NHS England moves tirzepatide prescribing into GP contract with £3,000 bonuses

England's health service has moved prescribing of the obesity drug tirzepatide — brand name Mounjaro — into the 2026/27 GP contract, offering practices up to £3,000 a year for prescribing and managing patients on it, supported by £25 million in ring-fenced funding ^[1][3]. The change took effect on 1 April 2026 ^[2].

The Department of Health and Social Care confirmed the plan on 23 February 2026 ^[1], and the BBC reported it on 24 February ^[3]. The money runs through Quality and Outcomes Framework (QOF) indicators, part of the standard GP contract in England ^[1][2]. Two new indicators track how practices identify and manage adults living with obesity, including recording BMI and referring patients into structured weight management programs ^[1].

One report describes the payment as up to £3,000 per practice actively managing patients on weight loss injections such as tirzepatide, and calls the £25 million ring-fenced ^[1]. Another describes a £3,000 average annual bonus whose size depends on the practice, plus about £1,000 a year for referring patients on to weight loss programs ^[3].

Who can get it, and where

Participation by GP practices is voluntary, and the NHS Cheshire and Merseyside integrated care board says uptake may vary between practices ^[2]. Meeting the eligibility criteria does not guarantee treatment, because prescribing depends on local service availability and clinical assessment, and the board says it cannot yet confirm which practices in its area will prescribe and that it expects a possible pause in prescribing ^[2].

National eligibility is being introduced in phases, and the sources describe the thresholds differently. Under the first group, introduced in June 2025, patients needed a BMI of 40 kg/m² or above (37.5 kg/m² for people from certain ethnic backgrounds) plus at least four of five conditions: type 2 diabetes, high blood pressure, dyslipidaemia, established cardiovascular disease and obstructive sleep apnoea ^[1][2]. One source says the criteria widen from 2026/27 to a BMI of 35 or above with four conditions, or a BMI of 40 or above with three conditions ^[1]. The other lays out a phased schedule: a second group from 23 June 2026 with four conditions and a BMI of 35 to 39.9, and a third group from 1 April 2027 with three conditions and a BMI of at least 40 ^[2]. For people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean backgrounds, the BMI applied is adjusted by 2.5 kg/m² ^[2].

Patients must also take part in "wrap-around" care covering diet, nutrition and physical activity, and cannot be prescribed tirzepatide if they decline it ^[1][2].

The incentives apply only to Mounjaro ^[3]. Wegovy (semaglutide) is not prescribed by GPs in England; it is given through specialist NHS weight loss services ^[2][3]. Mounjaro was rolled out in general practice from June 2025, with a national aim of reaching up to 220,000 patients over the first three years ^[1], and an expectation that 220,000 patients will be on NHS-provided Mounjaro by 2028 ^[3]. More than 1 million people are estimated to be using weight loss drugs, with nine in 10 paying privately ^[3].

Health Secretary Wes Streeting said access should be "based on need, not ability to pay" ^[1][3]. Katharine Jenner of the Obesity Health Alliance called the incentives welcome but said "NHS access will remain very limited and focused on those with the greatest clinical need" ^[3]. Dr Katie Bramall of the British Medical Association said the proposals do nothing to change NHS England's eligibility criteria and will not close the gap between those who can pay privately and those who cannot ^[3]. Professor Victoria Tzortziou Brown of the Royal College of GPs said GPs do not prescribe based on financial incentives and warned wider rollout could raise workload and "unrealistic expectations" among patients who may not be eligible ^[3].

Why it matters for patients

Access in England now depends partly on whether a local practice opts in, not only on whether a patient meets the national criteria ^[2]. The requirement for wrap-around lifestyle support means a prescription is tied to participation in that program ^[1][2]. The incentive money covers tirzepatide only, so patients seeking semaglutide through a GP in England are on a different path ^[2][3]. Whether this policy changes US insurance coverage, prices or availability of either drug has not been reported.

What happens next

One source dates the next eligibility group to 23 June 2026 and a third to 1 April 2027 ^[2]. NHS England expects 220,000 patients on NHS-provided Mounjaro by 2028 ^[3]. NICE has committed to reviewing the access criteria after year three ^[2].