What changed
NHS Western Isles recorded Scotland’s highest three-month prescribing rate for GLP-1 medicines between June and August 2025: 1,086.54 doses per head, compared with 392.97 in Greater Glasgow and Clyde and 100.31 in Shetland.
These medicines are used for type 2 diabetes and were approved for weight management in 2023. NHS Western Isles said 340 patients were receiving weight-loss medication and that its earlier structured access pathway was delivering “significant clinical benefit.”
Why it matters
The striking point is not simply that one island board prescribes more. It is that access to the same approved medicines can look very different depending on where a patient lives.
The figures cannot show how much prescribing was for diabetes and how much was for weight loss. Small island populations also mean a few prescriptions can move the per-head rate sharply. Still, the gap is large enough to raise a practical question for Scotland’s health service: when medicines are judged safe and cost-effective, should access depend so heavily on local systems?
The informed speculation is that earlier organisation matters. Western Isles said it created a structured pathway before other boards, with clinical assessment and dietetic support aimed at long-term behaviour change. If that approach is helping suitable patients reach treatment sooner, other boards may examine it. If prescribing remains uneven, the Scottish Government’s promise to reduce unwarranted variation will face a clear test.
Fewer than half of Scotland’s 14 territorial health boards were prescribing GLP-1 medicines specifically for weight loss, and fewer than 800 people had received them for that purpose. Six boards are taking part in pilot programmes, so the national picture may change as those schemes develop.
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