Refused GLP-1 on the NHS? What to Do Next

Being told no by the NHS for a treatment you believe is clinically appropriate is a frustrating experience. For GLP-1 medications specifically, refusals are common, and in many cases they do not mean you have no options. They mean the NHS route is not the right route for you right now.

Understanding why you were refused, what the NHS criteria actually say, and how the private pathway works will help you move forward without losing months to a dead end.

Why the NHS Refuses GLP-1 Prescriptions

There is rarely a single reason, and the reason you receive often depends on where in the process you were refused: by your GP, by a referral triage, or by a specialist service.

Your BMI Does Not Meet the Threshold

NICE technology appraisals set the eligibility criteria for NHS Wegovy prescriptions. The headline thresholds are:

• BMI 35 or above with at least one weight-related comorbidity, OR
• BMI 30 or above through a specialist Tier 3 weight management service

If your BMI sits below 35 and you do not have a qualifying comorbidity, your GP is not in a position to refer you through the NHS pathway. Not because they lack sympathy, but because the NICE criteria do not authorise it.

Your GP Cannot Prescribe It Directly

Even if you meet the criteria, your GP cannot hand you a Wegovy prescription. NHS Wegovy prescribing sits with specialist weight management services only, at Tier 3 or above. Your GP's role is to refer, not to prescribe. If your GP has told you they cannot prescribe it, they are almost certainly correct about the mechanism, even if the outcome feels the same.

You Are On a Waiting List, Not Refused

In many cases, people receive a communication that reads as a refusal but is actually a deferral. If your GP has said "the waiting list is 12 months" or "we do not have capacity," you have not been refused. You are waiting. These are different situations requiring different responses.

The Area You Live in Does Not Have Commissioned Services

NHS commissioning varies by Integrated Care Board (ICB). Some areas have established Tier 3 weight management pathways; others are still building them. If your ICB has not commissioned the service, you may be told no. Not because you are ineligible, but because the service does not yet exist locally.

You Have a Contraindication

There are genuine medical reasons why GLP-1 might be refused:

• Personal or family history of medullary thyroid carcinoma or MEN2 syndrome
• Active pancreatitis or significant pancreatitis history
• Severe gastroparesis
• Pregnancy or breastfeeding

If you have been refused on these grounds, the clinician is making a safety judgement that applies to both NHS and private routes.

What to Do When Refused: A Practical Sequence

Step 1: Get the Reason in Writing

Ask your GP or the refusing service to confirm the reason in writing, or document it in your medical notes. This matters because some reasons can be challenged or worked around; others cannot. Knowing the specific reason you were refused also prepares you for a private consultation.

Step 2: Check If You Actually Meet the NHS Criteria

Many people refuse themselves before being formally assessed, based on an incomplete understanding of the criteria. Before accepting a refusal, verify:

• Your current BMI (calculated correctly: kg divided by metres squared)
• Whether any weight-related conditions apply (hypertension, pre-diabetes, sleep apnoea, dyslipidaemia)
• Whether you qualify for the ethnic adjustment thresholds (BMI thresholds lowered by 2.5 points for South Asian, Chinese, Middle Eastern, Black African, and African-Caribbean backgrounds)

For the full NHS eligibility breakdown, see /guides/nhs-glp1-eligibility-uk.

Step 3: Request a Formal Referral to Specialist Services

If you meet the NICE criteria, your GP has a basis to refer you to a Tier 3 weight management service. If they have declined to refer, you can request this in writing and ask for their clinical reasoning. If you disagree with the decision, you can raise a complaint or ask to see another GP.

Step 4: Consider the Private Pathway

If the NHS route is not accessible (whether due to eligibility, waiting times, or capacity), private prescribing is available and legal. The private thresholds are lower:

• BMI 30 or above (no comorbidity required at most providers)
• BMI 27 or above with a weight-related health condition

A private online consultation with a CQC-regulated prescriber typically takes 1–2 weeks from inquiry to prescription. The process involves a medical questionnaire, GP sharing or a fresh consultation, and a clinical review.

Private Route: What It Costs

Private GLP-1 prescriptions are not cheap, but they are more accessible than many assume. Costs vary significantly between providers.

Wegovy (semaglutide 2.4mg): Typically £150–220 per month at full dose. During dose escalation (months 1–5), costs are lower because you are using smaller doses.

