FOI 2025/1357

Thank you for sending over the information I requested. Unfortunately, there appears to be a disconnect between what is written and what is actually happening in the field. For example: neither Semiglutide nor liraglutide are available to patients in GM under specialist weight management services (SWMS), despite their NICE TAs dating back as far as 2021 for liraglutide. Furthermore having fully reviewed NHSE’s interim commissioning “guideline’s” they very clearly state:

https://www.england.nhs.uk/wp-content/uploads/2025/03/PRN01879-interim-commissioning-guidance-implementation-of-the-nice-technology-appraisal-ta1026-and-the-NICE-fu.pdf

“Eligible patient cohort phasing and related setting of care
The NICE Funding Variation outlines a 90-day funding mandate in specialist weight management services for the full eligible population and a 180 day funding mandate in primary care settings in line with the prioritised patient cohorts set out by NHS England
o Implementation in NHS specialist weight management services
From 24 March 2025 (90 days after NICE final guidance publication), ICBs are required to meet the costs of funding access to tirzepatide (Mounjaro®) for the management of obesity in NHS specialist weight management services for any person who meets the eligibility criteria in the NICE TA1026 and where the treatment is approved by a prescribing clinician.
o Implementation in NHS Primary Care Settings
ICBs are required to meet the costs of funding access to tirzepatide (Mounjaro®) for the treatment of obesity in primary care settings from 23 June 2025 (180 days after final guidance publication), alongside other available treatment options, to patient cohorts on a phased basis. Tirzepatide (Mounjaro®) will be made available to prioritised cohorts in primary care settings during an initial phased implementation period, which reflects the available capacity in primary care. The initial implementation period will be used to evaluate and make the necessary arrangements to safely and efficiently scale a variety of implementation service models in primary care.”
As someone who was and continues to be under SWMS in GM , I know that Tirzepatide has not been funded despite the contracted provider, MoreLife, wanting to prescribe it and having capacity to do so, given it does so for other ICBs.

I suppose what I should ask is how many and which NICE TA approved drugs have NOT been made available to patients in GM in accordance with the criteria set out in their respective TA’s, in the last 5 years?

I hope you can understand why I need to ask for this information as I have also received a FoI response from NHSE. They stated:

“Commissioners have a statutory responsibility to make funding available for a drug or treatment recommended by a NICE within a time frame specified by NICE (usually 90 calendar days). Compliance is achieved when a patient, after discussion with a clinician, is able to choose a NICE-recommended treatment without any local funding or formulary restrictions. This duty can be found under Section 7 of the National Health Service (Standing Rules) Regulations 2012 (SI 2012/2996). The NHS Constitution also states that patients have the right to medicines and other treatments that have been recommended by NICE for use in the NHS, if their doctor believes they are clinically appropriate.

If a commissioner does not make a treatment available as per the NICE guidance, then they open themselves to potential legal challenge of failing to follow the 2012 regulation above. There are also a series of other checks and balances, operated by NHS England and others, to encourage ICB/provider compliance with their legal obligations for funding medicines. “

Thank you for your follow-up request regarding the availability of NICE Technology Appraisal (TA) approved GLP-1 receptor agonists for weight management within Greater Manchester (GM).

1. Statutory responsibilities under NICE TAs
NHS GM Integrated Care Board (ICB) recognises its statutory duty under Section 7 of the National Health Service (Standing Rules) Regulations 2012 (SI 2012/2996). This requires commissioners to make funding available for medicines and treatments recommended by NICE within the specified timeframes. In line with the NHS Constitution, patients have the right to medicines and treatments recommended by NICE if their clinician believes they are appropriate.

2. Position in GM – weight management indications
• NICE has approved three GLP-1 receptor agonists for weight management: liraglutide (TA664, 2020), semaglutide (TA875, 2023), and tirzepatide (TA1026, 2024).

• In GM, we have adopted NHS England’s (NHSE) eligibility criteria and phased rollout for tirzepatide for weight loss across both primary care and Specialist Weight Management Services (SWMS). GM has also applied local prioritisation within Cohort 1 to manage capacity and ensure equity. Prescribing is therefore being prioritised by clinical need, in line with NHSE’s cohort definitions (BMI and comorbidity thresholds) and the locally agreed sub-cohorts.

• GM has now put in place an approach to ensure that all three NICE-approved GLP-1 receptor agonists for weight management (liraglutide, semaglutide, and tirzepatide) are commissioned in line with NHS England’s defined cohorts and funding allocation. Prescribing of liraglutide and semaglutide is being introduced via SWMS, using the same eligibility criteria and phased rollout as for tirzepatide. This ensures equity, financial sustainability, and consistency across GM.

• Primary care commissioning of tirzepatide for weight management is planned to go live in late September / early October 2025, with a coordinated roll-out across all GM localities. This timing was agreed to ensure consistent communications and to avoid inequalities in access across different areas.

• Capacity is limited: NHSE has funded approximately 700 patients across GM in 2025/26 (Year 1, Cohort 1).

• Further detail on GM’s commissioning position is available in the GM Commissioning Statement on tirzepatide for weight management, which also includes GM’s position on liraglutide and semaglutide .

3. Clarification of compliance
• For weight management: From late September / early October 2025, all three NICE-approved GLP-1 receptor agonists will be commissioned in GM, with access aligned to the NHSE-defined cohorts and available funding. This approach ensures that prescribing is prioritised according to clinical need, while supporting equity and financial sustainability across the system.

• It is important to note that while this approach means not all NICE-eligible patients will access treatment immediately, NHS GM is implementing tirzepatide in line with NHSE’s national funding variation and phased rollout, which prioritises those at highest clinical risk first. This ensures equity, patient safety, and sustainability, and provides assurance that GM is acting consistently with national guidance and funding allocation.

• This approach ensures alignment with NHSE’s commissioning policy and funding variation.

4. Legal and governance assurance
• The phased implementation, limited to NHSE-defined cohorts, reflects national funding arrangements and ensures that GM does not exceed its mandated budget envelope.

• This is consistent with NHSE’s own commissioning guidance, which explicitly states that primary care implementation will be “on a phased basis” to reflect available capacity and funding.

• GM ICB is therefore compliant with its statutory obligations: NICE-approved medicines are being made available, subject to the nationally defined phased rollout and funding allocations.

• Where GM previously did not provide access (e.g. liraglutide, semaglutide for weight loss), this has been formally acknowledged and rectified as of September 2025 through GM consultation.

Summary
• For weight management, prescribing is scheduled to commence in primary care in late September / early October 2025 under a GM-approved service specification.

• Access is limited to NHSE-defined priority cohorts and to ~700 patients in 2025/26 (Year 1) due to national funding restrictions.

• While this means not all NICE-eligible patients will receive treatment immediately, NHS GM is implementing tirzepatide in line with NHSE’s national phased rollout and funding variation, ensuring equity, patient safety and consistency across the system. For those in whom semaglutide or liraglutide are more appropriate, they will be made available through SWMS. Tirzepatide will be available via both SWMS and primary care.