Update
Update: June 2026 – QOF OB005
Following the 2026/27 GP contract changes, NHS England’s published Quality and Outcomes Framework (QOF) guidance introduces indicator OB005, which states that practices should offer NICE-recommended medicines management (pharmacotherapy), where clinically appropriate, as part of the management of obesity.
NHS England’s intention is that this indicator enables practices to provide access to injectable weight loss medicines through general practice. However, the wording of the indicator requires practices to offer NICE-approved pharmacotherapy, which is not necessarily synonymous with delivering the prescribing service itself. Wessex LMCs, together with the General Practitioners Committee for England (GPCE), has sought clarification from NHS England on this point, and discussions remain ongoing (July 2026). Wessex LMCs are also in discussion with all of our ICBs over this point.
Our advice to practices
Practices should carefully consider whether participation in OB005 represents a sustainable use of practice resources. Before deciding whether to pursue this indicator, practices should:
- Calculate the maximum QOF income available from OB005 for their practice.
- Estimate the clinical, administrative and ongoing workload required to deliver the service safely, including any follow-up, monitoring and prescribing responsibilities.
- Consider whether the funding adequately covers the staffing and capacity required to provide the service.
QOF remains a voluntary framework. Practices are not contractually required to deliver every QOF indicator and may choose not to participate in individual indicators where, having considered the financial and operational implications, they conclude that doing so is not in the best interests of the practice or its patients.
Wessex LMCs will continue to update practices as further clarification is received from NHS England.
| OB005. Percentage of eligible patients (per NICE TA1026 Funding variation cohorts, accounting for ethnicity and comorbidity status) who have a recorded shared decision-making discussion about the management of obesity and are offered NICE approved medicines management (pharmacotherapy) for use in a primary care setting with accompanying referral to suitable behavioural support programme, in the preceding 12 months. | 13 points | Thresholds 50-80% |
UPDATE: June 25 NHS England changes and BMA response and guidance*
From 23 June 2025, Tirzepatide must be implemented in primary care. Tirzepatide represents a new therapy for weight management, but requires structured implementation, appropriate monitoring, and clarity around responsibilities. GPs should only engage in prescribing where clinically appropriate and safely resourced to do so.
GPCE has produced Focus on Tirzepatide (Mounjaro) for weight management in General Practice, which explains how it is used, commissioning arrangements (responsibility for funding lies with ICBs), and responding to information requests from private providers. It includes a template letter for practices to respond to requests for medical information following a private consultation. Read the guidance
Introduction
Injectable weight loss management options and their prescribing in Primary Care (eg Semaglutide (Wegovy) and Tirzepatide (Mounjaro)
Injectable weight loss drugs have been brought to the UK market in the last few years including Semaglutide (Wegovy) launched in the UK on 4 September 2024 and Tirzepatide (Mounjaro) joining it a few months later. Both are available on the NHS as an option for weight management in line with NICE guidance, alongside a reduced-calorie diet and increased physical activity.
Patients are eligible for treatment within a specialist weight management service if they have a BMI of at least 35, or at least one weight-related comorbidity, such as hypertension or cardiovascular disease, and a BMI of 30 to 34.9, provided they meet the criteria for referral to specialist weight management services, including that conventional treatment has been unsuccessful. These guidelines may be different from area to area depending on local commissioning arrangements.
Semaglutide and Tirzepatide are injectable medications which are given once a week, and other options are likely to be released to the market over time. They can be delivered using a pen device normally used by the patient themselves.
NICE’s guidance on injectable weight loss drugs for managing obesity can be found here (Semaglutide) or here (Tirzepatide)
Currently ICBs have strict prescribing criteria for injectable weight loss drugs and are mindful of potential cost implication. Examples used in some ICBs include ensuring patients have been taken all the way through the various tiers of weight loss services before the final tier (often tier 3) is reached and only at that point is a patient assessed for their suitability for the treatment.
Injectable weight loss drugs should not be prescribed in Primary Care (unless you are doing so under an enhanced service with a specific contract to do so).
Conception and contraception for Tirzepatide
Tirzepatide delays gastric emptying which may affect absorption of concomitant oral medicines. Since reduced efficacy of oral contraceptives cannot be excluded, it is advised that female patients who are overweight or obese and using an oral contraceptive should add a barrier method of contraception or switch to a non-oral contraceptive method for the first 4 weeks of treatment, and for 4 weeks after each dose increase.
Discontinue treatment at least one month before planned pregnancy.
This information is especially important when you are asked by a private provider whether it is safe for a patient to take Tirzepatide. As such, there is an alternative letter for GPs to send to private providers should a female patient be prescribed Tirzepatide privately and the GP be asked for information.
Private Prescribing
There are many private medical and pharmacy companies who will assess patients and prescribe to those who want to receive the treatment. We have been made aware of GP Practices receiving letters from these private companies stating that their patient has been prescribed an injectable weight loss drug and the company is requesting that the GP make sure their patient does not have any contraindications.
This practice confers significant workload to GPs, and also effectively seeks to transfer some of the risk of prescribing to those GPs.
In line with Good Medical Practice guidance, it is the responsibility of the prescriber to make an assessment of the patient and judge their suitability to receive the prescription. Wessex LMCs does not believe that it is acceptable for private providers to seek to transfer this responsibility to the patients NHS GP. Equally, provision of this type of information to a private organisation is not NHS work.
