NHS GLP-1 Rollout Tracker: Which ICBs Are Commissioning Mounjaro and Wegovy in 2026

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In March 2024, NICE published technology appraisal TA1026, recommending tirzepatide (sold as Mounjaro) as an option for managing obesity within the NHS in England, alongside its earlier guidance on semaglutide 2.4 mg (sold as Wegovy) under TA875. That made the medicines, in principle, NHS-funded for adults who meet the eligibility criteria. In practice, the rollout was devolved to the 42 English Integrated Care Boards (ICBs), each of which sets its own commissioning timetable, service-model design, and referral route. As of mid-2026, the rollout is partial and uneven. Some ICBs have full pathways live, several are running phased pilots through Tier 3 weight management services, and others have not yet commissioned a route at all. This guide is an editorial map of where things stand and how to read it.

1. The NICE TA1026 framework

NICE TA1026 sits on top of the existing structure for managing obesity in the NHS, it does not replace it. Two things are worth holding in mind before any rollout discussion makes sense.

First, eligibility is gated on BMI plus a second factor. The two main routes are:

A BMI of 35 kg/m² or above with at least one weight-related comorbidity (for example type 2 diabetes, hypertension, obstructive sleep apnoea, cardiovascular disease, or non-alcoholic fatty liver disease).
A BMI of 30 to 34.9 kg/m² where there is high cardiovascular risk, assessed via the relevant risk algorithm used by the prescribing clinician.

There are adjustments to BMI thresholds for patients of South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background, in line with established NICE practice on ethnicity-adjusted BMI cut-offs.

Second, the medication has to be coupled with a structured weight management programme. TA1026 anticipates that tirzepatide is prescribed through, or alongside, a multidisciplinary specialist weight management service (usually called Tier 3, sometimes Tier 4 for surgical pathways). It is not designed to be a stand-alone primary care prescription handed out at a ten-minute GP appointment.

Third, there is a 2-year treatment course limit built into the appraisal. Patients who complete a course are expected to be reviewed, with the medication discontinued at the 2-year point under the standard pathway. ICBs may build review and exit points before that, in line with their local service specification.

That framework is the same everywhere in England. What varies, sharply, is whether your local ICB has actually commissioned a service to deliver it.

2. The 42 English ICB rollout status

There are 42 statutory ICBs in England as of 2026. Below is an editorial summary of where rollout stands, grouped by NHS England region. Each ICB is tagged with one of three statuses:

Rolled out (R): a Tier 3 or equivalent specialist weight management service is live, commissioned, accepting referrals for TA1026 tirzepatide or TA875 semaglutide, and prescribing is happening at meaningful scale.
Pilot or partial (P): a phased rollout is under way, often capacity-limited, with capped referral numbers, geographic or cohort restrictions, or a specific pilot site rather than ICB-wide access.
Not yet commissioned (N): no live ICB-funded pathway, although patients may still be on legacy Tier 3 services that do not include the newer GLP-1 medications.

Important note on data quality. ICB commissioning positions move on a quarterly basis. Some ICBs publish position statements in board papers, others communicate only via primary care bulletins, and a handful do not publish their stance publicly at all. The summary below reflects PeptideClear’s editorial reading of publicly available board papers and NHS England statements as of May 2026. Where a specific ICB position is illustrative rather than sourced from a public document, it is marked with an asterisk (*). Always check your ICB’s own pages before drawing conclusions, and see the Sources section at the end.

London (5 ICBs)

NHS North West London ICB: Rolled out (R). Tier 3 pathway includes tirzepatide referrals through specialist obesity clinics linked to Imperial and Chelsea and Westminster trusts.
NHS North Central London ICB: Pilot (P)*. Phased pilot via UCLH-linked Tier 3 service, capped intake.
NHS North East London ICB: Pilot (P)*. Limited cohort access through Barts Health weight management service.
NHS South East London ICB: Rolled out (R). King’s College Hospital and Guy’s and St Thomas’ Tier 3 services accepting referrals under TA1026.
NHS South West London ICB: Pilot (P)*. Capacity-limited pilot through St George’s.

South East (6 ICBs)

NHS Frimley ICB: Pilot (P)*.
NHS Hampshire and Isle of Wight ICB: Not yet commissioned (N)*. Tier 3 service review under way.
NHS Kent and Medway ICB: Pilot (P)*.
NHS Surrey Heartlands ICB: Rolled out (R)*.
NHS Sussex ICB: Pilot (P)*.
NHS Buckinghamshire, Oxfordshire and Berkshire West ICB: Rolled out (R)*. Oxford Centre for Diabetes, Endocrinology and Metabolism is a long-standing Tier 3 hub.

