MPs warn slow Mounjaro roll-out is creating two-tier access

MPs have accused NHS England of prescribing the weight-loss drug Mounjaro to a 'woefully small' number of eligible patients and called for urgent action to widen access. The Commons Health and Social Care Committee says the roll-out is not ambitious enough and warns that slow progress is creating a two-tier system, with only those who can pay privately getting the treatment. The criticism centres on the scale of access rather than the drug's effectiveness.

NHS England estimated that around 2.8 million patients in England would be eligible for Mounjaro. If all of them came forward at once, the NHS would face a bill of around £15 billion over five years. The drug has therefore been phased in gradually. MPs say around 220,000 people in England will get it in the first three years, just 6 per cent of those eligible. Coverage of the report put the plan at 220,000 people by 2028 and said the NHS is phasing the roll-out over 12 years.

The current NHS criteria are tight. Patients need a BMI of 35 plus four chronic illnesses such as high cholesterol, diabetes or heart disease. The NHS expects each patient to require more than 30 medical appointments a year, which is one reason for the rationing. The report says the NHS should learn from private prescribers and provide much of the support online instead. It argues that the health service could develop a more cost-effective model, including by working with companies that already run such services, and challenges the NHS to think differently.

Access is also tightly restricted in the rest of the UK. In Scotland, a pilot project offers weight-loss jabs to a small number of patients. Kathleen, one of those on the pilot, needs to lose weight so she can have an operation safely; she has lost four stone and says the change has had a real impact on her life. A recent investigation found fewer than 800 people in Scotland had received weight-loss jabs in the three years since they were approved. Private prescriptions have soared across the UK, leading to fears of a growing gap between those who can afford the drugs and those who cannot.

The report points to a postcode lottery and says access can come down to luck or the ability to pay. One patient, Emily, lost 13 stone in total. She first lost weight through dieting and then took Mounjaro privately after finding she did not meet the NHS criteria. She said the drug helped quiet 'food noise' that had made previous attempts fail. Her case was used to illustrate how people who do not fit the NHS criteria can be left to pay for treatment themselves.

MPs say services are 'woefully inadequate' and that the care pathway is often missing. They warn that the vast majority of eligible people cannot get Mounjaro, and that wraparound, behavioural and bariatric services are not being used anywhere near as much as they should be. The committee says the government must urgently consider how the situation can be improved and that ministers need to be much more ambitious about rolling out GLP-1 treatments. It also says there must be other options for patients when the drugs do not work.

The cost of treating the consequences of obesity is put at £12 billion a year for the NHS, which the report says makes the case for faster action stronger. But clinicians warned that the health service is cash strapped and cannot simply start large numbers of patients on the medication without adequate staff, funding and time to support them. The NHS expects each patient to need more than 30 medical appointments a year, a burden the report says could be reduced by using online support.

NHS England says it is prioritising treatment for the most severe and complex cases and that more patients will get access when capacity and funding allow. The government says it is building the workforce needed to expand access to weight-loss drugs safely and will consider the MPs' recommendations. The story now turns on whether that expansion is fast enough and whether the NHS can avoid a widening split between patients who can pay and those who rely on public care.