NHS Western Isles prescribing weight loss drugs at triple the rate of other health boards.

A groundbreaking report, representing pharmaceutical companies, has revealed significant disparities in access to newly approved medicines across Scotland’s health boards, with NHS Western Isles prescribing weight loss drugs at a rate three times higher than the national average. The analysis, which examined NHS prescribing data from September 2020 to August 2025, focused on several new medicines approved by the Scottish Medicines Consortium (SMC) as safe and cost-effective for the health service.

The most pronounced variation among patients was observed in access to GLP-1 medications, a class of drugs now widely recognized for their efficacy in managing type 2 diabetes and, increasingly, in facilitating significant weight loss. The report highlights "substantial geographic variation" in the uptake of these treatments, painting a stark picture of unequal patient access across the country.

To quantify these differences, the report calculated a three-month average quantity of GLP-1 drugs prescribed per head of population for each Scottish health board, covering the period from June to August 2025. In this critical timeframe, NHS Western Isles emerged with the highest prescribing rate at an impressive 1,086.54 units per capita. This figure stands in stark contrast to NHS Greater Glasgow and Clyde, which followed with 392.97 units, and NHS Shetland, which recorded the lowest rate at a mere 100.31 units.

The authors of the report acknowledge certain limitations within the data, particularly concerning the small island populations served by boards at the extremes of the prescribing spectrum. In such communities, even a small number of prescriptions can disproportionately influence overall prescribing rates, potentially skewing the perceived difference. Furthermore, the report explicitly states that the aggregated data does not distinguish between prescriptions issued for the management of diabetes and those specifically for weight loss, a crucial distinction given the growing role of GLP-1s in obesity treatment.

This revelation follows closely on the heels of an earlier investigation by BBC Scotland News, which uncovered that fewer than half of Scotland’s 14 territorial health boards were actively prescribing GLP-1s for weight loss purposes. That report indicated that fewer than 800 Scots had received these injections for this specific indication up to that point, underscoring a broader issue of limited availability.

The Royal College of Physicians has previously voiced strong concerns over this lack of access, describing the situation as "discriminatory against obese people." They have argued that wider adoption of these "safe and cost-effective medicines" could lead to substantial savings for the NHS by mitigating the burden of obesity-related illnesses, which carry significant healthcare costs.

Further adding to the picture, freedom of information requests submitted by BBC Scotland News revealed that NHS Western Isles currently has 340 patients receiving medication for weight loss. This figure represents the highest number of patients on such treatments among all health boards participating in pilot programmes aimed at improving access to these medications.

NHS Western Isles is actively involved in one of six pilot programmes designed to enhance patient access to weight loss medication. The other health boards participating in these initiatives are NHS Forth Valley, NHS Borders, NHS Lothian, NHS Lanarkshire, and the NHS State Hospital at Carstairs.

In response to the findings, NHS Western Isles stated that it had established a "structured pathway" for accessing GLP-1 medicines significantly earlier than any other NHS board in Scotland. The board attributed its high prescribing rates not solely to its participation in a pilot scheme, but also to this early implementation and the "local clinical need." They emphasized that these medications are prescribed only after a thorough clinical assessment and are integrated into a comprehensive, dietetic-led program focused on promoting long-term behavioral change and healthier lifestyles. The board reported observing "significant clinical benefit" and positive patient outcomes.

Beyond the focus on weight loss drugs, the report also delved into the prescribing patterns for certain medicines used in the management of cardiovascular disease. Cardiovascular conditions, encompassing heart disease and stroke, are a leading cause of mortality in Scotland, affecting an estimated 800,000 individuals.

The study examined prescribing data for non-statin low-density lipoprotein (LDL)-lowering medicines, a category of drugs also approved by the SMC. The analysis revealed substantial variations in prescribing rates for these cardiovascular treatments, with differences ranging from eight to ten-fold between the highest-prescribing board, NHS Highland, and the lowest-prescribing board, NHS Forth Valley. The report authors suggest that health boards fostering closer collaborative links between specialist physicians and general practitioners tend to exhibit higher prescribing rates for these essential medications.

The Association of the British Pharmaceutical Industry (ABPI), which commissioned the report, put forth seven recommendations to address these observed disparities. These include enhanced strategic planning and inter-board cooperation, as well as greater transparency from health boards regarding their local prescribing decisions and the speed at which newly approved medicines are being introduced into clinical practice.

Victoria Jordan, ABPI Executive Director of Patient Access, commented on the findings, stating, "Scotland has a strong and respected system for assessing new medicines. However, 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." She added, "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." Jordan concluded by stressing the need for collaborative efforts across government, the NHS, clinicians, patients, academia, and industry to ensure that national SMC decisions translate into tangible patient benefits, irrespective of geographical location.