The LMC has been contacted by several practices concerned about private weight loss clinics writing to practices asking them for information about whether a patient has any contraindication to be prescribed medication (Wegovy/Mounjaro).
The responsibility to decide whether a patient is suitable lies with the prescriber. The LMC has issued the following statement that you can use in discussion with private clinics or patients.
LMC position statement on Wegovy / Mounjaro Prescribing by Private Providers
The Leicester, Leicestershire and Rutland Local Medical Committee has released its position statement regarding Wegovy / Mounjaro Prescribing by Private Providers.
Local Medical Committees were first established under the National Insurance Act 1911 and have been continued to be recognised by subsequent legislation (currently NHS Act 2006) and are the only independent representative body of general practice and have various statutory functions.
We have been contacted by local practices, as their statutory representatives, about requests from private providers asking practices to undertake a review of patient’s notes to check that private providers are safe to prescribe Wegovy or Mounjaro. This, by default, means that the practice takes responsibility for prescribing initiated by other organisations.
Under GMC regulations it is the responsibility of the prescribing clinician to assure themselves that their prescribing is safe – this would include taking an adequate history, examining the patient and are responsible for providing and acting on any appropriate pre-prescribing investigations. Professional medication safety guidelines (NICE) require examination of the patient. This would seem to include objective and accurate weight measurement, at initial assessment and at regular review. At no point is it expected that the provider asks the patient’s NHS GP to do this private work on behalf of other organisations. Private providers must be aware that they cannot assume that a non-response is an agreement that there are no contraindications to prescribing this type of medication.
General Practice is under extreme pressure and practices are not contracted or funded to provide this service for outside providers.
LMC Update
More patients are travelling abroad to have cheap bariatric surgery in Turkey, Egypt and other countries. If they are not entitled to NHS care, then this includes general practice.
There are some procedures that are so high risk that the LLR Bariatric Surgery service will accept referral for follow up, even if the patient did not meet the NHS eligibility requirements, and these include:
- Mini Gastric bypass, Single anastomosis Gastric bypass or OAGB (same procedure different names)
- Duodenal switch
- Biliary pancreatic diversion
- Single anastomosis duodenal switch (SADI)
- Single anastomosis sleeve ileal bypass (SASI)
If you are unsure whether a patient may fall into one of these groups, please contact one of the bariatric
surgeons for advice.
Please find below a letter than you can provide to patients and a poster which you can display in your waiting
room, and/or post on social media. Click on the images to download the files.
We have templated a guidance for practices to give to patients and a poster which can be displayed in public areas of the practice:
Since the guidance in the January Newsletter regarding the private provision of Mounjaro or Wegovy injections, there have been the following relevant announcements.
1 Guidance from the Medical Defence Union
2 Updated guidance for pharmacists by the General Pharmaceutical Council
In view of these, private pharmacists are more likely to be contacting GP surgeries for information before providing these medications to patients.
There is a tension as GPs have a duty of care to their patients, but this is unfunded work. We therefore provide the template letter below that practices can decide to use.
However, if a practice is aware that there is a contraindication for a prescription (e.g. underweight, eating disorder, history of pancreatitis) the practice should consider advising the patient and/or the private provider about this.
If a patient commences on treatment, consider adding the medication as a ‘hospital issued’ medication to ensure any interaction with medication prescribed in the future can be checked for interactions etc.
This is a developing area and the LMC will provide further updates as appropriate.
Any comments or concerns, please contact the LMC office.