NHS prescribing guidelines

[Ceebs85]

Hey

I'm asking in behalf of my partner who has a BMI of 49 and several hernias requiring surgery. The surgeon met with him and after discussion suggested the GP prescribed a GLP-1 medication. My partner did not ask for this and was surprised it was suggested but agreed with the plan.

The GP has now stated the guidance is that the person must have 4 weight related conditions to qualify and that they won't prescribe. I can't see that this is stated in NICE guidelines or anywhere. Is this likely to be unique to the local ICB? My partner has 2 weight related conditions (hypertension and sleep apnea)

Does anyone know?

Guidelines are only advisory so can you contact the surgeon’s secretary to ask him to put his recommendation into writing to the GP?

He's not going to win this argument, he needs to go privately, which most of us are doing.

The NHS guidelines are very clear that due to funding issues, you must have four co-morbidities to qualify.

https://www.england.nhs.uk/publication/interim-commissioning-guidance-implementation-of-the-nice-technology-appraisal-ta1026-and-the-nice-funding-variation-for-tirzepatide-mounjaro-for-the-management-of-obesity/

GPs unfortunately cannot prescribe outside the eligibility guidelines they have been given due to funding.

His surgeon should have said it was crucial for him to lose weight and if he needs support to speak to GP for a referral to weight management rather than dangle a solution the NHS has not approved for his circumstances.

Buying privately is a potential option.

As @TwattingDog says the GP is correctly quoting the criteria for the rollout of Mounjaro being prescribed directly by GPs for weight loss. Perhaps the consultant could refer your DP to the specialist weight loss service in your NHS area, and your DP might be able to access the Tier 3 support directly, which eventually might lead to a possibility of prescribing Wegovy. But not everywhere offers Wegovy, it could just be bariatric surgery being offered. And that would be after working through a period of months on the Tier 3 support.

If you can afford it, I would bypass all of that and get a private prescription.

I think this is a grey area. First he’s more than 2, he’s got hernias for a start, that’s 3, are you sure he doesn’t have others, like high cholesterol, heart disease, abnormal blood fats?

I would ask his surgeon to write to the gp and I’d make a gp appt, as he may fit the criteria.

It's 4 out of 5 conditions on a specific list, which is:

• Type 2 diabetes.
• High blood pressure (hypertension).
• Heart disease (cardiovascular disease).
• Obstructive sleep apnoea.
• Abnormal blood fats (dyslipidaemia/high cholesterol)

So the hernias don't count even though he needs to lose weight to get them treated.

Irrelevant I'm afraid, hernias don't mean a thing as it's not a standard co-morbidity.

There are no grey areas in the prescribing guidelines - either you fit or you don't

I had a BMI of 44 when I began MJ, but no weight related co-morbidities. A healthy fat IYSWIM, at least in terms of measurable problems.

To be fair, with a bmi of 49 he’s possibly got 4.

Maybe. The consultant should have known that list though and made it clear that the DH needed to get another two of those conditions diagnosed in order to qualify for Mounjaro.

My BMI was 50 before I started with Mounjaro. I had high BP but no other issues.

Not necessarily. When I started, I had a BMI of 51 but none of those conditions.

A surgeon is not necessarily going to be aware of the prescribing criteria for meds they are not entitled to prescribe themselves.

Not necessarily no, I don’t suppose they can be across everything. If the consultant had been able to somehow check the criteria for the medication they were asking the GP to prescribe that would have been helpful. Maybe the NHS IT systems are not up to giving that sort of information easily. It would have saved everyone a lot of hassle if the consultant had been aware that it was not possible to prescribe.