South West (7 ICBs)

NHS Bath and North East Somerset, Swindon and Wiltshire ICB: Pilot (P)*.
NHS Bristol, North Somerset and South Gloucestershire ICB: Rolled out (R)*. Active TA1026 pathway via Southmead Hospital weight management service.
NHS Cornwall and the Isles of Scilly ICB: Not yet commissioned (N)*.
NHS Devon ICB: Pilot (P)*.
NHS Dorset ICB: Pilot (P)*.
NHS Gloucestershire ICB: Not yet commissioned (N)*.
NHS Somerset ICB: Not yet commissioned (N)*.

East of England (6 ICBs)

NHS Bedfordshire, Luton and Milton Keynes ICB: Pilot (P)*.
NHS Cambridgeshire and Peterborough ICB: Rolled out (R)*. Addenbrooke’s-linked specialist obesity service offers TA1026 access.
NHS Hertfordshire and West Essex ICB: Pilot (P)*.
NHS Mid and South Essex ICB: Pilot (P)*.
NHS Norfolk and Waveney ICB: Pilot (P)*.
NHS Suffolk and North East Essex ICB: Not yet commissioned (N)*.

Midlands (11 ICBs)

NHS Birmingham and Solihull ICB: Rolled out (R)*. Heartlands and QEHB-linked Tier 3 pathway.
NHS Black Country ICB: Pilot (P)*.
NHS Coventry and Warwickshire ICB: Pilot (P)*.
NHS Derby and Derbyshire ICB: Pilot (P)*.
NHS Herefordshire and Worcestershire ICB: Not yet commissioned (N)*.
NHS Leicester, Leicestershire and Rutland ICB: Rolled out (R)*.
NHS Lincolnshire ICB: Not yet commissioned (N)*.
NHS Northamptonshire ICB: Pilot (P)*.
NHS Nottingham and Nottinghamshire ICB: Rolled out (R)*.
NHS Shropshire, Telford and Wrekin ICB: Not yet commissioned (N)*.
NHS Staffordshire and Stoke-on-Trent ICB: Pilot (P)*.

North East and Yorkshire (4 ICBs)

NHS Humber and North Yorkshire ICB: Pilot (P)*.
NHS North East and North Cumbria ICB: Rolled out (R)*. The Newcastle Hospitals weight management service is one of the larger Tier 3 hubs in the country.
NHS South Yorkshire ICB: Rolled out (R)*. Sheffield Teaching Hospitals Tier 3 pathway.
NHS West Yorkshire ICB: Pilot (P)*.

North West (3 ICBs)

NHS Cheshire and Merseyside ICB: Pilot (P)*.
NHS Greater Manchester ICB: Rolled out (R)*. Long-established Tier 3 and Tier 4 services in Manchester and Salford.
NHS Lancashire and South Cumbria ICB: Pilot (P)*.

Summary of the picture

Counting through that list, the pattern as of May 2026 looks roughly like this:

Rolled out: around 11 to 13 ICBs.
Pilot or partial: around 20 to 23 ICBs.
Not yet commissioned: around 8 to 10 ICBs.

That is an editorial estimate. The exact split shifts every quarter as new pilots go live or scale up. The single most important takeaway is that the majority of English patients today live in an ICB area where access is either piloted or partial, not where it is fully open through a primary care referral. The image of “Mounjaro is on the NHS” is true at the level of NICE guidance, but the local commissioning layer is the thing that decides whether you can actually receive it through your GP this year.

3. Wales, Scotland, Northern Ireland

NICE technology appraisals apply to NHS England (and, by convention, Wales for most appraisals). The other UK nations run their own appraisal and commissioning pathways. The picture is genuinely different.

Wales

In Wales, NICE guidance is generally adopted, but the All Wales Medicines Strategy Group (AWMSG) retains a coordinating role on local implementation, and the seven Welsh Local Health Boards commission services. As of 2026, several Welsh health boards have brought tirzepatide into their Tier 3 weight management offer, while others are still scoping. The pathway is functionally similar to England: BMI plus comorbidity, Tier 3 referral, structured weight management programme. Welsh patients should ask their GP to confirm whether the local health board’s Tier 3 service currently includes TA1026 medication.

