NHS England » Tirzepatide (Mounjaro®) in primary care for weight management: information on wraparound care

When tirzepatide (Mounjaro®) is prescribed for weight management, the National Institute for Health and Care Excellence (NICE) Technology Appraisal TA1026 “Tirzepatide for managing overweight and obesity” and the Medicines and Healthcare Products Regulatory Agency (MHRA) product licence confirm that structured wraparound care is a required treatment component.

Essential elements of wraparound care

Wraparound care consists of 2 distinct components. Both are essential for safe, co-ordinated and patient-centred prescribing and to ensure that patients are supported to achieve and maintain meaningful, sustainable health benefits.

Clinical support

Clinical support is the responsibility of the prescribing healthcare professional or clinical service to ensure medical oversight, appropriate reviews and follow up, and patient safety throughout the course of treatment. It includes:

assessment and prescribing, including eligibility assessment, safe prescribing and dose management and titration
regular medication reviews, including monitoring treatment response, and identifying non-responders, as well as proactive management of comorbidities, side effects, drug interactions, broader clinical risks and patient safety
integrated care planning, ensuring that tirzepatide (Mounjaro®) is fully integrated into the patient’s ongoing care
timely referrals to other clinicians based on individual need, ensuring additional clinical input is provided when needed, recognising that effective obesity treatment extends beyond medication alone

Behavioural support

Behavioural support focuses on delivering structured interventions to support patients receiving tirzepatide (Mounjaro®) with long-term sustainable diet, nutrition and physical activity routines. Behavioural support programmes have been designed specifically for patients taking the medication, using evidence-based behavioural change methods and psychoeducational principles, which aim to:

support patients to develop sustainable habits that improve metabolic health, physical wellbeing, and quality of life
promote balanced nutrition, energy regulation, and satiety through informed dietary choices, recognising the importance of maintaining nutritional intake in the context of reduced satiety while taking the medicines
equip individuals with practical tools to make informed decisions about movement, food and self-care
build understanding of how nutrition influences health and body composition, not just weight
acknowledge obesity as a chronic, relapsing condition shaped by biology, environment and psychology
foster non-stigmatising engagement, health literacy, and personal agency in managing weight related health
provide accessible, non-clinical support alongside prescribing pathways, distinct from medical monitoring, with signposting to local services where appropriate.

Dual-approach delivery

Delivery pathways are in place to ensure patients eligible for tirzepatide (Mounjaro®) under the NHS England interim commissioning guidance can access both behavioural and clinical support.

Clinical support delivery

This is provided by the prescribing healthcare professionals in primary and community care settings, with initial assessment, followed by monthly titration and monitoring appointments, with ad-hoc appointments or referrals to additional services as necessary. As part of the total funding allocation in 2025/26 to integrated care boards (ICBs), NHS England has made a targeted allocation of funding to support the implementation of tirzepatide (Mounjaro®) in primary care.

Behavioural support delivery

The MHRA product licence for tirzepatide (Mounjaro®), as well as NICE guidance, requires that patients taking the medication receive behavioural support. A referral to behavioural support is made by the primary care teams prescribing tirzepatide (Mounjaro®).

Depending on local ICB commissioning, behavioural support is provided either through the nationally funded and procured “The Healthier You: NHS Behavioural Support for Obesity Prescribing” service or by a locally commissioned equivalent service. ICBs will provide information about how behavioural support is commissioned for each local area. Contracted providers work directly with ICBs to integrate the service into local care pathways and make it accessible from primary care.

The nationally procured “The Healthier You: NHS Behavioural Support for Obesity Prescribing” service is delivered over 9 consecutive months, and can be delivered digitally, remotely or face to face. Patients should be able to choose which 1 of these methods best suits their needs. It is delivered by suitably trained staff, who may not be clinicians.

It should be noted that patients receiving weight-loss medications through specialist weight management services will not require referral to a behavioural support service, as behavioural support is provided through the specialist weight management service.

Behavioural support: complementing not replacing clinical care

A behavioural support service aims to compliment, not replace clinical care. Patients can benefit from structured and standardised behavioural wraparound support, while also receiving appropriate tailored person-centred clinical care through existing local pathways.

An appropriate behavioural support programme:

does not provide individualised medical advice or management of medication
does not replace the need for specialist input where clinically indicated; it remains the responsibility of the prescribing clinician or referring team to assess the patient’s needs across all aspects of health, including physical, psychological, and mental health and wellbeing
confirms each patient’s engagement and attendance with the relevant prescribing clinician or referring team, supporting a joined-up approach to patient care
signposts patients back to prescribing teams for any individualised medical advice or clinical management needs that arise

Further explanation of the different roles and responsibilities of clinical and behavioural support services can be found in the appendix.

Appendix: Clinical and behavioural support – roles and responsibilities

The principles and distinctions between clinical and behavioural components of wraparound care for patients prescribed tirzepatide (Mounjaro®) in primary care for the management of obesity.

