WWYD? - GP response to Mounjaro

[wanttoimprovemyhealth]

I have type 2 diabetes, high blood pressure and am overweight. Life has been stressful over the past few years and i have let my health slide (all my fault- focusing on other things). I know I need to get a grip.

Since January I have been watching what I eat and am trying to sort out my medication. I am also interested in trying Mounjaro, paying privately (I can't afford to take time off work to attend lots of NHS appointments). As a diabetic I thought I should check with my GP first. Have been trying to get an appointment for weeks- finally got one today and she said she doesn't know anything about Mounjaro, the side effects and as such said I should not try it. She said she would normally advise me to speak to the pharmacist to find out about counter indications etc but they are on maternity leave.

I feel quite deflated my her response. I have read lots of reviews and it seems that it could potentially be very beneficial for someone in my circumstances. Unfortunately there are no other GPs available to speak to in the practice for another opinion and she also runs the other local NHS practice. Just not sure where to go from here. Wondered if anyone else had experienced anything similar with their GP and what they did? Thank you.

Right so because she can’t be arsed to educate herself on a new drug, her advice is don’t try it? That’s terrible and I suggest that you contact one of the online providers instead. Some of them offer consultations with the pharmacist and you can ask questions of them before being prescribed the medication. Honestly I’d leave the GP out of it - she seems to know precisely nothing about it and therefore it’s like asking Dave from the pub whether you should take it or not. Speak to the experts. Alternatively, if you do want to speak to a doctor, I know there are private GPs who prescribe it but personally I’d just go straight to the provider unless you have any conditions that are contraindicated such as pancreatitis or gallstones.

That's terrible - I would also talk to one of the prescribers. You sound like exactly the kind of person whose life and health could be transformed. Very poor effort by the GP.

Tbf to the GP they aren’t trained to prescribe mounjaro yet, they are supposed to refer to a specialist - which the OP doesn’t want. It would be worse if the GP had given an uninformed opinion and the OP had ordered online and had problems.

I am also interested in trying Mounjaro, paying privately

So you need to speak to a private prescriber. You cannot expect the GP to be involved in making recommendations for a drug you intend to get elsewhere. It would be negligent of them to say you should do this whilst not under their care. Whoever you choose to get it from is who you much discuss your medical needs with.

The GP doesn't prescribe the medication, why would she be offering advice on it? Most of those who do get it the NHS have been through weight management programmes. Including diabetics.

Have you progressed through the weight management programme @wanttoimprovemyhealth ? Are you on semaglutide?

When you order online you give your medical history and current medication which is then reviewed and any potential problems identified. The online pharmacy will then ask for more information, and/or to discuss it with you, or they may decide not to prescribe.

You might get a decent response from one of the smaller pharmacies that offer a more custom approach such as Oushk who do consultations with the pharmacist if necessary, I think. [I am not a customer of theirs but I have seen this discussed many times on here]

I figured that it would be a similar response from my gp so I didn't bother. It is poor but I imagine they feel they are too busy to get involved with what is essentially going to be a private prescription. It has put me off the drugs as I would prefer to have the input of someone independent of the companies who are selling the medication. However it is what it is. I think if you really want to do it I would go to one of the well known pharmacies that offer it like Boots.

As a T2 diabetic my GP is not my go to person for questions relating to diabetes, that would be the diabetic nurse that does my annual review. Who does your annual review and can you speak to that person?
You can also speak to the prescriber who you get MJ from. I went with Oushk and they were great. Very knowledgeable IME

When are you next due to see your diabetes nurse? They will definitely be experienced in patients on Mounjaro or similar drugs.

You may be eligible for it on the NHS for control of your diabetes, however if you have already made a massive effort with your diabetes and got your HbA1C down you may now be ineligible.

My practice doesn't have a dedicated diabetes nurse- just a normal nurse. Last time I saw her she wasn't very familiar with the latest thinking for example, she recommended a diet that is high in carbs whereas I know my blood sugars go high if I eat a lot of carbs (even of they are brown or wholemeal).

Looking at the NICE guidance I think I may be eligible through the NHS but , given the waiting list all the hurdles/appointments, getting time off work etc, I would prefer the convenience of having it prescribed privately.

I suppose I just really wanted advice from my GP re how it may impact with my existing medications/health issues and if it did work I suppose they may need to reduce some of the medication I am currently on? So it seemed helpful for them to be onside? Im not really sure what to do now - I do want to take responsibility for improving my health but, given past attempts to diet have failed, I know the chances of me managing to eat a perfect diet (without some help) are probably not great? That's why I thought Mounjaro might help? Not sure what I should do now... Just wondered if anyone else had experienced anything similar? Thank you.

