Less than half of England’s population currently has access to the weight-loss drug tirzepatide, commercially known as Mounjaro, through their general practitioners (GPs), months after the National Health Service (NHS) officially began rolling out the treatment. Although the NHS’s phased introduction of this novel injectable therapy commenced over two months ago, a thorough investigation reveals significant disparities and limitations in accessibility, funding, and communication across the country. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist, has shown remarkable efficacy in promoting weight loss and improving metabolic health in obese patients, yet its promised widespread availability appears far from realization.
The NHS, along with its regulatory and financial oversight body, the National Institute for Health and Care Excellence (NICE), adopted a phased approach to distributing tirzepatide therapy over a 12-year period, starting on June 23, 2025. This cautious and prolonged timeline reflects concerns about the drug’s high cost and the enormous potential patient pool—estimated at approximately 3.4 million eligible individuals within England alone. However, inquiry responses indicate that only 18 out of 42 commissioning bodies—a mere 43%—have initiated prescribing tirzepatide in alignment with this scheduled rollout. This levies serious questions about whether equitable distribution and patient access are achievable under the current NHS framework.
Further compounding the issue is the allocation of financial resources. Integrated Care Boards (ICBs), the local health organizations responsible for planning and delivering services, have reported substantial underfunding. Despite NHS England’s projection anticipating that around 70% of eligible patients would pursue treatment, only nine ICBs have confirmed receipt of sufficient NHS funding to cover at least 70% of their eligible populations for tirzepatide therapy. Such funding deficits prevent many regions from meeting demand and limit the ability of GPs to prescribe this drug broadly, ultimately frustrating patients’ expectations and clinical benefit.
The financial shortfall and insufficient communication with patients have generated palpable distress and uncertainty among both patients and primary care practitioners. ICBs find themselves entrenched in challenging budgetary quandaries, forced to make difficult decisions that balance patient needs against constrained financial realities. In fact, among 40 ICBs responding to inquiries, four revealed that their allocated funds suffice to treat only 25% or fewer of their eligible patients, with Coventry and Warwickshire faring worst at just 21%. The ramifications suggest serious inequities, leaving large numbers of patients unable to access potentially transformative obesity treatments.
Moreover, rationing efforts are reportedly underway in some areas, with five ICBs considering further tightening prescribing criteria beyond the agreed phased plan or even imposing additional restrictions. For instance, Birmingham and Solihull ICB disclosed that its funding covers only 52% of eligible patients and emphasized the necessity for “difficult decisions” aimed at maximizing cost-effectiveness and achieving the greatest overall patient benefit. This reality underscores persistent tension between clinical ambition and budgetary limitation, indicating that rationing and prioritization could become the norm rather than the exception.
Within metropolitan areas such as London, the disparity remains stark. Of the five ICBs serving the capital, only South West London has reported commencing tirzepatide prescribing. Meanwhile, general practices across the country, including in regions like Suffolk and North East Essex where funding covers just 25% of eligible patients, have posted notices instructing patients not to contact GPs regarding the treatment. These messages highlight a troubling communication gap that may exacerbate patient frustration by fostering a perception of unavailability and eroding trust in the healthcare system.
Leading voices within the medical community have called for clearer messaging and greater transparency regarding access criteria and funding provisions at the ICB level. Tamara Hibbert, chair of Newham Local Medical Committee, stresses the importance of managing patient expectations by providing explicit information about what the NHS can realistically offer. Meanwhile, co-chair of the Doctors’ Association UK, Ellen Welch, criticized the rollout as “not fit for purpose,” pointing to a stark disconnect between optimistic national announcements and the restrictive reality experienced at local healthcare levels.
The continuing underfunding of tirzepatide access threatens to ripple into future years, raising concerns about sustainability as the candidate pool for weight-loss therapy inevitably expands. Modeling by health experts suggests that the initial NHS objective of treating approximately 220,000 patients within the first three years is overly ambitious given current funding. Jonathan Hazlehurst, a specialist at the University of Birmingham, highlights that first-year funding barely covers 10% of target patients, suggesting that the initial rollout has failed to adequately account for clinical demand or urgency.
Furthermore, Hazlehurst warns that many patients who require “urgent and immediate treatment” remain deprioritized under existing eligibility criteria. The paucity of resources and stringent guidelines deny critically obese patients timely access to this innovative treatment that could reduce comorbidities and improve quality of life. This issue reflects broader systemic challenges in balancing population health management with economic realities, particularly when deploying costly pharmacotherapies in public healthcare systems.
From a broader clinical perspective, tirzepatide represents a paradigm shift in obesity pharmacotherapy. By simultaneously targeting multiple incretin pathways, it not only promotes significant weight reduction but also improves glycemic control in type 2 diabetes and modulates appetite regulation, making it a highly versatile treatment option. The discrepancy between its demonstrated clinical benefit in trials and the restricted availability across NHS England thus represents a significant missed opportunity in tackling one of the nation’s most pressing health crises.
Nicola Heslehurst, president of the Association for the Study of Obesity, expressed profound disappointment with the evident disparity between need and provision, characterizing the situation as “another blow for people living with obesity who deserve evidence-based care.” She further condemned the current commissioning model, which she argued perpetuates a “postcode lottery” in obesity management, where access depends heavily on geographic location rather than clinical necessity or equity principles. Such a system undermines public trust and risks exacerbating health inequalities at a time when effective interventions are urgently needed.
In sum, while the NHS’s adoption of tirzepatide is a promising advancement in obesity treatment, the rollout strategy has thus far fallen short of equitable implementation. Funding constraints, inconsistent prescribing practices across ICBs, poor public and professional communication, and the looming threat of further rationing all paint a picture of a program struggling to deliver on its potential. Without swift remedial action—including adequately aligning funding with estimated patient need and transparent communication frameworks—patients and healthcare providers alike face ongoing uncertainty and frustration, with critical health benefits delayed for many.
At the time of reporting, NHS England had not responded to inquiries regarding these concerns, leaving many questions unanswered about how the service intends to address the evident disparities and fulfill its commitment to expanding access. The evolving story of tirzepatide’s implementation within England’s NHS thus underscores the complex interplay of innovation, economics, and health equity in modern public healthcare delivery.
Subject of Research: Not applicable
Article Title: Mounjaro: less than half of England has NHS access to jab months after roll-out, distressing patients and GPs
News Publication Date: 4-Sep-2025
Web References: http://dx.doi.org/10.1136/bmj.r1855
References: News article from The BMJ
Image Credits: Not provided
Keywords: Weight loss, Health care
