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 went to GP about something else but they'd noticed that I had the private mounjaro prescription on my record. They were transparent that they didn't know to much about it but were keen to hear more from me about what I'd experienced while on it, side effects etc. They were very positive about it. Especially given the evident reduction in my BMI.

But the GP manages ALL of the other medications right?! So for instance the privately prescribed medication - of which I agree they have no responsibility for - never suggested they did - has an impact on the body over time that means all of the currently prescribed medications need adjusting. Is it not prudent to have a discussion about this potential impact before starting a new private medication? Rather than the GP shrugging and saying ‘dunno? Don’t start it’.

Vitality now offers Mounjaro and other weight loss injections as part of their health insurance plans. A useful option for those exploring medical weight management - www.myhealthprotected.co.uk/vitality-becomes-first-uk-health-insurer-to-offer-discounted-weight-loss-jabs/

You literally said "if you are seeing a private specialist and they prescribe you meds the GP doesn't take any involvement in that either". I'm saying, that's not always true.

@baileys6904

You literally said "if you are seeing a private specialist and they prescribe you meds the GP doesn't take any involvement in that either". I'm saying, that's not always true.

And I stand by it. These new regs are about verifying the patients details, not bringing GPs in on private medicine.

I do hope everyone who is suggestions the GP should take time to discuss this with OP, despite the fact it is the responsibility of the prescriber, are not also moaning about lack of GP appointments.

OP, I am in a similar situation to you although my BMI is higher. When I was in A&E recently with a gallbladder infection, the consultant told me that I would qualify for bariatric surgery. I asked my GP if I could be prescribed injections for my T2 diabetes , which would have the side effect of weight loss and he said no. They cannot prescribe them for weight loss and as my sugar level is coming down on Metformin and Forxgiva, then I cannot start injections for the T2. I asked about Tier 3 programmes and he made no comment at all.

I have the annual diabetes check next week and am going to ask the nurse about the injections, but I am now going to consider paying privately for them , however I will need to discuss it with my doctor due to all the other medication that I am on to make sure that I can take them.

It is frustrating that I could get surgery on the NHS but not the injections.

When I was diagnosed in 2020, covid had just hit so I never even saw a nurse about it at the time. I had one phone call from a company called Oviva who just discussed my diet and that was it.

I don't understand why a GP would not equip herself with at least basic knowledge of one of the most commonly prescribed drugs, even if she won't be prescribing it herself in the near future. Isn't there such a thing as continued professional development? Or is it considered acceptable for GPs' expertise to be about five years out of date?

@scanni is correct.
All clinicians involved in the care of a patient should be aware of OP's PMHx and medications.
It is the medicolegal responsibility of the prescribing clinician to know all about their patient when making a prescribing decision.
As OP has confirmed she is seeking a private prescription pathway the advice requested should come from the prescriber, in this case not the GP.
The private prescriber should explain the interactions.
If this was a GP consultation about the NHS pathway as her diabetes was poorly controlled it would be a different matter, but it's not.

There absolutely is CPD but as a GP, which topic in the whole of General Practice are you going to prioritise in your very limited CPD time?

Probably not something that isn't currently prescribed in General Practice for weight loss.

For some people it seems yes, you’re taking up valuable appts if you are a diabetic and wish to discuss your other meds whilst on it. It’s mind boggling to me anyone would think that. And so openly embrace and argue for that level of shit service.

Because they have to inform them but the GP doesn’t have to do anything - they didn’t prescribe it!

Perhaps people should look up prescribing guidelines. The prescribing responsibility sits with the PRESCRIBER not a GP just because they are a GP! Just because prescriber CAN prescribe something doesn’t mean they will, or give advice. GP’s don’t want to be involved for a reason - it’s not their responsibility. The moment they get involved they end up with the responsibility and it doesn’t sit with them. Being diabetic and being prescribed a GLP1 is for management of diabetes, not weight loss in diabetes. In diabetes it is a positive side effect that you might lose weight. It’s been designed for years to help blood sugars. They found it helps with weight loss. Not the other way round. If your T2 is stable they are not going to add in a GLP1 to your regime as it’s based on your actual needs, not your wants

to clarify
the OP doesn’t need this drug in the management of t2 DM so the GP is not involved. The patient can choose to get this elsewhere for weight loss. How on earth would a GP know how it’s going to affect you that’s any different to the prescriber who prescribes it, who has the full responsibility - the side effects are well known, they can’t tell you it will or will not help if you don’t need it, you would like it.

