Talking GLP-1s: how GPs see their role in obesity management

Today, we’re speaking to Jadine Scragg, a researcher based at the University of Oxford, and Sabrina Keating about their recent paper published here in the BJGP.Title of paper: GPs’ perspectives on GLP-1RAs for obesity management: a qualitative study in EnglandAvailable at: https://doi.org/10.3399/BJGP.2025.0065General practitioners (GPs) play a central role in managing obesity yet face significant challenges due to limited treatment options and resource constraints. GLP-1RAs are emerging as a promising treatment for obesity but access in primary care is limited. This study provides new insights into GPs’ perspectives on the integration of GLP-1RAs into primary care, highlighting concerns around resource limitations, health equity, and misuse of the medications.TranscriptThis transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.Speaker A00:00:01.200 - 00:01:00.730Hello and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the bjgp. Thanks for taking the time today to listen to this podcast.Today we're speaking to Judine Scragg, a researcher based at the University Oxford, and Sabrina Keating, a DPHIL student who's also based at the University of Oxford within the Nuffield Department of Primary Care Health Sciences.We're here to talk about their recent paper, published here in the BJJP, titled GP's Perspectives on GLP1 Receptor Agonists for Obesity Management A Qualitative Study in England. So, hi, Judine and Sabrina, it's great to meet you both for this chat.I guess the first thing to say is that this work is really topical at the moment, especially given current plans to increase the rollout of GLP1 receptor agonists into the community. But, Judine, I'll come to you first and I wonder if you could just tell us a bit more about what you wanted to do in this research and why.Speaker B00:01:01.510 - 00:02:25.330Yeah, absolutely. So, for a long time, as you've said, the GLP1s have been very topical, both in clinical groups and with patients as well.So I'm first and foremost, I'm a weight management researcher and I've done work in populations with people living with type 2 diabetes and polycystic ovary syndrome. And within those populations, one of the things they've constantly asked about is about GLP1s, when do I qualify? When do I get it around?And similarly with the gps GP groups as well, there's been a lot of questions, there's lots of media about, you know, both good and bad about GLPs and outlining different people's thought processes and are they good? Are they bad?So what we sought to do with this was to sort of more robustly work out what it is GPs actually feel about the perceived integration of the GLP1s into primary care to very kind of firmly focus on GP specifically.And this ended up coming at a really timely point, as midway through the study, the NICE guidance was brought out on outlining the plans for how tirepatide would be rolled out. So it was a really timely piece to find out exactly what they were thinking and feeling about how this may impact them and their patients.So that's really what we set out to do.Speaker A00:02:26.200 - 00:02:55.660Great.And this was a qualitative interview study of 25 GPs across England working across different roles, and they all had different experience in weight management services. But I really Just wanted to come on to what you found here.And let's start with an area that's quite a common issue right now, and I certainly don't seem to go a day without a patient asking me about whether they can get a weight loss injection. But what did gps think about navigating these patient requests when they. When they get them?Speaker C00:02:56.140 - 00:03:56.260Yeah. So at kind of the moment we were conducting interviews, that was definitely a real source of sort of frustration and difficulty.There were quite a few patients presenting, asking for GLP1s, the majority of whom were ineligible often, or would only be eligible through kind of this longer, more drawn out process of accessing specialist care, which in many of the regions just did not exist or was going to take kind of years and years. So it was not necessarily an amazing option.This kind of left the gps we spoke to in quite an uncomfortable position where they kind of had to play the role of gatekeeper, really manage those expectations and potentially kind of have that compromising sort of interaction with their patients. So certainly the gps that we spoke to had some frustrations associated with that.Speaker A00:03:56.820 - 00:04:03.620Yeah, absolutely. And I suppose it's a little bit about how to manage those requests. So did the gps talk about that at all?Speaker C00:04:04.100 - 00:04:31.440Yeah, there were some different strategies that we heard about. I would say the primary one was just around identifying other options that would be available.That was more difficult in some cases where patients had already exhausted those options and were feeling quite frustrated.One of the other strategies that we heard about was testing patients for type 2 diabetes to try to identify whether maybe there was another avenue that they could kind of come in through.Speaker A00:04:31.840 - 00:04:47.040And did they talk at all about private prescribing or. We might come on to this a bit later. But did any of the gps talk about suggesting or dealing with patient requests for private prescriptions?Because I think that's quite a big industry and a growing industry at the moment as well.Speaker C00:04:47.360 - 00:05:42.850Yes, certainly our sample were very much aware of this going on and it had been kind of entering the remit of their practice, specifically kind of asking for prescriptions to be carried over into NHS care, which most of the time the answer was a pretty concrete and clear no on.So that could also be quite disappointing, particularly for patients who had come in through other international health systems who are then like, oh, I thought I would surely be able to get this on the nhs. And, yeah, a lot of the services didn't have, like, a great answer or kind of protocol to responding to those requests for private prescription.So there was also kind of the frustration of okay.This is taking up quite a lot of our time, quite a lot of our effort that could be put towards other things, especially at a time when we're so overstretched.Speaker A00:05:43.810 - 00:06:08.040And I think that leads on to the next thing I wanted to talk about.And I think that, as you say, one of the big concerns for GPs, especially given the increasing effort to provide GLP1 agonists to a wider community population, is how we're going to fit this in alongside all the other things that we're doing. So what else did the GP say about this and about the different resource limitations in general practice?Speaker B00:06:08.760 - 00:06:09.320Yeah.Speaker C00:06:09.400 - 00:07:15.450So I think many had an awareness that in kind of an ideal world, this made a lot of sense to be carrying out in primary care.A GP has that kind of connection, ideally to their patients, and is able to see kind of the broader context of where and how they live, who they are as an individual. But within that, there was an awareness that that was going to be exceedingly difficult given the resource limitations of the time.So a few of the gps we spoke to were essentially just like, we don't know how this is going to happen. This needs to stay in secondary care. It's just not kind of a viable model.Others were really worried that some of the components that should be integral to GLP1 delivery, like wraparound care, behavioral and psychological support, were certainly not going to be easy to provide within primary care. And there was a real discomfort of this is just simply not how the medications are or should be used.Speaker A00:07:16.570 - 00:07:48.870Yeah, I guess that goes back to How Current Tier 3 weight management services are provided or were provided, perhaps, in the nhs.And the fact that you're right, there's a bit of a wraparound system around it, and certainly GLP1 agonists would only have typically been prescribed in those services alongside, as you say, all of the different weight management services. So that's quite a hefty burden for a GP or practice to pick up.Judine, I don't know if you wanted to comment on that, given your background in weight management research as well.Speaker B00:07:49.590 - 00:09:14.320Yeah, I mean, I think, as Sabrina said, there's definitely concerns, but I think as well, there's definitely some very strong themes of these GLP1 drugs coming in as a very helpful tool as well, in a few different ways.So, for example, I think one of the gps that we spoke to voiced concerns about how sometimes it's quite tricky for people to navigate the best way to support themselves, to lose weight and to navigate