GLP-1 Post Treatment Aftercare

Clinical Intent

This workflow supports a 12-month, medicine-neutral aftercare programme for patients who have stopped, paused or completed GLP-1 / GLP-1+GIP weight management treatment (for example semaglutide, tirzepatide or liraglutide). It captures a structured discharge assessment, stratifies the patient's current support need, and delivers a personalised Maintenance Passport plus subsequent monthly check-ins so that the patient receives a clear bridge from active pharmacological support into long-term maintenance.

The pathway is intentionally patient-facing only. It is positioned as patient support, safety-netting and self-monitoring — not as diagnosis, prescribing, dose advice or a restart decision tool. Clinical decisions (diagnosis, prescribing, stopping/restarting treatment, individualised treatment advice) remain with the patient's prescribing clinician, GP or other regulated clinical provider.

The workflow answers the patient's core questions at the point of discharge:

• What is normal now that I have stopped treatment?
• What should I be monitoring?
• What symptoms might indicate a problem?
• How do I protect the health gains I have made?
• How do I re-enter clinician-led care if weight, symptoms or confidence deteriorate?

This is anchored to NICE Quality Standard QS212 Statement 7, which supports advice and support after stopping medicines for weight management or completing behavioural interventions.

Target Population

Adults who have completed, stopped or paused a course of GLP-1 / GLP-1+GIP receptor agonist treatment for weight management, regardless of the specific stop reason:

• Planned completion / goal achieved.
• Voluntary pause or uncertain next step.
• Side-effect or tolerability discontinuation.
• Administration or understanding barrier.
• Lack of expected benefit / plateau.
• Cost or access interruption.
• Pregnancy or planning pregnancy.
• Clinician-advised stop or contraindication.

Patients are enrolled by their prescribing service or pharmacy at the point of treatment ending. The aftercare programme runs for 12 months from discharge.

The pathway is not intended for:

• Patients still on active GLP-1 treatment (use the active-treatment pathway instead).
• Patients requiring acute medical assessment — those patients should be routed directly to urgent care via the safety-net layer.
• Personalised pharmacological recommendations — those remain with the prescribing clinician.

Expected Outcomes

For each enrolled patient the workflow produces:

1. A completed Discharge Assessment capturing stop reason, treatment timeline, current weight / waist / BP where available, appetite and symptom screen, urgent red-flag screen, support preferences and consent.
2. A patient-facing Support State (one of Maintain, Support, Clinical discussion, Urgent safety-net) derived by transparent, rules-based logic from the discharge responses.
3. A personalised Maintenance Passport email containing: the patient's stop reason, baseline measures, expectation-setting content for the first three months, red-flag guidance, named professional contacts and a clear plan for re-entering clinician-led care if needed.
4. A structured 12-month monthly cadence of check-ins and themed content emails. Months 1, 2, 4, 5 and 7–11 are short "pulse" check-ins (two minutes). Months 3, 6 and 12 are larger formal reviews. Each monthly theme follows the published phases of the pathway:
   • Months 1–2: expectation reset and routine stabilisation.
   • Month 3: first maintenance review with an optional clinician / nutritionist touchpoint.
   • Months 4–5: personalised reinforcement and Month 6 prep.
   • Month 6: midpoint review with an optional at-home health check.
   • Months 7–9: resilience phase (plateaus, holidays, stress, eating out, relapse prevention, muscle maintenance).
   • Months 10–11: future planning (what to do if weight increases; preparing for a clinical review).
   • Month 12: final maintenance summary with an optional final at-home health check, programme rating, downloadable summary and onward support preferences.
5. An always-on urgent escalation path. Every monthly check-in re-asks the same urgent-symptom question and shows the same inline urgent-care panel (NHS 111 / 999 / A&E / GP urgent care). If red-flag symptoms are reported at discharge or at any month, the patient is prompted to seek help today and the aftercare cadence pauses until they confirm they have been seen.

Method of Use

1. The prescribing service or partner pharmacy triggers enrolment when the patient stops, pauses or completes GLP-1 treatment.
2. The patient receives an email invitation to complete the Discharge Assessment — a short SurveyJS-rendered survey designed to be finished in approximately 60–90 seconds.
3. The survey screens for urgent red flags first; if any are reported, an inline urgent safety-net panel (a SurveyJS html element gated by visibleIf) is shown immediately and the patient is advised to seek same-day care before continuing.
4. On submission, the workflow stratifies the patient's current Support State and delivers a tailored Maintenance Passport email plus the relevant onward pathway.
5. The workflow then enters the 12-month monthly cadence: each month it waits 30 days, sends the next month's check-in (re-asking the urgent-symptom question), pauses for submission, and delivers the themed content email for that month (see workflow_logic.md for the per-month breakdown). The cadence ends at Month 12 with a downloadable final Maintenance Summary.

Clinical Boundaries

• Patient-facing materials are medicine-neutral. No specific weight management medicine is recommended, named in a promotional context, or routed to from patient-facing content.
• The workflow does not diagnose, prescribe, advise on dosing, recommend restarting treatment, or replace clinician review.
• Where the responses indicate that a clinical discussion is needed, the patient is signposted to their prescribing clinician, GP or registered nutrition professional with a clinician-ready summary made available for that conversation.
• Urgent symptoms always trigger the urgent safety-net path, regardless of other answers.

References

1. National Institute for Health and Care Excellence (NICE). Quality statement 7: Advice and support after stopping medicines for weight management or completing behavioural interventions. NICE quality standard QS212. London: NICE; 2025. Available at: https://www.nice.org.uk/guidance/qs212/chapter/Quality-statement-7-Advice-and-support-after-stopping-medicines-for-weight-management-or-completing-behavioural-interventions
2. National Institute for Health and Care Excellence (NICE). Overweight and obesity management. NICE guideline NG246. London: NICE; 2025; updated 2026. Available at: https://www.nice.org.uk/guidance/ng246
3. Medicines and Healthcare products Regulatory Agency (MHRA). GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists: strengthened warnings on acute pancreatitis including necrotising and fatal cases. Drug Safety Update. London: MHRA; 2026. Available at: https://www.gov.uk/drug-safety-update/glp-1-receptor-agonists-and-dual-glp-1-slash-gip-receptor-agonists-strengthened-warnings-on-acute-pancreatitis-including-necrotising-and-fatal-cases
4. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–1564.
5. Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024;331(1):38–48.
6. McGowan BM, Busetto L, Dicker D, et al. Framework for the pharmacological treatment of obesity and its complications from the European Association for the Study of Obesity. Nature Medicine. 2025.