Just to add the Wales perspective — we're on a completely different system. Welsh Government commissioned a separate review and semaglutide for obesity is not yet approved by AWMSG (All Wales Medicines Strategy Group). Our Tier 3 services don't prescribe it at all currently.

Scotland is ahead of England actually — the SMC approved it in 2024 and some NHS boards are already prescribing through their weight management pathways with waits of 4-6 months.

Devolution means four completely different systems for the same drug. Madness.

One more thing — check if your area has the NHS Wegovy pilot programme. It launched in parts of London, Manchester, and the Midlands in late 2025. Patients in the pilot get fast-tracked (2-4 week wait) and get free behavioural support alongside the medication.

I don't think mike_mealprep is in the pilot yet, but it's expanding. Novo Nordisk is partly funding it as a real-world evidence study.

This is all incredibly helpful. I'm going to:

1. Check the pilot programme — fingers crossed
2. Book a private endocrinologist consultation and try the shared-care route mentioned
3. Keep the Tier 3 referral active as a backup

The idea that I have to wait 16 months with a BMI of 38, diabetes, and hypertension while the drug is literally approved and sitting in pharmacies is just absurd. But at least there are workarounds. Will update the thread.