Scotland

In Scotland, the Scottish Medicines Consortium (SMC) appraises medicines for use in NHS Scotland. The SMC has issued advice on tirzepatide for obesity, and on semaglutide 2.4 mg. Where SMC advice is accepted, prescribing is then operationalised by the 14 territorial Health Boards. Several Scottish boards offer access via specialist weight management services, with referral generally through primary care. The eligibility framework mirrors the NICE criteria, but the local commissioning, capacity and waiting list situation varies by board. Patients in Scotland cannot rely on TA1026 directly, the relevant document is the SMC advice.

Northern Ireland

In Northern Ireland, services sit under Health and Social Care Northern Ireland (HSCNI). NICE technology appraisals are not automatically binding in Northern Ireland, although in practice many are adopted. Access to NHS-funded GLP-1 medication for obesity in NI is currently more limited and is generally routed through specialist endocrinology or weight management clinics, where they exist. Patients in NI should expect a longer and less predictable route than the equivalent journey in much of England.

4. Eligibility criteria in detail

The eligibility framework is the part of this story that confuses people the most, because the headline number (“BMI 35”) gets quoted without the conditions attached to it.

In broad terms, an adult might be considered eligible for NHS-funded GLP-1 treatment for obesity if all of the following apply.

BMI threshold met. Either BMI 35 kg/m² or above, or BMI 30 to 34.9 kg/m² with high cardiovascular risk. The relevant ethnicity-adjusted thresholds apply for South Asian, Chinese, other Asian, Middle Eastern, Black African and African-Caribbean patients (typically 2.5 to 5 points lower).
A weight-related comorbidity is present (for the 35+ route), for example type 2 diabetes, hypertension, dyslipidaemia, sleep apnoea, cardiovascular disease, non-alcoholic fatty liver disease, or osteoarthritis affecting weight-bearing joints. The exact list referenced varies a little by local pathway.
A referral has been made to a specialist weight management service (usually Tier 3), which has accepted the patient and agreed that GLP-1 medication is part of the appropriate plan.
The patient is willing and able to engage with a structured weight management programme, including dietary, behavioural and physical activity support. The medicine is not commissioned as a stand-alone intervention.
There is no contraindication. That is a clinical judgement made by the prescribing team, and is well beyond the scope of editorial guidance.

The referral route in England is generally:

Patient and GP discussion. The patient raises weight management. The GP records BMI, comorbidities, and history.
Tier 2 input (community-level weight management, often council-commissioned), where available.
Tier 3 referral, if the ICB has commissioned that service and the patient meets local criteria.
Specialist assessment, including whether GLP-1 medication is appropriate, and which one.
Treatment and review, with structured follow-up over the course.

A few things are worth being explicit about. Your GP cannot, on their own, decide that you are eligible for NHS-funded tirzepatide or semaglutide for obesity outside the locally commissioned pathway. The locally commissioned pathway is the thing that determines what is fundable. PeptideClear does not determine your eligibility. Your NHS GP and your local weight management service do.

5. What if your ICB has not rolled out

A large share of UK readers will find that their ICB is in the “pilot” or “not yet commissioned” category. That is the practical reality of a devolved rollout. There are several legitimate alternatives. None of them are recommendations, they are the categories of options.

Private weight management clinics

A growing number of UK-regulated private clinics offer structured weight management programmes that include GLP-1 prescribing where clinically appropriate. These are typically GMC-registered prescribers, working under CQC-regulated services in England, with equivalent regulators in the other UK nations. Programmes vary widely in scope, cost, level of clinical oversight, and length of commitment.

Editorial guide: /clinics/

Pharmacy-direct services

Some UK pharmacies, including online pharmacies regulated by the General Pharmaceutical Council (GPhC), offer GLP-1 medication via an online consultation pathway. These services are not equivalent in clinical depth to a Tier 3 weight management programme, and patients should be clear-eyed about that. The General Pharmaceutical Council and the MHRA have both issued statements on the standards expected of such services.

Editorial guide: /pharmacies/

Cost comparison

NHS-funded treatment is, of course, free at the point of use, with the standard prescription charge applying in England. Private GLP-1 treatment costs vary substantially by dose and by provider. For an editorial breakdown of typical UK price bands, supply availability, and the practical considerations of switching between routes, see:

/pillars/glp1-cost-and-supply/

PeptideClear takes no commercial position on private prescribing. We do not run a clinic. We do not dispense medication. The point of the editorial coverage is to map the landscape, not to push you down any specific route.

6. Watching the rollout

The NHS GLP-1 rollout is one of the more visibly moving parts of UK primary care commissioning in 2026. There are three places worth keeping an eye on.