Mounjaro (tirzepatide): Typically £140–180 per month at mid-tier doses (7.5mg–10mg). Some providers charge slightly more at 12.5mg and 15mg.

Consultation fees: Some providers charge separately for the initial consultation (£30–100). Others build it into the first month's cost.

Monitoring: Ongoing blood tests are typically not included. For a full monitoring protocol, see /guides/glp1-monitoring-protocol.

For a complete cost comparison across UK providers, see /guides/cheapest-glp1-prescription-uk.

Regulated Private Providers Worth Knowing

Not all private prescribers are equal. The key check is CQC registration (Care Quality Commission) for England, or equivalent registration from regulators in Scotland, Wales, and Northern Ireland. Any online prescriber operating legally in the UK must be registered.

For a fuller comparison of private prescribers in the UK, see /guides/best-glp1-prescriber-uk-2026.

What Happens During a Private Consultation

The private consultation process is straightforward and typically happens online:

1. Complete a medical questionnaire. This covers weight history, current medications, relevant medical conditions, and contraindications. Answer honestly: the prescriber is assessing clinical suitability, not gatekeeping.

2. BMI verification. Most providers ask you to self-report weight and height; some require a GP letter or GP record confirmation.

3. Clinical review. A prescriber (doctor, nurse prescriber, or pharmacist prescriber) reviews your questionnaire. For straightforward cases, approval often comes within 24–48 hours.

4. GP notification. Reputable providers notify your NHS GP of any private prescription. This is not just courtesy. It is important for your safety. Your GP needs to know what you are taking.

5. Prescription issued. The prescription is dispensed by the provider's pharmacy partner or sent to a pharmacy of your choice.

6. Ongoing follow-up. Private providers vary on follow-up. Some offer monthly check-ins; others are more transactional. Know what is included before committing.

Private vs NHS: Should You Wait?

This is a genuinely individual decision. Factors that favour waiting for the NHS:

• You meet the NICE criteria and the waiting list is under 6 months
• You have limited financial capacity for private treatment
• You have significant comorbidities that benefit from the multidisciplinary NHS pathway (dietitian, psychology, specialist physician)

Factors that favour going private:

• Your BMI is 30–34 and you do not meet the NHS threshold despite having weight-related conditions
• Your waiting list is over 12 months and your health conditions are deteriorating
• You can afford the monthly cost without significant financial stress
• You want to start treatment now and have time-sensitive reasons (planned pregnancy, cardiovascular risk profile, etc.)

The NHS and private routes are not mutually exclusive. Some people start privately, get good results, and eventually transition to NHS maintenance if they become eligible. Others continue privately because the access is more reliable.

Appealing an NHS Refusal

Formal NHS refusals can sometimes be challenged. The process:

1. Request a written decision explaining the clinical or administrative reason for refusal
2. Check the ICB's Exceptional Circumstances Policy. Some ICBs have a process for exceptional cases
3. Involve your GP. If they support your case, a GP-backed request carries more weight than a patient-initiated appeal alone
4. Contact your MP. GLP-1 access has become a policy issue; some MPs have been active in raising NHS access concerns

This route is slow and outcomes are uncertain. For most people, the private pathway will produce faster results than an appeal process.

When Private Is Not the Answer

Private prescribing is not appropriate for everyone:

• If you have a genuine medical contraindication, no prescriber (NHS or private) should prescribe GLP-1
• If you cannot afford the medication consistently, starting and stopping due to cost creates a worse outcome than not starting
• If you have significant mental health concerns, eating disorder history, or complex comorbidities, the multidisciplinary NHS pathway may serve you better

Be honest with yourself about your circumstances. A private GLP-1 prescription without any monitoring, follow-up, or lifestyle support is less likely to achieve durable results than a structured programme.

Staying Informed as Policy Evolves

NHS GLP-1 access policy is changing. NICE guidance has been updated multiple times since 2023, and the introduction of Mounjaro onto the NHS formulary and the cardiovascular indication for semaglutide (SELECT trial data) have expanded access for some groups.

If you were refused 12 months ago, the criteria may have shifted. Checking current guidance before dismissing the NHS route again is worthwhile.

For the most current NHS eligibility criteria, see /guides/nhs-glp1-eligibility-uk.