Interim specialist weight management referral criteria and primary care GLP-1 prescribing arrangements

GP practices in Lancashire and South Cumbria currently follow interim referral criteria for specialist weight management services and the primary care GLP-1 (for weight management) prescribing arrangements.

This criteria outlines the eligibility of people able to access tirzepatide via their GP practice and the specialist weight management pathway.

At present, prescribing of Tirzepatide is available to adults (aged 18 and over), via their GP, with a body mass index (BMI) of 35 kg/m² or above, or 32.5 kg/m² or above for people from minority ethnic family backgrounds, as well as at least four of the following long-term conditions:

• atherosclerotic cardiovascular disease
• hypertension
• dyslipidaemia
• obstructive sleep apnoea
• type 2 diabetes mellitus.

Patient must also participate in a behaviour support programme.

A patient may be referred to the Very Low Calorie Diet (VLCD)-supported specialist weight management pathway (Tier three services), where they meet either of the following BMI criteria:

• BMI of 50 kg/m² or above;

OR

• BMI of 40 kg/m² or above with at least one qualifying major obesity-related condition:

• Type 2 diabetes
• Obstructive sleep apnoea
• Severe hypertension treated with two or more agents
• Idiopathic intracranial hypertension
• non-alcoholic fatty liver disease and/or non-alcoholic steatohepatitis
• Severe osteoarthritis of the spine, hips or knees where surgery is awaited
• Weight-related infertility or PCOS where fertility treatment is awaited
• Established atherosclerotic cardiovascular disease
• Heart failure where obesity is a significant contributing factor
• A requirement for life-prolonging surgery or intervention that can only proceed at a lower BMI

For access to ICB-funded specialist weight management services where GLP-1 medicines form part of the treatment pathway, the ICB applies a single interim access framework. The framework is aligned to NHS England's phased implementation approach for obesity pharmacotherapy and is used consistently across ICB-funded specialist weight management services.

This is an access and commissioning arrangement for the locally funded specialist service. It is intended to provide a transparent, equitable and consistent approach to prioritising available specialist capacity and ensuring fair access to services. It does not amend NICE recommendations or direct clinicians to prescribe a particular medicine. Clinical decisions regarding treatment remain the responsibility of the specialist multidisciplinary team following assessment of the individual patient's needs.

Meeting the recommendations in a NICE technology appraisal does not, by itself, mean that a person meets the local access criteria for every specialist weight management pathway. If a person is accepted into the specialist service, the specialist multidisciplinary team remains responsible for assessing their needs and deciding which clinically appropriate interventions should be offered, in accordance with applicable guidance and the service model.