Over 200,000 patients may be eligible for treatment in the first three years, but some commissioners are already considering tighter prescribing criteria or rationing
Figures confirm the fear that the roll out is not fit for purpose, says expert
Less than half of England has access to tirzepatide (Mounjaro) through their GP, despite the NHS roll-out of the weight-loss jab officially starting over two months ago, an investigation by The BMJ has found.
Due to the large number of people who could benefit from tirzepatide – an estimated 3.4 million people – and the drug's price, NHS England and its spending watchdog, the National Institute for Health and Care Excellence, agreed the injections would be rolled out in phases over a 12-year period, which commenced on 23 June 2025, explains Elisabeth Mahase. Yet just 18 out of 42 commissioning bodies (43%) across the country confirmed that they have started prescribing tirzepatide in line with this roll-out plan.
The data, obtained through Freedom of Information requests, also shows that despite NHS England stating that it expects 70% of eligible patients to come forward for treatment, just nine Integrated Care Boards (ICBs) – responsible for planning health services for their local population – confirmed they have been allocated enough NHS funding to cover at least 70% of their eligible patients.
Experts are warning that the lack of funding and poor communication to the public about the roll-out are driving "distress and uncertainty both in patients and primary care" and have left ICBs in a difficult financial situation.
Of the 40 ICBs that responded to The BMJ's request, four reported that the NHS funding they had received covers just 25% or less of their eligible patients, with Coventry and Warwickshire faring the worst at 21% of its patients.
And five ICBs have said they are already considering further tightening the tirzepatide prescribing criteria or rationing the treatment beyond this 12-year phased plan.
Birmingham and Solihull ICB says it received funding to cover just 52% of its eligible patients, and said: "Difficult decisions are having to be made to ensure money is spent in the most effective and efficient way possible and for the greatest patient benefit."
In London just one out of the five ICBs – South West London – has started prescribing tirzepatide, while notices urging patients not to contact their GP as they cannot provide these drugs have been posted by practices around the country, including in Suffolk and North East Essex – where funding for just 25% of eligible patients has been provided.
Tamara Hibbert, chair of Newham Local Medical Committee, says: "While there is significant potential for these drugs to benefit patients, the messaging needs to be clear about what they can expect in terms of the criteria for accessing them on the NHS and the funding available at an ICB level."
Ellen Welch, Doctors' Association UK (DAUK) co-chair, says: "These figures confirm the fear that the roll out is not fit for purpose. There is a huge discrepancy between national messaging and what patients are actually being delivered on a local level."
Others warn that the underfunding will have a knock-on effect for the following years, especially as more people will become eligible each year.
Jonathan Hazlehurst at the University of Birmingham, says: "NHS England is talking about treating 220,000 patients in the first three years, but we can see that the initial funding for year one clearly only covers approximately 10% of that." He also warns that there are patients who would "benefit from really urgent and immediate treatment" with tirzepatide, but are not currently considered a priority.
Nicola Heslehurst, president of the Association for the Study of Obesity, says the deficit in funding compared with need "is another blow for people living with obesity who deserve evidence-based care to manage their health needs," adding that the current commissioning model has set up a "postcode lottery" of who can access obesity care.
The BMJ contacted NHS England for comment, but received no response at the time of publication.
