NEWPORT, Wales — Specialist primary care clinics for prescribing and managing weight-loss drugs received widespread support in a debate at the Royal College of General Practitioners (RCGP) Annual Conference 2025 on the role of GPs in prescribing such treatments.

Speakers and delegates agreed that any prescribing should come with dedicated funding, resources, and multidisciplinary input, including nutritional and psychological support.

The debate, held amid a surge in demand for weight-loss medications, explored both ethical and practical issues.

The speakers — Dr David Mummery, a South London GP and member of the RCGP Medical Ethics Committee, and Dr Sapna Agrawal, a West Midlands GP and RCGP First Five Medical Ethics Committee Representative — discussed patient safety, equity, and system capacity.

GP delegates showed both enthusiasm and unease about the expanding use of GLP-1 receptor agonists such as semaglutide (Wegovy) and the dual GLP-1/glucose-dependent insulinotropic polypeptide agonist, tirzepatide (Mounjaro). Audience polling during the session reflected a cautiously pragmatic mood, with most favouring prescription only within specialist primary care clinics.

A ‘Cultural Phenomenon’

Mummery described the surge in demand for GLP-1 agonists as a cultural phenomenon that GPs cannot ignore. “In our medical careers, I’ve certainly never seen anything like this,” he said. “There are obviously genuine medical benefits, unarguably, for the right people.”

Reflecting on the prescribing restrictions for GPs with respect to weight-loss drugs, Mummery added, “Pharmacies are basically just selling it. They do a basic sort of health questionnaire and sell it.”

Taking a precautionary view of some online pharmacies, in particular, he asserted that provision of GLP-1 agonists had become “an almost borderline criminal activity, in terms of fake pens — almost like drug dealing.”

Nearly every GP in the room acknowledged receiving daily alerts that their patients had started GLP-1 medications privately. “It’s extraordinary the amount of people who are on it,” Mummery said. “It’s in the media every day with celebrities on it, some saying it’s brilliant, others terrible. But people are making a lot of money out of it.”

Inequality and Access

Mummery stressed the ethical issue of unequal access. “It’s pricey; it’s approaching £200. If you have money, you can access it. If you don’t, and you probably would benefit from it, you can’t.”

Under guidance from the National Institute for Health and Care Excellence (NICE), semaglutide can be prescribed for weight management in patients alongside a reduced-calorie diet and increased physical activity in adults for a maximum of 2 years, and within a specialist weight management service. The patient must have at least one weight-related comorbidity and a BMI of at least 35.0, or if their BMI is over 30.0, they must meet the criteria for referral to specialist overweight and obesity management services. NICE guidance for tirzepatide has some slight variations from that for semaglutide. 

Integrated Care Boards impose their own limits on prescribing. Mummery reminded delegates that while NICE provides clinical standards, NHS England controls the rollout budget, creating tension between guidance and capacity.

In Mummery’s South East London area, where GLP-1 agonist prescribing is considered a specialist service only, around 2000 people out of 2.2 million inhabitants are eligible. Yet, he noted, “Our patients read the news, and see, ‘GPs can now prescribe weight-loss jabs on the NHS.’ That becomes their take-home message.” He asked delegates, “How many of you have had quite long, prolonged conversations with patients explaining why they can’t have it on the NHS? [I]t takes up an enormous amount of time.”

‘Not a Magic Fix’

Mummery urged caution against viewing these drugs as a simple solution. “They’re not a magic fix,” he said. “The evidence is that once you stop taking it, people put on weight rapidly, sometimes more than before. People are actually supposed to be on it for years, to actually get the health benefits.” 

He queried whether long-term use may shift attention away from addressing root causes such as diet, poverty, and food inequality. “Should we just inject ourselves rather than address those issues?”, he asked. “It may take the focus off doing that and medicalise everyone.”

He noted that side effects, though variable, are real. “[Gastrointestinal] upset, pancreatitis, [and] gallbladder disease have been reported, and you’ve got to be very careful if there’s a history of thyroid cancer, where it’s contraindicated [depending on the type of thyroid cancer].” He also flagged more subtle concerns, including hair loss, muscle loss, and bone density decline, particularly for older users.

Beyond side effects, the issue of system capacity loomed large. “General practice is under huge strain,” Mummery said, adding that “there are also issues around monitoring, governance, and medicolegal accountability, as well as whether there should be some sort of shared care agreement with other stakeholders involved with patient and prescribing management.” 

Mummery said: “We, in general practice, can’t absorb more unfunded work and responsibility without proper funding and monitoring, which does not exist at the moment. I don’t think anyone would argue the current situation is satisfactory.”

Case for Clinical Stewardship

In contrast, Agrawal argued that GPs are best placed to prescribe safely and equitably, provided they have appropriate frameworks and funding. “Medical oversight is critical,” she said. “As GPs, we assess the patient’s overall health, medications, and risks before prescribing. None of that happens when you buy it online.”

She cited recent data showing that only 188,000 patients currently access tirzepatide through the NHS, while around half a million obtain it privately.

“If we had 2 million NHS patients on Mounjaro, the cost would be around £2.8 billion, based on private pricing, and that is still only 14% of what the NHS spends annually on obesity. So we could be saving money overall if we prescribe responsibly,” she argued.

‘Hope Must Be Handled With Care’ 

Agrawal acknowledged risks such as counterfeit products, social media hype, misuse, and pressures around body image but emphasised that properly monitored prescribing can transform lives.

“In the fight against obesity and type 2 diabetes, yes, Mounjaro offers us real hope. But hope must be handled with care,” she said. “GPs can screen effectively, monitor longitudinal outcomes, and adjust treatment doses.

“Letting people buy powerful medications without guidance is like handing over a surgical tool to anyone who asks for it. It doesn’t make treatment easier; it makes it dangerous.”

She highlighted the need for structured monitoring, regular reviews, and multidisciplinary input, including nutritional and psychological support. 

Audience Reflections

Delegates raised concerns that focusing solely on weight loss could mask malnutrition. One GP described a patient who lost nearly half her body weight while surviving on “white toast and a bread roll perday, with no nutrition whatsoever, in my opinion.”

The delegate highlighted that if specialist clinics were the way forward then capacity to accommodate nutritional advice was also needed to encourage behaviour change. 

Other audience members suggested the debate was already moving beyond if to how the prescribing of weight loss medications would be managed.

“It’s inevitable we will be prescribing these drugs. There are over a hundred in development,” one GP observed. “If we want control, we must be proactive and design the system rather than react to it.”

The session concluded with another live poll in which most supported specialist-led prescribing within primary-care networks, rather than open access or total exclusion. And, for both speakers, the takeaway was to find a balance.

Agrawal asserted that “GPs should be the gatekeepers. Let’s keep the prescription pad where it belongs — that is in the hands of qualified GPs — because when it comes to your health, convenience should never come before safety.”

“We can’t medicalise everyone. We need funding, monitoring, and honest conversations about diet, poverty, and the causes of obesity,” Mummery concluded.

The chair, Michael Mulholland, RCGP’s Honorary Secretary, agreed and welcomed the majority conclusion. “It’s good to see an audience that is wanting to support lifestyle modification and hear that general practice does not want to medicalise every ill that comes along,” he said.