The Wrexham Maelor Hospital (Welsh: Ysbyty Maelor Wrecsam) is a district general hospital for the north east region of Wales. It is managed by Betsi Cadwaladr University Health Board.
Abstract The NHS faces mounting financial pressure, with medicines expenditure reaching £19.9 billion in 2023–24. Cost awareness among prescribers is an important but underexplored determinant of sustainable prescribing. Between April and June 2025, an audit identified the most frequently prescribed dermatological medications in one UK region: lymecycline, mometasone furoate 0.1% w/w cream, adapalene 1 mg (0.1% w/w) and benzoyl peroxide (2.5% w/w) gel, prednisolone, isotretinoin, acitretin, methotrexate and trimethoprim. An electronic survey assessing drug-cost awareness was distributed to dermatology physicians across the UK. Of 178 respondents, 116 (65.2%) were consultants and 62 (34.8%) were junior doctors; 113 (63.5%) were female and 65 (36.5%) male. Among consultants, 47.4% (n = 55) worked exclusively in the NHS, 44.0% (n = 51) undertook combined NHS and private practice, and 8.6% (n = 10) were solely in private practice. Cost awareness was limited: 47.2% (n = 84) reporting partial awareness and 25.8% (n = 46) had none. Overall cost identification accuracy was 37.7%, lowest for trimethoprim 200-mg tablets (25.8%). Only 1.1% identified all costs correctly, while 6.7% answered all items incorrectly. Accuracy was highest among consultants solely in private practice (59%), compared with NHS only (38%) or mixed practice (39%). Most respondents considered cost awareness as somewhat important (62.3%) or extremely important (30.9%). Participants anticipated that displaying drug costs within electronic prescribing would somewhat influence decisions (61.8%), strongly influence decisions (19.1%) or have little or no impact (19.1%). This first UK-wide study highlights substantial gaps in dermatology clinicians’ awareness of costs of commonly prescribed treatments, with greater knowledge among private practitioners. Enhancing prescriber cost literacy and embedding cost information into electronic prescribing may support value-based decision making and NHS financial sustainability. Integrating cost-awareness training into dermatology curricula represents a feasible strategy to address this need.
BACKGROUND:Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin therapies have significantly advanced obesity management by facilitating clinically significant weight loss and enhancing cardiometabolic outcomes. Nevertheless, their growing application calls for careful consideration of nutritional and behavioural factors, including decreased dietary intake, gastrointestinal symptoms, loss of lean mass, micronutrient deficiencies, and potential weight regain following treatment cessation. METHODS:This narrative review synthesises evidence from clinical trials, observational studies, reviews, professional guidelines, and MBS nutrition protocols to evaluate the role of structured dietetic care in adults receiving GLP-1 RAs or related incretin-based therapies for weight management. MBS pathways provide a comparative framework for investigating how established principles of nutritional assessment, monitoring, and dietetic follow-up may inform pharmacological treatments of obesity. RESULTS:The literature indicates that pharmacological weight-loss treatments should not be administered solely as prescription-based treatments. Structured dietetic care can facilitate nutritional assessment, personalised dietary interventions, the management of gastrointestinal symptoms, protein optimisation, behavioural counselling, physical activity support, and long-term weight maintenance. MBS pathways illustrate the role of dietitians in pre-, peri-, and post-major weight-loss interventions through assessment, guidance on supplementation, dietary progression, biochemical monitoring, and long-term maintenance. Although these principles require adaptation rather than direct application to GLP-1 RA pathways, they offer a valuable system for integrating dietitians into comprehensive obesity pharmacotherapy. CONCLUSIONS:Structured dietetic care should be regarded as a fundamental component of the pharmacological management of obesity, especially as GLP-1 RAs and incretin-based therapies become more prevalent. Dietitians are well positioned to help optimise nutritional adequacy, preserve lean mass, manage gastrointestinal symptoms, and support sustained weight maintenance. Future research should investigate effective models for delivering dietetic care alongside incretin-based therapies, including strategies to identify patients who need more intensive support.
