Weight Loss Medication

MEDICAL THERAPY STATEMENT 29TH JULY 2024

Thank you for your interest in GLP-1 medical therapy for weight loss. Over the last few years, the demand for these therapies has been unprecedented. Unfortunately what is represented in the media and through the private sector is not representative of what is currently possible within the NHS. Despite various drugs being licensed and approved by the National Institute for Health and Care Excellence (NICE) for weight loss, actual implementation within most NHS services across the country has been challenging for a number of key reasons:

1. Certain drugs have been limited to prescribing within specialist weight management services only. Only 44% of NHS Trusts provide specialist obesity services (Tier 3). This places existing services such as ours under immense pressure – increasing waiting lists and workload for an already overstretched workforce. This means we can not safely serve every patient who meets criteria. As consistent with the national position and endorsed by our Drugs and Therapeutics Committee,  roll-out will therefore be done in phases. We will initially focus on the highest risk patients for phase 1 and there are clear criteria for this phase. If you meet these criteria then we will inform you. If you do not meet these criteria, we will not routinely inform you but you will be provided with this statement should you request further information. We are unable to respond to repeated demands unless there has been a relevant change in your clinical status as this places additional demand on staff and compromises care for other patients. Repeated or aggressive demands will follow Trust behavioural policy.
2. There has been an increased global demand for GLP-1 analogues outpacing increases in manufacturing capacity, exacerbated by wide-spread cross-prescribing of GLP-1 analogues indicated for diabetes. In June 2023, a National Patient Safety Alert was published indicating that no new prescriptions should be initiated for certain drugs. This places increasing pressure on available drugs and means that we must work to manage supply for the highest risk patients
3. Anecdotally, many patients have been unable to obtain the medication and have resorted to purchasing privately, through the black market or from abroad. This has led to further confusion and mixed messaging.
4. GLP-1 prescription pathways lead to increased costs and staffing needs for the service. It is crucial that these pathways are mapped out with appropriate support for follow up and reliable prescription delivery across a wide geographical region such as ours. This is a significant process which requires extensive work and agreement. It is essential that this is done safely so we do not place any patients at risk.

Based on these factors, we will adopt a phased approach to delivery of medical therapy. This position of Bedfordshire Metabolic Institute Tier 3 is consistent with national guidance for implementation. Our key priorities are to ensure that we start provision of GLP-1 therapy but do this safely and effectively.  As with any prescription, it is vital that people are screened and receive appropriate support alongside. Whilst we work towards shared decision making, it is ultimately a prescribers decision as to whether to prescribe a drug.

We appreciate from working with people living with obesity the detrimental impact it can have on both physical and emotional health. Therefore it is understandable that limitations around accessing medical and other therapies can be frustrating. We hope the above therefore provides clarity for why a phased approach is being taken. Thank you for your understanding.

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