💷 What do I need to know?
This template supports review and monitoring of patients prescribed tirzepatide under the NHS obesity medication pathway.
While there is no direct QOF payment, accurate use ensures:

• Compliance with NHS Funding Variation review requirements

• Safe continuation of tirzepatide in eligible patients

• Appropriate stopping where criteria are no longer met

• Support for correct funding and reduced prescribing risk

📊 High-level overview of the specification requirements
This template supports:

• Recording of weight, BMI, and percentage weight loss at review

• Assessing continued suitability for tirzepatide

• Checking medication side effects and tolerability

• Documenting maximum tolerated dose status

• Completing wraparound care pathway review

• Stopping medication where pathway criteria are not met

📌 What do you need to know?

📖 Reference Guidance

• Review NICE Practical Guide before completing review

• Check BNF cautions, interactions, SmPC, and local policy

🩺 Obesity Medication Review

• Tick to confirm review completed

✅ Continued Suitability for Tirzepatide

• Select Yes or No for continued prescribing eligibility

💊 Maximum Tolerated Dose

• Record whether patient is on maximum tolerated dose

⚠️ Side Effects Check

• Tick to confirm medication side effects reviewed

• Note: Tirzepatide is a black triangle drug – report suspected adverse reactions via MHRA Yellow Card

🚫 Stopping or Declining Pathway

• Tick if unsuitable for NHS obesity medication pathway

• Tick if obesity medication has been stopped

📏 Measurements

• Height (cm)

• Baseline weight (kg)

• Current weight (mandatory at every review)

• Percentage weight loss from baseline

• BMI (kg/m²)

ℹ️ Weight Loss Criteria

• If <5% weight loss after 6 months on highest tolerated dose → reassess continuation based on risk/benefit

🤝 Wraparound Care

• Tick if NHS obesity medication wraparound support pathway completed

• Note: National wraparound care is 9 months duration

💡 Hints and Tips

• Always record current weight – it is mandatory for every review

• Use the percentage weight loss calculation to guide continuation decisions

• If patient has not achieved 5% loss after 6 months at maximum dose, consider stopping

• Ensure side effects are actively monitored and documented – this is a black triangle drug

• Check wraparound care engagement – this is linked to ongoing prescribing eligibility