous positive airways pressure.
• Established type 2 diabetes mellitus.
• All patients prescribed weight management pharmacotherapy by General Practice must be referred to the nationally procured “The Healthier You: NHS Behavioural Support for Obesity Prescribing” service (BSOP) (9-month programme; digital, remote, or face to face).

Prescribing Responsibilities

Where practices choose to prescribe, they will assume full clinical responsibility for treatment. This includes confirming eligibility, undertaking and documenting shared decision-making, initiating and titrating treatment safely, and providing ongoing monitoring and review. Practices will also need to manage side effects, consider interactions, and assess treatment response, with discontinuation where appropriate (for example, where less than 5% weight loss has been achieved after six months on the maximum tolerated dose). Tirzepatide should not be prescribed for patients who do not meet the eligibility criteria.

Behavioural Support Requirement

A key requirement of prescribing is that all patients must be referred to the nationally procured “The Healthier You: NHS Behavioural Support for Obesity Prescribing” (BSOP) service. This is a structured nine-month programme, delivered digitally, remotely, or face-to-face. For Cambridgeshire and Peterborough, the local provider is Thrive Tribe. Engagement with this service is a core part of the pathway; where a patient declines to participate or does not complete the programme, treatment should be discontinued.

Role of Specialist Services

This represents a significant change from previous pathways. Under earlier arrangements, patients were referred to specialist services for assessment, prescribing, and monitoring. Under the current model, specialist services are no longer routinely prescribing, and primary care is expected to take on a more central role in both pharmacological and non-pharmacological management.

LMC view

We would remind practices that QOF participation remains voluntary, and the formulary change does not constitute a direction to prescribe. Practices may prescribe for eligible patients where this is clinically appropriate and where they have the capacity and systems in place to do so safely. Equally, practices may decide not to prescribe, based on workload, safety considerations, or the absence of commissioned service support.

Our view is that this represents an unprecedented use of the QOF framework to introduce a new area of clinical responsibility into general practice. We have advised that a locally commissioned enhanced service would have been a more appropriate mechanism to support delivery. However, we recognise that this is a nationally driven decision.

Practices may wish to ensure a consistent internal approach to these requests, with clear communication to patients, particularly where patients do not meet eligibility criteria or where the practice has taken a decision not to prescribe. LMC resources, including template communications, are available to support this.

We will continue to engage in both local and national discussions and will keep practices informed as the position evolves. Please contact office@cambslmc.org if you are encountering any issues or would like further support.