News

Mounjaro from your GP

A new weight loss treatment, called Tirzepatide (Mounjaro) is now “allowed” to be prescribed for people by GPs. We have previously only been able to use this medication for people with poorly controlled type 2 diabetes.

Tirzepatide (Mounjaro) weekly injections make you feel fuller and lowers your appetite, helping people lose weight. It especially seems to help  people reduce hunger cravings, which are sometimes now called “food noise”, helping people choose healthier foods and smaller portions, avoiding snacking.

Gradual rollout

The rollout of this medication in Devon and nationally is limited to protect NHS budgets and drug supply, therefore year 1 will be limited to people with Body Mass Index (BMI) over 40 plus 4 of the following 5 weight related conditions:

  • Type 2 diabetes – A condition which causes too much sugar in the blood.
  • High blood pressure and on medication to treat this – When the force of your blood pushing against the walls of your blood vessels is too high.
  • Dyslipidemia – When your blood lipids (like cholesterol) are not in the right balance.
  • Obstructive sleep apnoea and on treatment for this – When your breathing stops and starts while you are sleeping.
  • Atherosclerotic cardiovascular disease – Where your arteries become narrowed, making it difficult for blood to flow through them. This may lead to a heart attack or angina, a stroke, heart failure or poor circulation to the legs also known as (peripheral vascular disease).

There is an online NHS BMI calculator here.

Private supply

Currently around 10 people in the UK are buying mounjaro through private pharmacys for every 1 person prescribed this drug through the NHS. We have spoken to many of our patients who have found this medication very helpful to lose weight. It has also allowed people to feel in control of their eating and wellbeing.

There is a website called monj.co.uk which list the pharmacies selling mounjaro, and costs, with a discount price list to show best prices. Your private supplier will also be responsible for checking you are eligible and supporting you in using mounjaro safely, not just selling you the medication.

Risks of Mounjaro

As a new drug, we have several concerns regarding long term safety:

  • Will people be able to sustain weight loss beyond treatment? Current data is a lot of people regain most of their excess weight after stopping treatment. You will need to sustain lifestyle changes to avoid medication forever.
  • Will mounjaro for women in pregnancy harm the baby? This is especially important as weight loss can often trigger a boost to fertility, so contraception while on treatment is especially important.
  • What other harms might be linked to mounjaro? It may take many years to known if there are other risks to people.

But despite the risks both known and unknown, we also consider the very important harms of being very overweight. Obesity is linked to heart disease, stroke, many cancers, blood clots, dementia, diabetes, joint damage.

Beyond Mounjaro

Long term Mounjaro and other weight loss drugs, like wegovy (semaglutide) have given us a new way to understand obesity:

What makes us obese is our hormones, especially high levels of Insulin (sugar hormone), cortisol (stress hormone), ghrelin (hunger hormone).

Controlling these hormones will control our weight. This can be managed in other ways, not just weight loss medications:

  1. Eating a healthy diet, with unprocessed foods, low in sugar and starch, these keep insulin levels low. Everything about processed foods – even the bright packaging, may contribute to eating too much.
  2. Improving our stress and sleep, including exercise, time with friends, good sleep patterns, these keeps cortisol low. Aim for at least 7 hours of good sleep.
  3. Avoiding snacking, alcohol, sweet drinks, which keeps our hunger hormones active all day, keeps ghrelin low. The problems with snacks is they make us hungry!

For more information about these lifestyle changes, see Healthyhart.co.uk. For meal planners see the excellent Freshwell Low Carb project.

 

 

Anticoagulation medication swap to apixaban

As part of an NHS budget saving scheme, We are switching patients on repeat from once daily edoxaban (Lixiana) costing around £600 each year per person to twice daily apixaban, costing under £50 per year.

Apixaban has the best evidence of safety and effectiveness in this family of medications and its patent has recently expired making it a better value replacement.

We fully support this switch, and are happy to discuss any concerns that arise.

Frequently asked Questions (FAQ)

When do I start the new medication?

Use up any existing supply of edoxaban. Take your last edoxaban in the evening as usual, then take the first apixaban tablet the next morning and evening.

Do I need a test to monitor this medication is working?

The same as with edoxaban: We usually just check your kidney function and weight each year. Sometimes we lower the dose in people with lower kidney function, especially if aged over 80 or weight under 60kg (below 9 and half stone).

Can I take apixaban once daily?

Apixaban must be taken as a twice daily medication. Another drug called rivaroxaban can be taken once daily, standard dose is 20mg once daily.

Rivaroxaban is also “off patent” and therefore much cheaper to prescribe as well.

We have preferred apixaban because there is some data to suggest it has better safety for bleeding risk compared to rivaroxaban, but the risks are still low for both.

There is not enough safety data to prefer edoxaban or rivaroxaban with regards bleeding risk, so we will advise rivaroxaban if you prefer once daily medication as the best value medication.

Will I get side effects?

Usually not. Bruising or Bleeding is a risk with all blood thinners. Apixaban has the best safety data for lower bleeding risk in this family of medications.

Another side effect is some tummy upset, sickness or diarrhoea. If you did have problems with apixaban (or rivaroxaban), we can swap you back to edoxaban.

Half day closure this Wednesday 15th May Afternoon from 1pm and new phone system.

We are closed for quarterly training on Wednedsay afternoon from 1pm.

Our clinical staff are attending training in Barnstaple which is shared across all practices in North Devon “half day shutdown”.

Our admin staff will be training with our new phone system which will go live on Thursday 16th May. You will notice a new voice message when you call the surgery, with a call queue system.

GP letters for Personal Independence Payment (PIP) and Employment and Support Allowance (ESA).

We do not provide “letters of support” for PIP application, or ESA.

When you apply, the Department for Work and Pensions (DWP) will usually contact us to provide a report, which is supplied directly to them.

We are therefore unable to provide additional letters of supports as the information we provide will normally be included in the report requested by the DWP.

You may request your medical records if you feel this may help your case. If you wish a copy of your medical records, please contact our admin team, or access online using the NHS app.

Citizens advice has more information for applying for PIP and ESA at links below:

Sat 4th May, COVID spring boosters for over 75s at Hartland Surgery

We are planning to provide COVID booster vaccines in Hartland in the coming weeks. The dates are just being finalised, and then the slots to book will be made available through the national booking system. We are planning to provide on a couple of Saturdays.

If you are keen to have your vaccine at the surgery, we should have more information within the next week.

When the dates and slots are released, you will not be able to book this slot through the surgery, we have to use the national booking system (online or telephone, call 119)

Amended below on Mon 22 April:

You can now book online as above Saturday 4 May

Christmas opening

Merry Christmas and Happy new year to all of our community.

We will be closed on bank holidays for 25 and 26 December and 1 January 2024.

We will be open as usual on

  • Fri 22 Dec
  • Wed 27 Dec
  • Thu 28 Dec
  • Fri 29 Dec
  • Tue 2 Jan 2024

Due to the shorter working week over Christmas we will be prioritising urgent care, and would kindly request you to delay more routine requests until the new year during this busy time if possible.