New research shows varied access to new medicines across Scotland

A new report finds innovative new medicines are being prescribed at higher rates in some areas of Scotland than others, suggesting there may be ‘unwarranted variation’ in patient access.

A new report published today by the Association of the British Pharmaceutical Industry (ABPI) suggests that patients in different parts of Scotland can access some new medicines more quickly than others, and that part of this variation may be due to avoidable barriers.

Medicines studied included those used to treat type 2 diabetes and weight loss, and medicines that help people at high risk of heart attack and stroke.

'Analysing the adoption of SMC-accepted medicines in Scotland', supported by analytics firm LCP Health, examines NHS prescribing across all 14 Scottish NHS boards from September 2020 to August 2025. It is the first study to compare several types of medicine in this way. [1]

In Scotland, the Scottish Medicines Consortium (SMC) decides whether a new medicine works well enough and is good value for the NHS. Once the SMC accepts a medicine, each NHS board decides how to make it available locally. Boards are expected to decide within 90 days whether to add it to their local list of medicines, known as a formulary. [2]

The report identified the greatest variation in access in GLP-1 medicines, used in NHS Scotland to treat type 2 diabetes and, in some adults, for weight management. By the end of the study period, the highest-prescribing NHS board, the Western Isles, was prescribing around 10 times as much as the lowest NHS board, Shetland. Diabetes and obesity levels in each area did not fully explain this gap. In some areas, it took more than a year to add these medicines to local formularies. [3]

However, the report notes several potential mitigating factors when interpreting the data, including that the boards at either end of the range serve small island populations, where a few prescriptions can make a big difference to prescribing rates. The data could not show whether a medicine was prescribed for diabetes or for weight management, and they did not include private prescriptions. Most NHS prescribing of this medicine class is likely to be for type 2 diabetes, because NHS weight-management services are still being introduced in stages.

There was also variation in access to non-statin cholesterol-lowering medicines that help people at high risk of heart attack and stroke. By the end of the study period, prescribing rates differed eight- to 10-fold between the highest-prescribing (Highland) and lowest-prescribing (Forth Valley) boards. Rates were generally higher in boards in the west of Scotland than in the east. [4]

How local cholesterol services are set up appears to matter. Specialist lipid clinics, which treat people with high cholesterol, are mostly based in hospitals and run by small teams. Boards with clearer links between these specialists and GPs generally recorded higher prescribing. However, here the analysis did not adjust for differences in patient need or local services. High prescribing across a whole board can also hide differences within it. NHS Highland has a single lipid clinic serving a large rural area. Its prescribing per person was high, but the report notes that access may be concentrated among people who live closer to the clinic.

The report is clear that many limitations in the available data limit the conclusions that can be drawn. Some variation is likely to reflect real differences between areas, for example in the health of local people, how services are organised and where specialist care is based, but some is likely to be from avoidable barriers. The report does not rank NHS boards, and it cannot show the reasons for differences in any one area. [5]

Victoria Jordan, ABPI Executive Director of Patient Access at the ABPI, said: “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.”

The report makes seven recommendations for the Scottish Government and NHS Scotland. These include:

• earlier planning, so that services have the right staff, tests and care pathways ready before the SMC publishes its advice

• more openness about local formulary decisions and how quickly accepted medicines are being introduced

• extra support and checks for complex medicines that rely on specialist services

• a learning system to test whether early planning leads to new medicines being used sooner

• tracking specialised medicines by where patients live, not only where they are treated

• closer working between government, the NHS, academia and industry, using Scotland's 'Common Understanding' framework and the ‘triple helix’ approach

• a pilot of protected funding for a small number of high-impact medicines, where local budget pressures could cause delays