A new report reveals substantial disparities among Scotland's health boards in prescribing new medicines, particularly GLP-1 medications used for weight loss and cardiovascular treatments. The analysis, conducted by the Association of the British Pharmaceutical Industry (ABPI), examined NHS prescribing data across all Scottish health boards from September 2020 to August 2025.
Variation in Weight Loss Drug Access
The most significant variation was observed in access to GLP-1 medications. NHS Western Isles prescribed these drugs at the highest rate, with an average of 1,086.54 prescriptions per head of population between June and August 2025. This rate is more than triple that of NHS Shetland, which had the lowest rate at 100.31 prescriptions per head. NHS Greater Glasgow and Clyde followed NHS Western Isles with 392.97 prescriptions per head.
The report authors noted limitations to the data, acknowledging that small island populations, like those served by NHS Western Isles and NHS Shetland, can see prescribing rates heavily influenced by a few individuals. Additionally, the data does not distinguish between prescriptions for diabetes and those specifically for weight loss.
Earlier reports indicated that fewer than half of Scotland's territorial health boards were prescribing GLP-1s for weight loss, with fewer than 800 individuals receiving these injections for that purpose. The Royal College of Physicians has described the uneven access to these medicines as potentially discriminatory against individuals with obesity and has suggested that improved access could lead to significant cost savings for the NHS in treating obesity-related illnesses.
NHS Western Isles is participating in one of six pilot programs aimed at improving access to weight loss medication. This health board reported having 340 patients on weight loss medication, the highest number among participating boards. NHS Western Isles stated that its higher prescribing rates are a result of establishing a "structured pathway" for GLP-1 medicines earlier than other boards and reflect local clinical need, not solely participation in a pilot.
"Our prescribing rates reflect that early implementation, as well as local clinical need, rather than participation in a pilot scheme," an NHS Western Isles spokesperson said. "These medicines are prescribed following clinical assessment and form part of a wider dietetic-led programme supporting long-term behaviour change and healthier lifestyles. Patients are reporting and we are seeing significant clinical benefit."
Disparities in Cardiovascular Drug Prescribing
The report also examined prescribing data for non-statin low-density lipoprotein (LDL)-lowering medicines for cardiovascular disease, a leading cause of death in Scotland affecting approximately 800,000 people. Prescribing rates for these drugs showed an eight-to-10-fold difference between the highest-prescribing board, NHS Highland, and the lowest-prescribing board, NHS Forth Valley.
According to the report's authors, health boards that have closer collaboration between specialists and general practitioners generally exhibited higher prescribing rates for these cardiovascular medications.
The ABPI has put forward seven recommendations to address these prescribing variations. These include enhancing planning and cooperation among health boards, and increasing transparency regarding local decisions on medicine use and the speed of introducing newly accepted medicines.
Victoria Jordan, ABPI executive director of patient access, commented on the findings: "Scotland has a strong and respected system for assessing new medicines. But this report shows that the use of some accepted medicines can vary widely between NHS boards, and that differences in patient need do not fully explain this. While the data we have does not tell us everything, it does show we need to look more closely at this issue. When avoidable barriers slow things down, patients can wait longer than they should for medicines already judged effective and good value. We need to plan and work together across government, the NHS, clinicians, patients, academia and industry. That way, we can help make sure national SMC decisions have benefit to patients, wherever they live."