Doctors Warn of 'Postcode Lottery' in London Access to Weight Loss Injections

Senior doctors and pharmacists told a London Assembly health committee that access to new weight loss injections is highly uneven across the city, with some patients able to obtain treatment while others are left without access.

Tirzepatide, marketed as Mounjaro, has been prescribed on the NHS for people with severe obesity since June, and the health service has said about 220,000 people with the "greatest need" are expected to receive the drug over the next three years. Clinicians told the committee that demand has risen sharply and services vary widely between boroughs, creating what one specialist described as a postcode lottery.

Dorottya Norton, an NHS weight management specialist, said the lack of consistency was visible to patients. "The lack of fairness is apparent to patients – some are able to get started and others are not," she told the committee, adding that referrals had seen "a huge increase." Norton said the gap between patient expectations and available services was creating a difficult clinical environment and that many patients were self-funding treatment, which was intensifying inequality.

Clinicians described the drugs as an additional tool to address rising obesity and to reduce pressure on the health service. The injections act on appetite regulation to make people feel fuller for longer and can reduce overall food intake. NHS leaders have positioned the medication as one element in broader weight management strategies.

But representatives from the pharmacy sector and private providers warned that constrained supply and varying local policies had driven some people to seek unregulated sources. Sokratis Papafloratos, founder of online provider Numan, told members that illicit access may be underestimated. He said people were buying active ingredients intended for clinical research from foreign suppliers and injecting them, a practice he described as alarming.

Sukhi Basra, vice chair of the National Pharmacy Association, said patients had shown her images of packages containing counterfeit medicines. "They're being sold as generic medications, and that petrifies me," she told assembly members, citing patient reports and the risk posed by unverified products.

The committee heard that the imbalance between supply and demand means those who can afford private care may obtain the injections more easily, furthering health disparities. Some patients have turned to online sellers or informal markets to bypass referral systems and waiting lists, creating safety concerns for clinicians who must manage adverse events and unknown product quality.

NHS guidance limits prescriptions to people meeting defined clinical criteria, and roll-out plans prioritise patients judged to have the greatest need. Clinicians at the committee repeated calls for more consistent commissioning across London so patients in different boroughs do not face widely different access to services. They said clearer pathways, shared criteria and increased capacity in weight-management services could reduce the reliance on private purchases and dangerous black-market supplies.

Public health experts have highlighted long-term challenges in addressing obesity, noting that medications are most effective when combined with structured support for diet, activity and underlying conditions. Committee members were told that many patients come to consultations with incomplete or inaccurate information about the drugs' effects and availability, increasing pressure on already stretched services.

Regulators and professional bodies have previously warned about the harms of counterfeit medicines and of using products imported for research purposes in humans. Clinicians at the hearing urged increased public information about approved treatment pathways and the risks of unregulated products, and called for coordinated action to ensure equitable access across London.

The London Assembly committee did not set out a timetable for policy changes but its testimony from clinicians, pharmacists and private providers highlighted immediate tensions in the current roll-out: rising demand, constrained availability, and a growing private and illicit market that clinicians say threatens patient safety and exacerbates health inequality.

Local commissioners, clinicians and national health bodies will face choices about how to allocate limited supplies, expand service capacity and communicate clear and safe pathways for patients seeking treatment for obesity. Until those issues are addressed, committee members warned, access is likely to remain uneven and some patients will continue to seek risky alternatives.