If you lost weight without using Mounjaro, and your health improved you would possibly then think about contacting your GP to review the medication that you're on. The same would be true if you took Mounjaro to lose the weight. So, the outcome is the same either way, and it should be much easier to lose the weight when taking Mounjaro than without.

Are you on medication for the diabetes, or only for the high blood pressure?

If she's the nurse that does the diabetes clinic she has had extra training in diabetes.

So if you see her clutching the NICE guidance and explain 'I think I should be on a GLP 1 drug because of x, y and z' see what she says.

Your prescriber asks for all medical information. They make the decision, however I get your point, and it seems a lot of gp’s do this.

i was lucky, mine recommended it when I asked, said they’d had huge success with these drugs for diabetes, said she wished she was allowed to prescribe, and that she would monitor me, because even though she wasn’t supposed to, I was still her patient.

for some reason some gp’s are really cunty about it, I suspect they are sick of being asked, but that should be irrelevant. If they can’t cope with the questions they should try a new career. Your gp knows full well these drugs could be helpful to you, she just doesn’t know for sure.

personally I’d go for it privately, keep monitoring my blood sugar, and ask for a medication review based on that when you’ve lost weight.

Your GP gave you the only response that she could given that she does not have direct professional knowledge of the drug or its interactions with your other medications. It’s deflating but sadly we live in a litigious society and she has to give the most risk-averse advice. GPs have to keep across a huge range of constantly changing medical advice and they can’t be expert in everything. She was correct to say that a pharmacist would likely be more knowledgeable on the matter. Surely there is another pharmacist available covering her maternity leave?

Thank you. I am on Metformin for the diabetes and Ramipril for the blood pressure. My BMI is 32.5 (the highest I have ever been!). I need to get a grip of it all, but to be successful I think I probably need help (eg Mounjaro).

When I have lost weight in the past (through diet and exercise) I have found that I can quickly feel a bit light headed/unwell as the medication needs changing but its very difficult to get to see a GP. I had hoped that if they had agreed to my taking Mounjaro they might be more reactive/even agree that should my readings fall then I can reduce the amount of medication I am on. Unfortunately it doesn't look like that will be possible.

I called the practice about when a pharmacist may be available. They said one is on maternity leave and the other is on a long term vacation. Apparently the service isn't provided by them - they are going to email the private company to find out if cover can be provided. In the meantime they said to call each morning to see if and when new pharmacy arrangements are being put in place.

In the nearly two months I have been waiting to see a GP I have spoken to the local chemist but they said I need to speak to my GP. its all bit frustrating. Im going to have think. I did hope my GP might be a bit more helpful - we have a family history of medical problems so I was keen to get them onside. A bit tricky...

Just contact the private pharmacy you would be ordering from, this isn't really a matter for your NHS practice

What do you think your GP can add that a private prescriber can’t? As long as you give a completely full medical history and details of all current medication, the prescriber will know just as much about you as your GP does, but will also know a lot about Mounjaro. I’m not really seeing the issue here.

It's a specialist secondary care only medication that GPs are not allowed to prescribe. As such they would not necessarily be able to advise about it. It stands to reason as far as I can see.

It is the responsibility of the private prescriber to advise you before giving you the drug not your GPs responsibility. The private sector are taking money to provide the advice so they should be doing it

Firstly gp’s can prescribe this drug for diabetes, so saying they don’t know it is appalling. And secondly the op has explained why she wants gp support, she is diabetic. For me the gp behaved terribly.

That’s nonsense, thr gp’s can prescribe for diabetes.

Our GPs can't. It's been approved but not rolled out yet.

But GPs cannot prescribe it for obesity
She doesn't want it for diabetes
If that was the question asked the conversation would have gone differently

GPs are sick of being bombarded with requests (not all of them polite) to prescribe a drug that they cannot prescribe. Like any private script the prescriber needs to take full responsibility for advising the patient

This is not yet the case nationally. The roll-out will take three years and is scheduled to start next month. You may be in a pilot area if it is applicable to you.

@wanttoimprovemyhealth

Mountjaro works! I have lost 4 stone in a year. I get it from Boots online [quite costly I'm afraid]. You can have a free consultation and if they cannot prescribe it does not cost. Mostly online but you can talk to a "doctor/pharmacy person". They may not be in UK I feel