Patients’ access to GLP-1 medicines varies sharply between Scottish health boards, according to an analysis covering NHS prescribing over five years. The largest difference was recorded between island boards, although the data cannot show how many prescriptions were issued for diabetes and how many for weight management.
The report, produced by an organisation representing pharmaceutical companies, examined prescribing of several newer medicines that had been assessed by the Scottish Medicines Consortium as suitable for NHS use and offering value for money. It compared activity across Scotland’s health boards between September 2020 and August 2025.
Wide differences in recorded prescribing
GLP-1 medicines showed the most pronounced variation. These drugs are used in the management of diabetes and, in some circumstances, obesity. The report calculated the average quantity prescribed per head of population over the three months from June to August 2025.
| Health board | Three-month average quantity per head |
|---|---|
| NHS Western Isles | 1,086.54 |
| NHS Greater Glasgow and Clyde | 392.97 |
| NHS Shetland | 100.31 |
NHS Western Isles recorded the highest rate, followed by NHS Greater Glasgow and Clyde, while NHS Shetland had the lowest. However, the authors cautioned that both boards at the extremes of the range serve small island populations. In such settings, a relatively small number of prescriptions can produce a substantial change in a per-person measure.
The figures also have an important interpretive limit: they do not identify the condition for which each medicine was prescribed. As a result, the comparison cannot be treated as a direct measure of access to weight-loss treatment alone. Higher overall prescribing may partly reflect diabetes care, rather than greater availability of GLP-1 medicines specifically for obesity.
Weight-management pilots
Separate information obtained through freedom of information requests found that fewer than half of Scotland’s 14 territorial health boards were prescribing GLP-1 medicines specifically for weight loss. Fewer than 800 people had received the injections for that purpose, according to the earlier findings cited in the report.
Six boards are participating in pilot programmes intended to improve access to weight-loss medication: NHS Western Isles, NHS Forth Valley, NHS Borders, NHS Lothian, NHS Lanarkshire and the NHS State Hospital, also known as Carstairs. NHS Western Isles said 340 patients were receiving medication for weight loss, the highest number among boards involved in the pilots.
The island board said it had introduced a formal route into treatment earlier than any other Scottish health board. It attributed its prescribing levels to that earlier implementation.
“Our prescribing rates reflect that early implementation.”
Debate over fairness and NHS costs
The Royal College of Physicians said the uneven availability of what it described as “safe and cost-effective medicines” was discriminatory towards people living with obesity. It also argued that wider access could save the NHS money by reducing illness associated with obesity.
Those claims concern the possible consequences of access decisions rather than proof that differences in prescribing have caused different health outcomes. The available analysis does not establish why individual boards prescribed at different rates, whether patients had comparable clinical needs, or whether greater use led to better outcomes. It also does not provide a national comparison of the medicines’ effectiveness when used for weight management.
The report therefore indicates a marked geographical difference in prescribing, but its findings should be read alongside the limitations of the underlying measure. Population size, the earlier introduction of local treatment pathways and the mixture of diabetes and weight-management prescriptions all affect the comparison. The forthcoming impact of the pilot schemes will be important in assessing whether access becomes more consistent across Scotland and whether any expansion is associated with improved health or reduced obesity-related disease.
