Access to weight management medicines in north west London
Guidance for General Practice
Updated: July 2025
Approved by: North West London Integrated Medicines Optimisation Committee
Review date: 31 January 2026
Overview
This guidance outlines the criteria and principles for prescribing semaglutide (Wegovy®) and tirzepatide (Mounjaro®) for weight management on the NHS in North West London. It has been developed in line with NHS England Interim Commissioning Guidance and in collaboration with clinical experts and weight management services across north west London.
What’s included
This guidance covers:
- eligibility criteria for prescribing Wegovy® and Mounjaro®
- priority cohorts for initial rollout
- prescribing principles including equity, proactive care, and financial stewardship
- implementation approach, including phased access and future updates
- patient access protocols, including referral pathways and exclusions.
Priority cohorts
Access is being introduced through a phased rollout, starting with patients who have the highest clinical need:
1. BMI ≥ 40 kg/m²
With four or more qualifying co-morbidities:
- cardiovascular disease
- hypertension
- dyslipidaemia
- obstructive sleep apnoea
- type 2 diabetes mellitus.
2. BMI ≥ 35 kg/m²
With one weight-related co-morbidity and one of the following:
- active malignancy requiring urgent weight loss for therapy
- urgent weight loss needed for organ transplant
- idiopathic intracranial hypertension (IIH) with visual compromise
- planned time-sensitive surgery for life-limiting conditions
- under NHS fertility care requiring weight loss for assisted conception
- obesity hypoventilation syndrome (OHS).
Note: For individuals from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean backgrounds, BMI thresholds are reduced by 2.5 kg/m².
Future cohorts will be added as NHS England guidance evolves.
How GPs can use this guidance
- identify eligible patients using a case-finding approach, prioritising those with the highest clinical need
- refer to the guidance documents for full prescribing criteria and protocols
- ensure equitable access by applying the criteria consistently across patient groups
- support the management of patient expectations through sharing of the eligibility criteria
- stay updated: This is an interim position and will be revised as national guidance changes.
Patient access
Patients cannot self-refer for NHS funded weight management medication – referrals need to be initiated in primary care.
Patients transitioning from private to NHS weight management care
As part of the national rollout of NHS-funded weight management medicines, we may begin to see patients transitioning from private, self-funded care to NHS services. It’s important to be clear that while patients may become eligible for NHS-provided care, this does not mean the NHS will fund the continuation of treatment started privately.
Eligibility for NHS-funded treatment is determined by the patient’s BMI and co-morbidities at the time of referral into NHS care, not at the point when they began private treatment. This distinction will be particularly relevant as we move beyond Cohort 1 and more patients present with a history of self-funded use.
We are following NHS England’s Interim Commissioning Guidance and are funded only for patients who meet the defined eligibility criteria. We are unable to consider exceptions to this approach.
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