Specialist services
Specialist weight management services – access to Semaglutide (Wegovy) and Tirzepatide (Mounjaro) in Surrey Heartlands
Surrey Heartlands commission a specialist weight management pathway that combines referrals for both medical and surgical treatments within the hospital service for obesity.
Semaglutide (Wegovy) is a weight loss drug that was approved by the National Institute for Care and Excellence (NICE) in the UK on 4 September 2023. Tirzepatide (Mounjaro) has since been approved by NICE on 23 December 2024.
The current medical pathway within our specialist weight management service utilises Semaglutide (Wegovy) as advised by NICE TA875.
There is a phased implementation with regards to the implementation of NICE TA875 in line with the guidance issued by the Society for Endocrinology and Obesity Management Collaborative UK.
Availability of Semaglutide (Wegovy)
Eligible patients
Initially, patients who meet the eligibility criteria listed in phase one of the guidance issued by the Society for Endocrinology and Obesity Management Collaborative will be prioritised for referral to the specialist weight management service. This will allow those with the combination of the highest and most urgent clinical need to be assessed.
Eligible patients will have a Body Mass Index (BMI) of 35 kg/m2 or above (-2.5 kg/m2 for ethnic minorities) and one of the following:
- Precancerous or cancerous condition in which weight loss would aid access to therapies
- Patients requiring urgent weight loss for organ transplant
- Idiopathic intracranial hypertension (IIH) requiring frequent lumbar punctures under neurology specialist and/or with visual compromise
- Patients awaiting surgery for life limiting conditions, where high BMI is the primary barrier to surgery and weight loss would be beneficial
- Weight loss required for assisted conception in women currently not eligible for fertility treatment and have been advised to lose weight
- Proven genetic cause of obesity and not eligible for Setmelanotide (Imcivree®)
- Severe (AHI > 30) Obstructive Sleep Apnoea established on CPAP
Over time, these criteria will change.
Ineligible patients
Individuals who do not fulfil the criteria, or who do not wish to receive injectable or surgical treatments, other sources of care are provided.
- Criteria: Over the age of 18 and has a BMI greater than 30 (greater than 27.5 or over more for people from South Asian, Black and minority ethnic groups). BMI reading must have been recorded within the last 12 months of referral..
Service: One You Surrey (Local Authority funded T2WMS) -
Criteria: Over the age of 18 and has a BMI of 30 or more (greater than 27.5 or over more for people from South Asian, Black and minority ethnic groups) and has a diagnosis of diabetes (Type one or Type two) or hypertension or both.
Service: NHS Digital Weight Management Programme - Criteria: Not pregnant and has diabetes with a HbA1c level between 42 – 47.9 mmol/mol (6.0-6.4%) or has a Fasting Plasma Glucose reading between 5.5-6.9 mmol/mol within the last 24 months.
Service: NHS Diabetes Prevention Programme (NHS DPP)
Availability of Tirzepatide (Mounjaro)
The National Institute for Health and Care and Excellence (NICE) published a Technology Appraisal for Tirzepatide for managing overweight and obesity (TA1026) in December 2024.
NHS Surrey Heartlands Integrated Care Board (ICB) is currently working to design a model in line with the requirements of the NICE technology appraisal with experts across the system.
This approach will involve working closely with NHS England as well as clinicians from primary and secondary care, public health colleagues, ICB clinical leads and pharmacy teams. Part of this work includes prioritising individuals who have a combination of highest and most urgent clinical need so that they can be assessed initially in line with national guidance.
At present, we are asking primary care to not initiate or continue patients on Tirzepatide for weight loss. We are awaiting a national prioritisation criteria.
Tirzepatide will be available initially via the medical pathway within our specialist weight management service as a treatment option alongside Semaglutide from 23rd March 2025. This is in line with the recommended NICE timelines for implementation.
A phased implementation approach will be undertaken, as for Semaglutide, in line with the guidance issued by the Society for Endocrinology and Obesity Management Collaborative UK. Work will continue to progress in designing a model for implementing the NICE technology appraisal across Surrey Heartlands.