On the other hand, we do want our patients to receive safe treatment and not come to harm. Therefore, providing the information (ie detailed report) for a fee is an option. Alternatively, the patient could be provided with a simple computer summary of their key medical history and medications to share with the private provider (free of charge) or they could be signposted to access their medical information via the NHS app.
One option that Wessex LMCs suggests is that Practices could respond with a template letter and the wording of the letter could include the following:
| Dear Provider
Thank you for your request for information regarding this patient for whom you have recently prescribed/are planning to prescribe Semaglutide (Wegovy) / Tirzeptatide (Mounjaro). As you are aware, GMC good medical practice imbues responsibility for safe prescribing onto the prescriber themselves, which in this case is you/your organisation. Ways of ensuring safety would include taking an adequate history and checking with the patient’s NHS app for confirmation of medical history and medication, as well as undertaking and acting on any appropriate pre-prescribing investigations. It is not appropriate to ask the patients NHS GP to undertake this assessment on your behalf. On receipt of signed patient consent, we are happy to share a computer-generated patient clinical summary report without charge. Alternatively, this information can be provided to you by the patient via the NHS app. Providing any information in a patient summary does not mean that a clinician has checked whether it is safe for you to prescribe the weight loss medication you are proposing and responsibility for prescribing remains entirely with you. Yours sincerely |
| Contraception: Insert this paragraph if female being offered Tirzepatide:
In light of the risk of gastric emptying delays and therefore malabsorption of the oral contraceptive pill in women taking Tirzepatide we assume that you, as the prescriber, have assessed this risk and informed the patient appropriately as described in the BNF: “Since reduced efficacy of oral contraceptives cannot be excluded, it is advised that female patients who are overweight or obese and using an oral contraceptive should add a barrier method of contraception or switch to a non-oral contraceptive method for the first 4 weeks of treatment, and for 4 weeks after each dose increase. Discontinue treatment at least one month before planned pregnancy.” |
MDU View
It is however worth noting that The MDU has more recently (4th Feb 2025) issued its own guidance, which you can see here.
Importantly this advises GPs not to ignore letters that are either informing them of a private weight loss injection or requesting sharing of relevant information.
- Importantly, it recommends GP practices record that patient is taking a weight loss medication (eg recording it as a Hospital prescribed medication) to reduce risk of drug interactions with other medications that may be prescribed in primary care.
The MDU states:
“Our advice: do not ignore requests for patient information, and make sure patients have given their consent to share it.”
- If you ignore these letters and do not make a record that the patient is on this medication, you may later make an incorrect or suboptimal management plan that could have been informed by this information, or prescribe something with a significant drug interaction with weight loss injections.
- You may wish to record the weight loss injection as a “Hospital issued” medication in your clinical system, or delegate this to your practice teams, in order that drug interactions etc are automatically checked.
- You can respond to requests for information to confirm consent and to confirm the terms under which you will be paid (you are entitled to charge the private provider a fee under GMS Regulation 25 part (b) or (f)) , for example as follows:
| Dear Provider
Thank you for informing us that you are prescribing or intend to prescribe medication. You have asked for us to review medical records for presence / absence of contraindications to your treatment, and/or for a confirmation of the patient’s current physical parameters e.g. weight/BMI. We do not have capacity to provide this review unresourced and it is not an NHS role to supervise your private episode of care. The patient may be able to share their records with you, so you can review directly. Providing any information or copies of GP records / a “patient summary” does not mean that a clinician has checked whether it is safe for you to prescribe the weight loss medication you are proposing and responsibility for prescribing remains entirely with you. We would be happy to reply with a review of the notes for presence/absence of the conditions specified, upon receipt from you of signed patient consent and our appropriate fee (typically INSERT YOUR USUAL e.g. 15 minutes report fee HERE) (fee may be higher if physical assessment / examination of the patient, or gathering of new information, e.g. updated weight/BMI is required) Yours sincerely |
You may wish to delegate this process to your practice administrators , document clinical coders, or other staff as appropriate.
Patient facing information
Wessex LMCs is aware that patients are often left wondering what happens next and will come to the practice to find out. We have devised the following information for patients that might help practices communicate with patients regarding their access to their medical information and these medications.
Information for patients seeking NHS funded prescriptions:
| Dear Patient
Thank you for seeking advice about accessing weight loss medication. Currently, the NHS delivers support for weight management through multiple weight loss support organisations that are funded by the NHS. In most cases there are guidelines that govern who can access these services which are directed by NHS England. These include:
There are many easily available public weight loss support groups which you can sign up to and you can see all of these by following this link or searching for NHS weight loss services: https://www.nhs.uk/better-health/lose-weight/ If you have any questions about accessing weight loss services via the NHS we would advise you to complete an online consultation via our website, providing details of your height and weight, as well as options you have tried so far. Keeping your weight within safe limits will improve your health and we strongly support you in that journey. Yours sincerely |
Information for patients approaching the Practice for health information for a private provider of weight loss services:
| Dear Patient
Thank you for letting us know you are accessing weight management support through a private provider. The provider has requested that we (your GP practice) provide medical information for them to help them make safe decisions regarding your care. The information can safely be given to the provider via the NHS app yourself. If you are unable to do this then we can supply the same information in a computer generated summary for you to forward, although we will make it clear that this does not mean we have made an assessment as to the suitability or safety of the private provider commencing a specific treatment. The responsibility for prescribing your weight loss treatment sits with the company you have chosen. Yours sincerely |