Encyclopedia entry
NHS GLP-1 access
NHS England is rolling out tirzepatide (Mounjaro) for weight management in three phased cohorts defined by BMI threshold and the number of weight-related comorbidities. The phasing is set out in the NICE technology appraisal TA1026 (2024) and operationalised by Integrated Care Boards (ICBs) at different paces across England.
The three cohorts
- Cohort 1 (live since June 2025): BMI 40+ (37.5+ with ethnicity adjustment), four or more weight-related comorbidities.
- Cohort 2 (launches 23 June 2026): BMI 35+ (32.5+ with ethnicity adjustment), three or more comorbidities.
- Cohort 3 (expected April 2027): BMI 30+ (27.5+ with ethnicity adjustment), two or more comorbidities.
What counts as a comorbidity
Weight-related health conditions defined in NICE TA1026: type 2 diabetes, hypertension, dyslipidaemia (raised cholesterol or triglycerides), obstructive sleep apnoea, cardiovascular disease (including heart failure and ischaemic heart disease).
Ethnicity-adjusted BMI
NICE recommends a 2.5 kg/m² downward adjustment of the BMI threshold for South Asian, Chinese, Black African, and African-Caribbean populations, reflecting higher metabolic risk at lower BMI in those populations.
ICB pace variation
The 42 English ICBs operate at different paces. Some launched Cohort 1 immediately in June 2025; others took six to twelve months to commission specialist weight management services to manage referrals. PeptideClear tracks the rollout status on the ICB rollout tracker page.
Related: NHS access editorial · ICB rollout tracker · NICE TA1026 explained · ethnicity-adjusted BMI.