NICE’s announcement on Tirzepatide: Frequently asked questions
1. What is changing in the management of obesity as a result of NICE’s announcement?
People in England over the age of 18 who are living with obesity and another weight-related health issue will be able to access the weight loss drug tirzepatide through specialist weight management services (SWMS) from spring 2025. In primary care services, access will begin in summer 2025.
Tirzepatide is currently prescribed for the treatment of type 2 diabetes but will now also be available for weight loss purposes.
2. Who can access tirzepatide?
This medication is for people living with obesity who have a body mass index (BMI) of 35 or over and a weight related health problem; or a BMI of 32.5 and one weight related health problem for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean ethnic backgrounds, as they are at a higher risk of medical problems at a lower BMI.
NHS England will provide more information early next year about exactly which weight related health problems will benefit the most from tirzepatide and which will be eligible for consideration for the medication.
3. Can I access tirzepatide straight away?
Introducing this new treatment to NICE’s estimated 3.4 million eligible patients requires the NHS in England to develop a completely new service for primary care and many healthcare professionals will need to be trained to deliver it. A staged approach will help manage demand on existing healthcare services. This allows the safe prescribing of tirzepatide and the appropriate support for patients.
Tirzepatide will initially be offered to individuals facing the most significant health risks related to their weight, starting in spring 2025 through specialist weight management services (SWMS).
Tirzepatide will not immediately be available and will not be accessible to everyone who wishes to use it. Initially, tirzepatide will only be available on the NHS to those expected to benefit the most. People who are eligible for tirzepatide through primary care services should only expect to start to get access by mid 2025.
4. What is a staged approach?
A staged approach to service rollout within primary care means NHS in England will manage the flow of patients to the health system so it does not become overwhelmed.
This approach will ensure the service is delivered safely and that the NHS in England is able to plan for an increase in service demand, whilst building specific skills and knowledge within the workforce.
5. How does tirzepatide work for weight loss?
Tirzepatide works by supressing appetite centres in the brain that control gut hormones. It decreases the appetite and slows the movement of food passing through the body, making you feel fuller for longer.
Clinical trials have shown tirzepatide can help people living with obesity lose up 20% of their starting body weight, depending on the dose and accompanying diet and lifestyle support.
Tirzepatide can only be prescribed by a healthcare professional alongside programmes which support people to lose weight and live healthier lives by making changes to their diet and physical activity
Tirzepatide comes as an injection, which can be self-administered once a week.
6. What if a patient is already receiving tirzepatide treatment?
Patients can continue taking tirzepatide if they are prescribed it to manage their diabetes.
If patients are using tirzepatide they have acquired privately, they may be able to access the medication through an NHS prescription if they meet the NICE and NHS qualifying criteria. More information about this will be made available in the new year.
7. Will everyone who is eligible have access to the drug?
Tirzepatide might not be suitable for everyone and not everyone who meets the eligibility criteria will want to use it to support their weight loss. A healthcare professional will discuss the most appropriate care and support, based on individual patient’s need. This could include behavioural support programmes, medical options including prescribing or bariatric surgery.
8. I’m currently on a waiting list for NHS specialist weight management services. Can I transfer to another list to access this drug?
A healthcare professional will determine if it is appropriate for you to receive tirzepatide as part of your care in a different care setting (for example, through primary care).
9. The NICE announcement mentions ‘wraparound’ care. What does this mean?
Any patient prescribed tirzepatide must participate in the specifically designed ‘wraparound’ care required by NICE guidance. This focuses on diet, nutrition and increasing physical activity. As NHS England develops the service, it will provide more details of the wraparound support offer for patients who qualify. Patients cannot be prescribed tirzepatide if they do not wish to undertake the wraparound care support.
10. Will there be a cost to the patient for being prescribed tirzepatide?
Normal prescription charges will apply unless you are entitled to free NHS prescriptions (for example, because you have a medical exemption certificate).