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Original poster

AIBU to question GP incentives for prescribing weight-loss drugs?

80 replies

NinaNinComPoop · 19/04/2026 07:25

And to ask what other prescribed medication awards GPs with financial incentives?

Beginning in April 2026, GPs in England will receive financial incentives, averaging £3,000 a year, to increase the prescription of weight-loss drugs, specifically Mounjaro (tirzepatide), to eligible patients. This move is part of a government initiative to accelerate the NHS rollout of these treatments to manage obesity, with up to £25 million in ring-fenced funding.
BBC +2
Key Aspects of the New Initiative:

  • Targeted Incentives: The bonus is intended to encourage GP practices to prescribe Mounjaro to those with the greatest clinical need, rather than just those who can afford private prescriptions.
  • Eligibility Restrictions: Despite the push, access remains restricted to specific groups. Initially, this includes patients with a BMI of 40 or higher (or 37.5 for certain ethnic groups) who also have at least four weight-related conditions. The eligibility threshold is expected to drop in 2026/27.
  • Concerns over Implementation: While aimed at improving access, some GP leaders and experts have voiced concerns that the incentives may not overcome the "stark divide" in access and could strain GP workloads.
  • Alternative Care Models: Amidst the focus on medication, some GPs are also expanding "social prescribing" to improve mental and physical health through non-clinical activities like community projects, which can in some cases reduce the need for medication.
  • BBC +5
The move follows a broader push to make weight-loss treatments "to the many, not the few," aiming to reduce the long-term health burdens on the NHS.
OP posts:
Original poster
NinaNinComPoop · 19/04/2026 10:14

Why would GPs want cash incentives knowing this?

Because Mounjaro (tirzepatide) is relatively new, its long-term safety profile beyond 72 weeks remains unknown, though it has a stable record in clinical trials. Known potential long-term risks include serious digestive issues (gastroparesis), gallbladder problems, pancreatitis, kidney injury from severe dehydration, and a possible increased risk of thyroid cancer (thyroid C-cell tumors).

Potential Long-Term Risks and Concerns:

  • Thyroid Cancer Concern: Animal studies indicated a risk of thyroid tumors, including medullary thyroid carcinoma; it is unknown if this occurs in humans.
  • Pancreatitis: A potential serious side effect causing severe stomach pain, which can be recurrent.
  • Gallbladder Disease: Increased risk of gallstones or inflammation, particularly due to rapid weight loss.
  • Stomach Paralysis (Gastroparesis):Mounjaro slows digestion, which may lead to severe, long-term gastroparesis.
  • Kidney Injury: Severe nausea, vomiting, and diarrhea can cause dehydration, potentially leading to acute kidney failure.
  • Weight Regain: Studies show that a significant majority of patients regain weight once they stop taking the medication, with one study showing 82% of participants regained at least a quarter of the weight they lost.

Key Considerations:

  • Safety Data Limitations: While 72-week studies showed efficacy with no new negative long-term safety signals, long-term effects beyond that period are not yet fully understood.
  • Management: Potential side effects often require consistent monitoring of blood pressure, kidney function, and blood sugar.
  • Contraindications: It should be avoided by those with a personal or family history of medullary thyroid cancer or serious digestive issues.
OP posts:
Original poster
NinaNinComPoop · 19/04/2026 10:10

MoneyJo · 19/04/2026 09:49

You misunderstand the situation.

I totally understand about rules for what GPs can prescribe and how that changes. I'm not stupid.

I also know that many GPs have had different views about WLI and have not prescribed them even when they could. Many GPs don't understand obesity.

Show quote history

They don’t know the long term effects of these medications which is scary too.

The BHF verdict states that More research is also needed to find out how weight-loss injections impact people’s risk of developing cardiovascular disease and their overall health if they take them long term.

OP posts:
dunroaminaroind · 19/04/2026 10:08

NinaNinComPoop · 19/04/2026 10:03

I’m very wary about taking medications and even more wary now.

Can you explain why?

Original poster
NinaNinComPoop · 19/04/2026 10:03

I’m very wary about taking medications and even more wary now.

OP posts:
Nowvoyager99 · 19/04/2026 09:51

But this is how it works for all medications! Why are you singling out WLI?

Shall we guess?

MoneyJo · 19/04/2026 09:49

jacks11 · 19/04/2026 09:03

You misunderstand the situation- it has never been the case of GP’s being reluctant to prescribe weight loss medication. The fact is that they have not been allowed to prescribe these medications in non-diabetic patients as there was no NHS funding for it. They were specifically prohibited from prescribing it on an NHS prescription other than as treatment for diabetes (and in some other conditions- not related as a route to weight loss- when advised by a specialist).

it is still going to have inclusion criteria for prescription, as currently the NHS budget would struggle to meet the costs if everyone with a raised BMI became eligible for NHs funded weight treatment with these medications.

Show quote history

You misunderstand the situation.

I totally understand about rules for what GPs can prescribe and how that changes. I'm not stupid.

I also know that many GPs have had different views about WLI and have not prescribed them even when they could. Many GPs don't understand obesity.

jacks11 · 19/04/2026 09:03

MoneyJo · 19/04/2026 08:19

Excellent move. It will help tackle the huge problem of obesity and save more money in the long term.

Hopefully it will also make GPs who have been reluctant to prescribe the WLI a bit more willing to reconsider.

