Research into the prescribing of approved new medicines across Scotland is showing access can depend on where you live – with the differences being most stark for dual-use medicines for diabetes and weight management. The Scottish government says its planned reform of NHS Scotland should improve equality of access.

The Association of the British Pharmaceutical Industry (ABPI), a trade body for companies developing, manufacturing and providing medicines and vaccines to the NHS, commissioned analytics firm LCP Health to examine NHS prescribing of five groups of medicines across Scotland’s 14 NHS boards during the period from September 2020 to August 2025.

Their report, Analysing the adoption of SMC-accepted medicines in Scotland, found new medicines are being prescribed at higher rates in some areas of Scotland than others.

The greatest variation was in access to GLP-1 medicines, used to treat type 2 diabetes and, in some adults, for weight management. By the end of the study period, the highest-prescribing NHS board, NHS Western Isles, was prescribing at around 10 times the rate of the lowest NHS board, Shetland.

Although the data provided to researchers does not distinguish between prescriptions for diabetes and those for weight management, the report authors say the gap isn’t explained by different levels of diabetes or obesity between the two boards.

Meanwhile, prescribing rates for non-statin cholesterol-lowering medicines, used by people at high risk of heart attack and stroke, were at least eight times higher in NHS Highland than in NHS Forth Valley.

The researchers found higher prescribing of these medicines in places where there was a ‘clear link’ between specialist lipid clinics and local GPs.

Bureaucratic barriers

If Scotland’s medicines gatekeeper, the Scottish Medicines Consortium (SMC), accepts that a new medicine is cost-effective for use in NHS Scotland, NHS boards are expected to include it on their formulary of available medicines for prescribers, or publish their reasons for not placing it on the list, within 90 days.

The report says that, in the case of GLP-1 medicines, formulary delays in some areas exceeded one year following SMC acceptance.

The authors say differences in local pathways and protocols also contributed to unequal access.

Their recommendations include earlier NHS planning so the right staff, tests and care pathways are in place when SMC publishes its advice. There should be greater transparency over local decisions and better monitoring of delays and inequalities in access. The authors also suggest additional support should be given for complex treatments, with consideration given to piloting a system of protected funding for the small number of high-impact medicines where local budget pressures could cause delays.

In a statement, a Scottish government spokesperson told healthandcare.scot:

“We will carefully consider the findings of this report and have been clear our reforms to NHS boards are intended to improve equity of access to services and reduce the unwarranted variation and bureaucratic barriers we currently have in place.”

Scottish Labour health spokesperson Jackie Baillie says decision-makers need to look carefully at the recommendations for the sake of patients:

“We cannot have a situation where people across the country face a postcode lottery when it comes to accessing medication. This report has identified an implementation gap between the SMC approving medications, and those then being adopted across NHS Scotland.

“The Scottish government, along with health board bosses, must consider this report and evaluate what more can be done to close that gap and ensure that there is equitable access for patients across Scotland.

“Part of addressing this must be in planning earlier to reduce avoidable implementation delays but also bolstering accountability and transparency across the system.”

Victoria Jordan, Executive Director of Patient Access at the ABPI, says Scotland has a “strong and respected system” for assessing new medicines but the wide variation in prescribing is not fully explained by local differences in patient need:

“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.”

 

Please note: Ettrickburn, the former health and care communications consultancy founded by the publisher of healthandcare.scot, worked with the ABPI in Scotland until earlier this year.

Read more: Millions to go to support NHS obesity programmes; Scottish life sciences to be £25bn sector; Call to address climate impact of medicines; Common Understanding to promote joint work;

Sign up to receive our bulletin for key health & social care updates straight to your inbox.