Weight Management - Tirzapetide (Mounjaro) - DRAFT

Overview

***Update 13.6.25***

NICE guidelines (1) in December 2024 advised that Tirzapetide (Mounjaro) should be available in primary care for weight management and NHS England have been working towards implementation (provisionally for 23rd June 2025).

The BNSSG Weight Management Group (including representatives from BNSSG ICB, GPCB and Avon LMC) have been developing a LES so that this can be delivered locally in primary care.  There are several elements that need to be put in place before this can happen and the ICB are working to put the infrastructure required in place as quickly and as safely as possible.

Primary Care Delivery Model and offer to Practices (LES)

A delivery model and offer of a LES to practices has been supported by GPCB, LMC and the ICB Executive Team. The proposed model is shown below.

• Face-to-face appointments in green on initiation, at 6 months and at 12 months.
• Patient contact at weeks 4, 8, 12 and 16 shown in blue (do not need to be face-to-face).
• Wraparound care (WAC) touchpoints are shown in brown – see WAC details below. 

Model costs in primary care have been provided by OneCare colleagues and the proposed offer to practices, through the sign up to a Local Enhanced Service (LES), is:

• One-off payment of £500 per practice to allow for backfill for training and practice set up costs for Year 1 only.
• Payment of £230/patient/year for year 1 of treatment.

The LES will be offered to all Practices.

Wrap Around Care (WAC)

WAC is mandated by NICE alongside tirzapetide prescribing (1) and should encompass, nutrition and dietetic advice, physical activity and functional movement, behavioural support and lifestyle change tools.

NHSE have commissioned an interim WAC provider to allow systems to mobilise a weight management service in primary care through the NHSE Diabetes Prevention Programme (NDPP); in BNSSG this is Living Well Taking Control.

Patients will be provided with Behavioural Support for Obesity Prescribing (BSOP) accessed from primary care as a 9-month programme. Patients will be offered a choice of three delivery models:

1. Face to face group sessions – traditional format with peer interaction within community settings.
2. Remote digital groups sessions – live, interactive support via video conferencing.
3. Fully digital delivery – self guided App or wed-based model that allows flexible support.

A referral form is being developed with NHSE and NDPP which will be provided on this page once available.

It is hoped that WAC via Living Well Taking Control will be available by June 23rd, however there may be a slight delay, the ICB will keep practices informed and when service scan go live.

**Please note: Tirzepatide should not be prescribed for weight management until WAC can be offered. It should also not be offered if the patient does not agree to engage with WAC.**

Prescribing criteria

The primary care eligibility criteria for the NHSE cohort 1 in Year 1 are as follows*:

• BMI ≥ 40 and;
• 4 or more ‘qualifying’ comorbidities from the following list – hypertension, dyslipidaemia, obstructive sleep apnoea, cardiovascular disease, type 2 diabetes mellitus.

Use a lower BMI threshold (usually reduced by 2.5 kg/m2) for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds.

* NICE technology appraisal TA1026 recommends tirzapetide BMI ≥ 35 and 1 or more weight related comorbidities but the recommended implementation from NHSE for primary care at this stage is as above. Patients meeting the NICE TA criteria can be considered for referral to Tier 3 & 4 Weight Management Service - BNSSG , if appropriate.

Using EMIS coding it appears that there is a variation in the numbers of patients that meet the eligibility criteria for cohort 1 across PCNs. Estimated number of patients ranges between 1 and 14 pts/10,000 population depending on PCN.

Note that some of these patients may already be receiving treatment via other routes or criteria and this should continue.

The ICB will support Practices with searches for eligible patients.

GP IT template

NHSE have generated new SNOMED codes to capture tirzapetide implementation and an EMIS template is being developed.

Training

A live Teams webinar for Practices was run on Wednesday 11 June. This has been recorded and held will be held centrally by the ICB for Practices to access alongside other useful prescribing resources.

Practices will be paid to attend this session or view the webinar retrospectively. Details were circulated in the GP bulletin on 5.6.25.

Further update/Q&A sessions will be planned to support Practices.

Resources

Patient Information

NHSE have provided FAQs for patients and this can be found on the Joint Formulary Remedy website:

• Obesity (Remedy BNSSG ICB) - see link to Tirzepatide FAQs for patients.

There is also information on the NHSE website:

• NHS England » Weight management injections

References

(1) Tirzepatide for managing overweight and obesity | Guidance | NICE

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.