NHS England statements

NHS England publishes periodic updates on national rollout, including planning guidance and operational letters to ICBs. These are the highest-altitude view, and they tend to be slightly behind the on-the-ground commissioning reality.

Your ICB’s board papers and website

Every ICB publishes its board papers, including, usually, a “prescribing and medicines optimisation” or “clinical commissioning” update at intervals. These are where local position statements on TA1026 and TA875 actually live. Search your ICB’s name plus “tirzepatide” or “Mounjaro” plus “board papers” and you will normally find the current local position.

PeptideClear quarterly update

We refresh this tracker each quarter. The next scheduled review is summer 2026. If you spot an ICB position that is out of date, the editorial inbox is open.

7. What we are NOT saying

It is worth being explicit, because this topic attracts confusion.

We are not telling you whether you personally qualify. We do not assess BMI, comorbidities or cardiovascular risk. We are not your clinician.
We are not advising on doses, titration, or how any medicine should be taken. NICE guidance, the Summary of Product Characteristics, and your prescribing clinician are the references for that.
We are not advising you to switch from NHS to private, or vice versa. The trade-offs are personal.
We are not ranking ICBs in any judgemental sense. The “rolled out / pilot / not yet” status is a description of where commissioning sits, not a comment on the quality of local care.

The function of this page is to make the structure visible. The decisions sit with you, with your GP, and with your local weight management service.

8. FAQ

When will my ICB roll out tirzepatide on the NHS?

There is no single national timetable. Each ICB is making its own decision based on local capacity in Tier 3 services, local prevalence of obesity, and local budget pressures. Some ICBs have signalled rollout dates publicly, others have not. Your ICB’s board papers are the most reliable place to check.

Can I be referred straight from primary care?

In most commissioned pathways, the GP refers into a Tier 3 specialist weight management service, which then assesses and decides on GLP-1 medication. Direct primary care prescribing of tirzepatide or semaglutide for obesity is not the standard route. (Type 2 diabetes prescribing is a different story, with a separate pathway.)

What if my BMI is under 30?

The TA1026 framework does not cover obesity treatment at a BMI below 30 kg/m². If your BMI is in that range, NHS-funded GLP-1 medication for weight management is not currently within scope. Patients with type 2 diabetes may still receive GLP-1 medication for that indication, under different criteria, again decided by a clinician.

Is Wegovy or Mounjaro better on the NHS?

That is a clinical question, not a commissioning question. NICE has appraised both, the prescribing clinician decides which is appropriate for a given patient based on clinical profile, comorbidities, and the local pathway. PeptideClear does not rank medications against each other.

Does the 2-year course limit mean I have to stop after 2 years?

Under the TA1026 framework, NHS-funded tirzepatide is recommended within a 2-year treatment course as part of a wider weight management programme. What happens at the end of the 2 years, and how weight is maintained, is part of the conversation that the specialist service has with the patient before that point. This is one of the most important reasons the medication is paired with a structured programme rather than prescribed in isolation.

If I start on a private programme, can I move to NHS later?

It depends. ICBs typically require that the patient meets eligibility criteria and goes through the standard referral route. Time spent on private treatment does not automatically translate into a place on the NHS Tier 3 pathway. If you are considering this, raise it openly with your GP early.

9. Sources

Editorial references used in compiling this tracker.

NICE TA1026: Tirzepatide for managing overweight and obesity. National Institute for Health and Care Excellence, March 2024. Available at nice.org.uk.
NICE TA875: Semaglutide for managing overweight and obesity. National Institute for Health and Care Excellence, March 2023. Available at nice.org.uk.
NHS England operational planning and prescribing guidance, published statements on weight management medicines rollout, 2024 to 2026.
AWMSG (All Wales Medicines Strategy Group) advice on tirzepatide and semaglutide for obesity, with reference to NHS Wales local health board commissioning.
Scottish Medicines Consortium (SMC) appraisals of tirzepatide and semaglutide for the obesity indication.
HSCNI specialist services information for Northern Ireland.
Individual ICB board papers and clinical commissioning bulletins for the 42 English ICBs, accessed via each ICB’s published board papers archive. Where the position summarised in section 3 is illustrative rather than directly sourced from a specific public document, it is marked with an asterisk.

If you spot something on this page that is out of date for your ICB, the editorial inbox is open. We refresh the tracker quarterly.

Editorial by Oliver Mackman, PeptideClear. Last updated 19 May 2026. Next scheduled review: August 2026. PeptideClear is an editorial publication and does not provide clinical advice, dispense medication, or determine individual eligibility for any NHS or private treatment pathway.