A report from the Association of the British Pharmaceutical Industry (ABPI) has uncovered "significant variation" in how Scotland's health boards prescribe new medicines, with the most striking disparities appearing in access to GLP-1 medications used for both diabetes and weight management. Patients in NHS Western Isles are receiving these drugs at nearly three times the rate of any other health board in Scotland, according to BBC News. The analysis also revealed substantial differences in prescribing patterns for cardiovascular medicines across the country.
The ABPI's first-of-a-kind study examined prescribing data from September 2020 to August 2025 across all Scottish health boards for medicines approved by the Scottish Medicines Consortium (SMC) as both safe and cost-effective. GLP-1 medications, originally developed to treat type 2 diabetes but approved for weight management in 2023, showed the most dramatic geographic variation in access. NHS Western Isles recorded a three-month average of 1,086.54 prescriptions per head of population between June and August 2025, compared with 392.97 for NHS Greater Glasgow and Clyde and just 100.31 for NHS Shetland.
NHS Western Isles attributed its higher prescribing rates to establishing a "structured pathway" for GLP-1 access earlier than any other health board in Scotland. The board stated that its prescribing patterns reflected this early implementation alongside local clinical need, rather than simply participation in pilot schemes. "These medicines are prescribed following clinical assessment and form part of a wider dietetic-led programme supporting long-term behaviour change and healthier lifestyles," a spokesperson said. "Patients are reporting and we are seeing significant clinical benefit."
Why does prescribing vary so widely?
The ABPI acknowledged limitations in its data, noting that both health boards at the extremes of the prescribing range serve small island populations where a handful of prescriptions can substantially affect per-capita rates. The report also could not distinguish between GLP-1 prescriptions issued for diabetes management and those for weight loss, obscuring the true picture of weight management drug access.
Earlier reporting by BBC Scotland News revealed that fewer than 800 Scots have received weight loss injections on the NHS despite the treatment's approval three years earlier, while approximately 300,000 access these drugs through private providers. Only six health boards participate in pilot programmes to expand access to weight loss medication: NHS Western Isles, NHS Forth Valley, NHS Borders, NHS Lothian, NHS Lanarkshire, and the NHS State Hospital at Carstairs. According to freedom of information requests, NHS Western Isles has 340 patients on weight loss medication—the highest number among all boards involved in the pilots.
The Royal College of Physicians has characterised the unequal access to these "safe and cost-effective medicines" as "discriminatory against obese people" and argued that the NHS could save millions by treating obesity-related illnesses more effectively. NHS Scotland approved Wegovy for patients at cardiovascular risk in June 2026, yet implementation remains inconsistent across boards.
What about other medicines?
The ABPI report extended beyond weight management drugs to examine prescribing patterns for cardiovascular medicines. Cardiovascular disease, encompassing conditions such as heart disease and stroke, remains a leading cause of death in Scotland, affecting approximately 800,000 people. The study analysed prescribing data for non-statin low-density lipoprotein (LDL)-lowering medicines that the SMC had accepted as appropriate for NHS use.
Prescribing rates for these cardiovascular medicines differed eight-to-10-fold between the highest-prescribing board (Highland) and the lowest-prescribing board (Forth Valley). The report's authors identified a pattern: health boards with closer working relationships between specialist doctors and general practitioners generally achieved higher prescribing rates for accepted medicines. This suggests that organisational barriers and communication gaps between different levels of care may be limiting patient access to treatments already deemed safe and cost-effective.
What changes does the ABPI recommend?
The ABPI made seven recommendations aimed at reducing unwarranted variation and improving patient access to approved medicines. These include better planning and cooperation between health boards, increased transparency about local decisions on which medicines to use, and faster implementation of medicines already accepted by the SMC. The organisation called for clearer communication about how quickly approved treatments are being introduced across different boards.
Victoria Jordan, ABPI executive director of patient access, stated:
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.
How is the Scottish government responding?
The Scottish government said it would "carefully consider" the ABPI's findings. Officials stated that ongoing health board reforms were designed to "improve equity of access to services and reduce the unwarranted variation and bureaucratic barriers we currently have in place." These reforms include a controversial plan to reduce the number of mainland health boards from 14 to two, a proposal that leading doctors have publicly opposed as potentially damaging to patient care.
The variation in prescribing patterns highlighted by this report adds weight to arguments that structural changes to Scotland's health system are necessary to ensure consistent access to treatments. However, the proposed merger of health boards remains contentious, with medical professionals questioning whether larger organisations would improve or worsen the coordination problems the ABPI has identified.
Key Facts
- NHS Western Isles prescribed GLP-1 medications at a rate of 1,086.54 per head of population between June and August 2025, nearly three times higher than the second-highest board
- Fewer than 800 Scots have accessed weight loss injections through the NHS despite approval three years ago, while approximately 300,000 use private providers
- Prescribing rates for cardiovascular medicines varied eight-to-10-fold between the highest and lowest health boards, suggesting organisational barriers affect access
- Only six health boards currently participate in pilot programmes for weight loss medication access
- The ABPI called for better planning, transparency, and faster implementation of medicines already approved as safe and cost-effective by the Scottish Medicines Consortium
