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.

I'm a practice nurse - specialising in diabetes

. Guidelines support its use for diabetes as a 3rd line treatment if diabetes remains poorly controlled on 2 agents AND if you have a high BMI. Or if other agents are not tolerated.

for example I would prescribe you MJ if you were already taking metformin and dapagliflozin but your bloods were still not well controlled.

Can I make a suggestion, I think you need to register at a different surgery where they have actual properly trained diabetes practices nurses.

Alternatively find out what your HBA1c level is and if it is high go back to the GP armed with the NICE guidelines. Obviously if your diabetes is well controlled or you currently don't take any medication for diabetes then you won't be eligible through your GP so I would then just buy it from a reputable online pharmacy if that's what you want to do.

Hope this helps.

@wanttoimprovemyhealth you did exactly the right thing going to your GP and your experience was poor.

I would think about changing GP if possible to a practice with a dedicated diabetic nurse and/or GP. Of course they need to be part of this conversation because they're prescribing you diabetic medication. It's appalling to just say I don't know. They should be going away to find out and then updating you. I wouldn't be happy with being fobbed off to an external pharmacist.

There's a lot of inaccuracies on this thread and possibly because things vary between health authorities but this is why you need clear medical guidance.

It's absolutely normal for someone with diabetes (t2) to be managed entirely by the GP and not a hospital clinic with a consultant.

GPs can and are prescribing Mounjaro now but it will take time to get it rolled out everywhere. If they're not then they won't have had training but as above they could go and find out what you/they need to know.

It's 4th line here.

I'm curious whether that variation because of interpretation of guidelines or different authorities setting different protocols?

My advice as someone taking it for weight loss is to talk to a private provider. They are pretty thorough about taking your history. Many are getting stricter about who they prescribed to. It may be better to stick to one provider rather than changing each month (which I do to keep costs down) so that they get to know you. Some do a subscription where it's a much more personal service but this does cost more.

Mounjaro has worked wonders for me bmi from 35 to 28 but I don't have any other health issues.

Honestly go for it, you have nothing to lose.

You can speak to any pharmacist about medication interactions, they are the experts. Try another pharmacist and go at a chilled time.

Your GP is just uneducated about this particular medication. The person who prescribes you the Monjaro should go through the risks with you.

However it does sound like you are making some real steps to look after yourself, and maybe that is a better route to go down at this particular junction. If you can find a dietician/pysch that can support you with making choices that are better for you then you will be in a much better position in a year to take Monjaro, and the pathway might be easier.

@wanttoimprovemyhealth

I think @unclejonnymademydress gives good advice. It sounds like you are not currently getting good support for your diabetes from your GP practice. Are they doing the regular weight, foot and eye checks?

I'm fortunate that my local diabetes support is good. My diabetes nurse recommended mounjaro and the GP did the actual prescribing.

As well as diabetes I have some other autoimmune conditions which are separately managed but all are kept aware, by me, of other medications I'm taking.

Since starting on mounjaro both my warfarin and levothyroxine requirement have reduced by proportionately more than my weight. I think this may be because mounjaro affects how other drugs are absorbed.

I hope you can find a way to get mounjaro. I started at a much higher weight/BMI than you. I am losing weight at a steady 1kg per week and am now roughly 14kg down.

Best wishes

I have type 2. My gp practice rang me and proactively offered mounjaro. My understanding is that you have to show that either 2 other medications haven’t worked or you can’t tolerate them. I couldn’t take metformin due to side effects. Mounjaro has brought my hba1c back to normal. I’m also 2.5 stone lighter.

My late DH also had a diabetic nurse that used to do reviews for him. They weren't attached to the GP surgery, they were part of the local health authority and were based elsewhere. You should enquire OP to see if your LHA has such a team.

I found this on Gov.UK (apologies if you have already looked at it):
"The Medicines and Healthcare products Regulatory Agency (MHRA) has approved a four-dose version (covering a month’s treatment) of the diabetes and weight management medicine Mounjaro (tirzepatide) - Mounjaro KwikPen.
Mounjaro KwikPen is approved to treat adults with type 2 diabetes and for weight management in adult patients with a BMI of 30kg/m² or more (obesity), as well as those with a BMI between 27-30kg/m² (overweight) who also have weight-related health problems such as prediabetes, high blood pressure, high cholesterol, or heart problems.
The medicine is to be used together with a reduced-calorie diet and increased physical activity."

i presume you want it prescribed by GP? there’s a threshold for that to happen - i think a specific obese level. do you know if you meet all the requirements under NHS? i would book another appointment and persist

This is outside your GPs remit.

It’s a bit like going to a corner shop mini supermarket and asking for their recommendation on specialist cuts of meat. Some would give you a generic comment along the lines of I’ve heard fillet steak is good because that’s what they see on posh menus. Others would say I don’t know anything about it so can’t recommend.

If you want professional advice on a specialist medication then speak to a professional who works in that specialism. There are plenty of private providers, including ones like bupa who don’t market specific products. Pharmacists are the expert on drug interactions.

Your GP is the sole GP in the practice and has two practices? This seems very unusual. If you are concerned about their medical knowledge please feed this back to the CQC

And you can’t afford to take time off work for appointments but you can afford to pay privately for Mounjaro?