	Behavioural support	Clinical support
Wraparound care	Provide behavioural support as part of the 2 elements of wraparound care (also clinical support) and explain the importance of engaging with both as part of the complete treatment pathway.	Provide clinical support as part of the 2 elements of wraparound care (also behavioural support) and explain the importance of engaging with both as part of the complete treatment pathway.
Workforce training and competencies	Sessions may be delivered by non-clinical staff.	Clinical management by responsible registered healthcare professional, such as GP or specialist prescriber.
Eligibility	Not required to assess eligibility	Clinical assessment for tirzepatide (Mounjaro®) eligibility in the management of obesity. Considering individual patient factors to determine if primary care prescribing is the most appropriate pathway. Identify if referral to additional specialist services may be clinically appropriate.
Weight management pharmacology	Overview of how tirzepatide (Mounjaro®) will impact the service user, including suppression of appetite.	Risks and benefits of starting tirzepatide (Mounjaro®) following NICE guidance and using relevant resources.
Comorbidities	Acknowledgement that tirzepatide (Mounjaro®) may influence wider aspects of health and wellbeing beyond weight management.	Individualised clinical support around effect of tirzepatide (Mounjaro®) on comorbid conditions. Appropriate clinical reviews, including medication titration reviews and deprescribing when appropriate.
Medication interactions	General information sharing that tirzepatide (Mounjaro®) can affect the absorption of other medications being taken. In some cases, this may affect how well and/or how fast those medications work; or it may make no difference.	Monitoring any impact of tirzepatide (Mounjaro®) on other medications, using relevant resources, for example, British National Formulary (BNF) and NICE prescribing guides, including, but not limited to, advice regarding contraception.
Side effects	Overview of common side effects and how nutrition and physical activity can be used to help alleviate some side effects. (See nutritional advice section.)	Individualised support around specific side effects, management of side effects, drug interactions, and how medication doses or titration schedule may need to be altered to manage side effects.
Expected weight loss	Acknowledge that weight loss is expected while on tirzepatide (Mounjaro®) due to the mechanisms of action. Confirm and reiterate there is no specific guidance on the expected trajectory of weight loss and that a minority of patients may lose only a very small amount of weight.	Discuss specifics of weight loss, consider using NICE resources (for example, NICE discussion aid for healthcare professionals and patients). Identify and manage non-responders or those with unusually rapid weight loss.
Nutritional advice	Supporting patients to understand the impact of weight loss medications on appetite, satiety, and food preferences and the importance of diet quality to improve long-term metabolic health outcomes. The influence of dietary and nutrition habits on gastrointestinal side effects when using weight loss medications. Ensuring patients have the knowledge necessary to help them make choices to ensure healthy macro and micronutrients dietary requirements in the context of a diet that consists of reduced portion sizes. Empowering patients who have specific dietary requirements, for example, vegetarian or vegan, to understand what adequate nutrient intake is appropriate for them. Supporting patients to understand the importance of nutritionally complete meals.	General advice about nutritional intake in the context of tirzepatide (Mounjaro ®) prescription. Identify when referral to additional services may be clinically appropriate, for example, dietetics.
Physical activity advice	Empowering patients to increase their day-to-day movement levels. Embedding resistance and strength focused physical activity as a cornerstone of health, rather than weight loss alone. Tailoring recommendations to provide personalised movement plans to the patient’s capacity and baseline, prioritising muscle retention, cardiovascular health, mobility, and confidence. Providing a range of supportive, positive pathways into activity that are inclusive and sustainable, avoiding shame based or punitive models. Enabling patients to connect activity with outcomes, including improved mood, energy, metabolic health, and independence, rather than focusing on weight loss.	General advice on undertaking physical activity in the context of tirzepatide (Mounjaro ®) prescription. Identify when referral to additional services may be clinically appropriate, for example, physiotherapy.
Psycho-educational advice	Supporting patients to understand the impact of mental wellbeing and lack of sleep on weight management. Signposting to the prescribing healthcare professional or team for further advice if there are specific concerns regarding a patient’s psychological wellbeing.	General advice centred on holistic patient management and the impact of sleep and mental health. Identify when referral to additional or alternative services may be clinically appropriate, for example, talking therapies, local mental health services, eating disorder services or specialist weight management services.
Stopping tirzepatide (Mounjaro ®)	Empowering patients to take informed actions and make lifelong, sustainable choices that promote long-term health and can be maintained independently to medication use. Signposting to the prescribing healthcare professional or team to discuss making changes to the medication, including stopping treatment.	Assessment of weight loss as a key part of clinical review, including progress after 6 months at the maximum tolerated dose and whether treatment should continue. Shared decision-making on when and how to stop the medication if circumstances indicate this should be considered and how to minimise weight re-gain in such situations.

Further resources

Publication reference: PRN02199

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