You misunderstand the situation- it has never been the case of GP’s being reluctant to prescribe weight loss medication. The fact is that they have not been allowed to prescribe these medications in non-diabetic patients as there was no NHS funding for it. They were specifically prohibited from prescribing it on an NHS prescription other than as treatment for diabetes (and in some other conditions- not related as a route to weight loss- when advised by a specialist).

it is still going to have inclusion criteria for prescription, as currently the NHS budget would struggle to meet the costs if everyone with a raised BMI became eligible for NHs funded weight treatment with these medications.

aredrosegrewup · 19/04/2026 08:27

Greengagesnfennel · 19/04/2026 08:12

Yabu
This sounds like a worthy initiative to try to get the medicine to those who need it. Rather than it being used by those who can afford it as a lifestyle drug.

The majority of people who can afford it are not using it as a lifestyle drug. Would you like an example? I'm using it in order to start IVF (my weight is not the cause of infertility). It is being used as a tool to lose weight for a multitude of health concern reasons. Please educate yourself. My mental health took a massive hit after my 3rd pregnancy loss and I need a bit of help. Is that reason enough? Or would you class that as a lifestyle use?

aredrosegrewup · 19/04/2026 08:23

What's your incentive to post this OP? Are you against overweight people taking the opportunity to get control back over their weight and health? Why are you only questioning WLI's? We could provide a list of all the other treatments GP's provide through the same processes.

Binus · 19/04/2026 08:21

MoneyJo · 19/04/2026 08:19

Excellent move. It will help tackle the huge problem of obesity and save more money in the long term.

Hopefully it will also make GPs who have been reluctant to prescribe the WLI a bit more willing to reconsider.

Fingers crossed!

MoneyJo · 19/04/2026 08:19

Excellent move. It will help tackle the huge problem of obesity and save more money in the long term.

Hopefully it will also make GPs who have been reluctant to prescribe the WLI a bit more willing to reconsider.

BadSkiingMum · 19/04/2026 08:17

I think that sounds like quite good news, rather than people having to go through Tier 3 weight-loss services, which are often miles away.

Not eligible myself due to BMI but I have watched many of the documentaries about weight loss injections.

youalright · 19/04/2026 08:17

Binus · 19/04/2026 08:09

Well, hopefully OP has learned something about how primary care is funded today!

You would think someone would learn about a subject before posting about it

PrizedPickledPopcorn · 19/04/2026 08:16

ManyATrueWord · 19/04/2026 08:02

Given you have to have four related conditions it's still a very high threshold. I can only muster up being fat so nowhere near qualifying.

Frustrating, isn’t it? I know my health would improve significantly, but those signifiers aren’t the ones they look at. My blood pressure, heart, blood sugar etc all seem to be ok. I’m hanging on for the wider roll out and hoping nothing breaks too badly while I wait!

Greengagesnfennel · 19/04/2026 08:12

Yabu
This sounds like a worthy initiative to try to get the medicine to those who need it. Rather than it being used by those who can afford it as a lifestyle drug.

Binus · 19/04/2026 08:09

Well, hopefully OP has learned something about how primary care is funded today!

PlumPlumb · 19/04/2026 08:05

Now ask Chat GPT about how GPs are incentivised to fit mirena coils, do age related health checks, offer flu vaccines and do smear tests and see what it churns out.

This is how GP practices are paid by the NHS!!!

youalright · 19/04/2026 08:04

VillageMilton · 19/04/2026 07:27

This is literally how Primary Care funding works, OP. All of it.

First post nails it.

Twasasurprise · 19/04/2026 08:03

Yes, YABU. Why no vote?

ManyATrueWord · 19/04/2026 08:02

Given you have to have four related conditions it's still a very high threshold. I can only muster up being fat so nowhere near qualifying.

Boomer55 · 19/04/2026 07:59

GPs get extra money for all sorts of things. They are now business’s and obviously want extra money where possible.

But, it’s up to individuals whether they choose to take certain meds etc. 🤷‍♀️

PermanentTemporary · 19/04/2026 07:58

You’re objecting to GPs being paid for work done?

Do you know what a BMI of 40 plus looks like?

Do you know how much it costs to treat ONE person who has had a stroke effectively, even quite a minor one? And how much it might save us as a country to reduce the number of strokes people have?

For some reason the idea that changing the NHS funding model would solve problems inherent in having health services is gaining traction. This is one example of this country’s ability to identify a health issue coming down the tracks and actually do something about it. Nationally. For everyone, whether they could pay for this out of disposable income or not. Because we have a national network of experienced general physicians out in the community who, given a chance, can build relationships with people and do things to improve their health.

Whyhaveibeencutoutofmamsnot · 19/04/2026 07:57

Don't forget most GP practices like dentists, pharmacies and opticians are private businesses with NHS contracts. They are keen to do the extras as will get paid on treating a certain number.

WonsWoo · 19/04/2026 07:53

Just echoing that this is literally how GP funding works. The government wants them to do extra work, it needs to be resourced.

jacks11 · 19/04/2026 07:50

WutheringTights · 19/04/2026 07:31

Prescribing WLIs require GPs to do more work, eg additional appointments, monitoring etc. So under the current funding model they need to be paid for the additional resources required. Otherwise they would need to cut other services to free up resource.

Exactly this. If you wish gp’s to take on additional work, they will have to be allocated the funding to do it- or allow them to reduce/stop other responsibilities. As this would fall outside the remit of the current GMS contract, it is not unreasonable to expect gp’s to be funded for it.

The rules which are to be applied to these new plans means it is not simply a case of gp seeing a patient once and prescribing the drug on repeat thereafter- there is going to have to be additional monitoring of progress and support with weight loss. In the case of patients with some other health conditions, these other conditions are going to require more intensive monitoring too. I doubt the funding is going to allow any significant profit for the practices, especially with rising costs they are currently facing. They won’t be raking it in by prescribing weight loss drugs.