You would be assessed by the prescriber for the medication. They’ll take into account your latest hba1c and any prescribed medication you take as well as many other factors. Even though you’re paying, you wouldn’t be prescribed it if you don’t fit the right criteria.

Following the NICE guidance publication at the end of last year the NHS is now expanding use of weight loss drugs. Specifically the use of the 12m doses of mounjaro they signed a deal for.

This means that for people with a BMI of 35 or more and who have a comorbidity the drug will be prescribed as part of Stage 2 weight loss services. Initially this will be via specialised weight loss service not GP services. But from the summer of 2025 GPs will be offering this option and will be able to prescribe.

Since GPs don’t provide weight loss services and don’t prescribe these drugs at the moment. There fore they won’t be very knowledgeable about them at the moment. This will change as the service is implemented in GP services. Also worth noting that a clinical pharmacist can provide good advice on contraindications and medication interactions.

Fundamentally Mounjaro is a diabetes medication under a different name. The private prescriber should be informed of your current condition and medications. They will be able to determine if it is suitable for you. They will inform your GP you are taking it.

But GPs don’t have to agree to share care with this provider. They could if they wanted to. And they could give you support and advice about private care if they wanted to or were able to. They should have put the OP on the NHS pathway for weight loss services. Where she would get advice on diet and exercise.

GPs in South West told yesterday, "Please do not prescribe tirzepatide (mountjaro) for weight loss yet, while clinical experts are developing options for new local services"
GPs are not specialists and every new area not commissioned literally gets dumped on them. And people will complain they can't get an appointment because GPs doing more work they are not contracted to do,but "someone" needs to do it!
OP, I hope you get sorted,but it's really not for your GP to deal with when it is for weight loss.

No but again, the op is Diabetic, so it is for them to deal with.

So because SHE doesn’t know anything about it you shouldn’t go on it. What a lazy GP 🙄 I have recently bought my first dose (not started yet) and I had to go through an online consultation before I could purchase it. I would also recommend joining Facebook groups as who better knows medications and side effects that people with/on them 🤷🏼‍♀️ also with Mounjaro if you start and lose weight you may no longer be diabetic with high blood pressure so a massive pro for you! Cx

I ordered from Asda online and had to provide lots of info about my current medication and any concerns I had.

After they have prescribed they offer follow up checks with a doctor if you feel you need it to discuss side effects or concerns etc. I don’t know how good the service is as I have not used it but the offer is there.

i didn’t bother going to my GP.

My dad has type 2 diabetes and he has been prescribed both Ozempic and Mounjaro (not at the same time) by his GP to manage his blood sugar and help him lose weight. He did not have to jump through any hoops. I can’t advise on what to do about your GP being so useless but I wanted to let you know you can definitely get the medication on the NHS.

You need to approach a private endocrinologist if you have diabetes and want to consider a glp1.

As regards weight management only, Primary care is completely swamped with the amount of communication about people starting private medication and in some parts of the country are refusing to acknowledge it and returning letters.

However, there may be data soon to show that rates of obesity are declining which is impressive.

Op you need a specialist diabetes nurse. I paid privately for the first 2 months (while I was waiting for my annual diabetes review) I emailed the surgery before taking it and asked the pharmacy to confirm that I could take it with my other meds.
Nurse prescribed it in my annual review BUT she said she could only let me have 5mg pens AND it would be only for 12 months - those are the boundaries that they are working in at the moment. I am anticipating having to pay privately for the maintenance dose once I’ve lost weight.

People saying this is because GPs are not knowledgeable and n GLP- 1 are missing the point. If they don't prescribe it due to current regulations, which OP GP doesn't then they are not supposed o have any involvement in it. I think OPGP probably knows more about MJ than the average person, but it's like any private healthcare, you don't go to your GP you speak to the private practitioner. Expecting NHS GPs to spend appointment time discussing something they have zero involvement in is ridiculous and wasteful. OP is planning to go private so OP needs to do just that and leave the GP alone.

So, you've been trying for weeks to get a GP appointment to discuss this yet you only started a healthy lifestyle regime in January, you've really not given that change much time.

Specialist medication is prescribed by specialists - not every GP can be educated on every medication - that's a huge ask and a huge risk.

It's crazy in my mind that people just want the easy option without any of them trying to life and maintain a healthy lifestyles, options that come with side effects and costs to the NHS.

Why are you at that practice? It sounds awful. I would switch to another one with a range of doctors and proper diabetic nurse, even if further to travel.

Also, if you're using a private provider, good ones will be able to give you advice.

I do agree with you but from the OP I got the impression that she told the OP not to take it. Thats the bit I think is wrong - she could have explained that she can’t prescribe and doesn’t know much about the drug but suggest to the OP that she goes elsewhere.

But I do agree that it’s a waste of the GP’s time for people to discuss medication that they don’t even prescribe at the moment.

And again, the gp is duty bound to discuss medication a patient is taking with them when it impacts on health conditions such as diabetes. The op is diabetic. Yes it is wasteful and ridiculous for those who are not diabetic, but for those with diabetes, the gp is supposed to discuss. It is their job.