Schopwick Surgery

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Weight Loss Injections

Weight loss injections are not available for prescribing in Primary care, please see further information below:

01) Semaglutide (Wegovy®) for managing overweight and obesity –  NICE TA875 – not recommended for primary care prescribing

On 8 March 2023 the National Institute for Health and Care Excellence (NICE) published a Technology appraisal guidance on the weight-loss drug semaglutide (Wegovy®).

NICE has recommended semaglutide as an option, alongside a reduced-calorie diet and increased physical activity, within specialist weight management services, to people with at least one weight-related co-morbidity and a body mass index (BMI) of at least 35kg/m2 or between 30kg/m2 – 34.9kg/m2 who meet the defined criteria for referral to specialist services.

There has been significant media coverage and attention from members of the public.

Semaglutide for weight loss/maintenance is not recommended for primary care prescribing at the current time. It can only be initiated via specialist weight management services

This guidance is not decided by us, but rather imposed by the local Integrated Care Board (ICB) https://hertsandwestessex.icb.nhs.uk/. The ICB is the local NHS organisation that plans and oversees how NHS money is spent and makes sure health services work well and are of high quality.

The ICB have reported to us that work is being progressed with local specialist weight management services and other stakeholders to initiate the national guidance, and will issue further advice in due course.

Patients who are eligible for weight management referrals should be managed appropriately in line with current pathways.

What is the pathway for weight management services?

Currently, the pathway is as follows – patients must move across a tier system

Tier 1: Healthy eating, physical activity, population-wide services. Such as ‘Active Herts’ https://www.activeherts.org.uk/

Tier 2: The ICB have only provided the ‘NHS digital weight management programme’ for our surgery. The NHS Digital Weight Management Programme supports adults living with obesity who also have a diagnosis of diabetes, hypertension or both, to manage their weight and improve their health.

It is a 12-week online behavioural and lifestyle programme that people can access via a smartphone or computer with internet access https://www.england.nhs.uk/digital-weight-management/

Inclusion criteria:

– Must not have accessed the programme in the last 18months.

– BMI >30 (patients with BMI >50 can be referred directly to Tier 3

Tier 3:

Tier 3 weight management services offer weight management support for people who live with obesity. The service includes:

  • Psychologists/psychotherapists.
  • Weight management advisers
  • Specialist dietitians/nutritionists.

Inclusion Criteria:

  • BMI > 40  AND must have already completed two 12 courses of Tier 2 (one funded, one self-funded) in the last 12 months
  • Have BMI >35 and OTHER SIGNIFICANT DISEASE (hypocholesteraemia / Diabetes / Sleep Apnoea) that would improve if they lost weight AND must have completed two 12 courses of Tier 2 (one funded, one self-funded) in the last 12 months
  • BMI > 50 can be referred straight to Tier 3 without any other requirements

Tier 4:

GP’s cannot direct refer for Tier 4 services. At Tier 4 services options such as weight loss injections and/or bariatric surgery can be considered, via a multidisciplinary team

Inclusion Criteria:

– BMI >40 or >35 with comorbidity

– Patient must have complied with Tier 3 12-24months

– Raised BMI >5years

Where we can use semaglutide:

Ozempic® brand semaglutide pre-filled pens are only licensed for use in the management of type 2 diabetes. They should not be prescribed off label for weight loss. Prescribing should be for the management of type 2 diabetes only and this also avoids any potential pressure on the supply chain resulting in stock shortages. As per local and national guidance, this agent is a 3rd line medication, so you have to be on two other diabetes medications before we can start this. We would not tend to use this if you sugars are already well controlled.

Liraglutide for managing overweight and obesity is also not recommended for primary care prescribing.

How do I raise concerns with the health authority about this policy:

To discuss concerns with the above policy, you can contact the medicines authority directly;

Email: [email protected]

Telephone: 01992 566122.