They will not do this. There is no requirement for any privately prescribed medication. They can do routine checks but GP’s will never agree to a check before. They are not funded for this work and will refuse. They will only agree to verify if there is an issue. Usually history of an ED, or very low BMI they would alert. However the patient can just choose to jump to another prescriber!

Private medicine is prevalent across all of the UK. Consultants and pharmacists prescribe all manner of things every day. Acne creams - online, UTI - at your chemist. You can book to see a private consultant and start on any medication they choose, at your own cost. Each and every time the onus is on the PRESCRIBER to verify all the information BEFORE prescribing - and it will never ever be on the GP to verify anything before prescribing. GP’s are not specialist, they are ‘general practitioners’.

what is more likely is some kind of ‘shared record access’ to the patients info via the NHS spine, or even locally commissioned weight loss services managing the prescribing.

I do not think in our generation the NHS will ever afford to bring this into primary care. The cost is exponential and it’s not a primary care management - there are already T2, 3 and 4 weight loss services commissioned and people need coaching and support. Campaign for the community services to be better, not your GP to do this work.

I work in primary care.

Your GP must have been hiding in a cupboard for the last year or so. Information about MJ is everywhere. Why don’t you contact one of the prescribing pharmacies and run your situation past them? Btw, I am on Ramipril and there is no reason not to take MJ with it, quite the contrary. I’m afraid I don’t know anything about your other medication. Good luck.

Read my previous post.

I went to the GP and asked about weight loss medication due to my high BMI and taking medication for weight loss.

The referral for the t3 weightless programme came from my GP, and to do so they had take my bloods and various other measurements to be able to refer.

The op has said she didn't want to go via the NHS due to the perceived need for various appointments. Once the initial referral has been made via the GP, it then goes to a commissioned private provider

It’s different everywhere. A lot of weight management is a self referral now. And you have to complete tier 2 to get to 3. You can google your local ICB and look up the guidelines before booking a GP appt so you know where you are likely to stand. Just google your area/county ICB weight loss services

Yeah mine had literally just started and I'm in Lancashire

I think they definitely are trying to tighten the use/safety of private providers as I do know so many people that don't need the help getting privately prescribed.

At least via the GP, they are aware of the medication and the doing it through them seems a well controlled journey, so I only assume for once, we are in the lucky ICB ha ha

That's terrible. I'm also type 2 and high blood pressure, and my GP has prescribed Mounjaro for the diabetes, she's really enthusiastic about it and said she's been impressed by the patient outcomes from using it. Both she and the practice nurse who showed me how to use it have obviously dealt with a lot of patients who have been prescribed it. I think your GP is woefully behind the times and I would seek advice elsewhere.

If you go to a reputable pharmacist, they will ask what meds you are on, and should be able to advise accordingly. The pharmacist does not have to be connected with your GP, there are many high street (and online) chemists nowadays who sell and advise on weight loss injections. Good luck.

Unfortunately it isn’t your GPs job to advise on the suitability of someone else’s prescribing. If you are going private it is the responsibility of the private provider to discuss these things with you. GPs are so overwhelmed at the moment (as is the rest of the NHS) they just don’t have the time for this currently

Diabetes specialist nurse here.
Have you ever been under a diabetes team? Could your GP refer you? I know you say you don't want to attend lots of NHS appointments, but his is no miracle solution.
You'll your medical history looking at as there are contraindications, you'll need blood test, reviews, dose increase depending on side effects, weight checks to review positive effects on you.
Also there are many GLP1s, if mounjaro does not work for you there are plenty of others that might and depending on side effects they might advice you on one or the other.

This. For 12-18 months now there's been supplying issues since it can be purchased, and people that needs it to control glucose levels for example, not being able to get their prescriptions.

I havent read the rest of the thread so someone may have already said this, but esentially I have found with GPs, if they dont prescribe it, they're risk averse about advising you about it

Using supplements as an example, unless its for specific things that have come up on a blood test, my GP surgery will not, categorically will not enter into a conversation about them, not even to tell me not to take things, only to tell me they simply just cant discuss it at all. Zero opinion.

And theyve got the nerve to have a sign at reception advising people not to use Google to seek health advice!!!

What? What is in short supply? Are you not in the uk?

Yes, in the UK, GLP1s have been on and off shortage for the last 18 months or so because of private prescriptions

Where's that bingo card...

@AliciaSoo there was a shortage of semaglutide but that has been resolved. There has not been a shortage of Mounjaro. If diabetics who are prescribed Mounjaro by the NHS can't get their prescription fulfilled it's not because of obese people taking it from them via private prescriptions.