In Wales the diabetes consultant at my local hospital is not allowed to prescribe doses above 5mg/ml to diabetic patients.
He told me he finds it very frustrating, because many of the patients he sees are morbidly obese and would benefit from the higher doses (up to 15mg/ml) that some tier 3 weight management services in England are able to prescribe. He said he thought it was a short sighted decision, that would end up costing the NHS more in the long run, but that is very common in a lot of UK service provision. So he fully approved of my going privately, and I now take one 5mg/ml injection courtesy of the NHS and one privately paid for 10mg/ml injection each week, with his blessing.
The NHS in Wales is so far behind the times that they are still offering bariatric surgery instead of GLP-1 injections to their morbidly obese patients who manage to jump through all the hoops of the 3 tier weight management programme.
My friend in Cambridge was prescribed Wegovy after completing tier 3 but the side effects were so bad she asked to be switched to Mounjaro. She was told that while they fully intended rolling out Mounjaro to their obese patients that would require them retraining staff and printing out new information leaflets, which wasn't in the budget yet, and nobody had any clue when they would be able to start making the changes.
More recently she spoke to the nurse in charge of rolling out Mounjaro prescriptions to NHS patients in her area, and was told that it has been quite difficult to find any patients who fit the NHS criteria which are "a BMI of 40 or higher, and a minimum of 4 out of these 5 chronic health conditions; type 2 diabetes, high blood pressure, heart disease, obstructive sleep apnoea, and abnormal blood fat levels".
The fact that she has a BMI well over 50, and suffers from 3 of those 5 conditions, is insufficient. The nurse regretfully informed her that being crippled by rheumatoid arthritis, lupus, coeliacs disease, hypothyroidism, PCOS, having worn out hip and knee joints and needing a wheelchair (on the rare occasions when she is able to leave the house) doesn't count.
Unless she has an official diagnosis of at least 4 of the 5 listed diseases she can't be added to the group. Though the nurse did say that it was turning out to be so hard to find enough patients that do qualify within the area that it didn't look as if the group would get off the ground, unless the criteria were relaxed slightly.
Meanwhile she is in constant pain, with worn out hips and knees, that all should have been replaced years ago, but no surgeon will operate on her (even if she paid privately) because her BMI is too high.