Templates:

The standardised Integrated Patient Review Templates have been rolled out on a national scale in England for all GP practices through NHS England’s GPIT Providers. The templates support in the capture of essential data related to the NICE Funding Variation for the implementation of prescribing of tirzepatide (Mounjaro®) for the management of obesity.

Initial Assessment Template:

The template displays the presence or absence of qualifying morbidities. It is not a clinical management template. The template is to confirm assessment of the patient under the NHS Priority Cohorts under the NICE Funding Variation for tirzepatide (Mounjaro®) for the management of obesity in primary care. It is the prescriber’s responsibility to review the BNF cautions, medication interactions, SmPC and local criteria – all are contained within the template.

Review Template:

The review template is used to record patient follow up appointments for those patients prescribed tirzepatide under the pathway. It is not a clinical management template. The template supports coded reviews, prompting for recording of any adverse reactions with links to MHRA Yellow Card report submission. You can track percentage weight loss from baseline and set diary dates for future follow-up.