The Scottish Government has announced plans to replace Scotland’s 14 territorial NHS boards with two strategic health boards, in what First Minister John Swinney has described as the most significant structural reform of NHS Scotland during the devolution era.
Announced as part of the Programme for Government 2026-2031, the reform is intended to simplify decision-making, reduce duplication and create a more joined-up health service.
For Scotland’s community pharmacy network, the changes could bring significant opportunities. However, important questions remain about local decision-making, service planning and how the transition will affect pharmacy teams and contractors.
What has been announced?
The Scottish Government has committed to replacing the current 14 territorial health boards with two strategic health boards.
Ministers say the new structure will allow resources and expertise to be used more effectively across Scotland, while reducing differences in access to treatment caused by existing health board boundaries.
The reform will form part of a wider programme of public service restructuring. The government has also committed to reducing the number of special health boards and removing duplication across the public sector.
According to the First Minister’s statement to Parliament, the changes will support plans to increase NHS capacity and ensure that, by the end of 2031, no patient waits longer than 26 weeks for treatment.
The government has not yet confirmed when the existing boards will formally be replaced, how the new boards will be governed or how local services will operate beneath the two strategic organisations.
An East and West structure?
Work towards greater regional collaboration has already been taking place.
In November 2025, NHS boards were grouped into two sub-national planning units known as Scotland East and Scotland West.
The existing Scotland East grouping includes:
- NHS Borders
- NHS Fife
- NHS Grampian
- NHS Lothian
- NHS Orkney
- NHS Shetland
- NHS Tayside
The Scotland West grouping includes:
- NHS Ayrshire and Arran
- NHS Dumfries and Galloway
- NHS Forth Valley
- NHS Greater Glasgow and Clyde
- NHS Highland
- NHS Lanarkshire
- NHS Western Isles
These arrangements were designed to encourage boards to plan services collectively, share resources and reduce variation in access and outcomes. Although the government has not confirmed that these will become the final boundaries, they provide the clearest indication of how a two-board model might operate.
The current sub-national units have initially concentrated on planned care, urgent care, financial sustainability, performance and shared national systems. Scottish Health Council papers also identify remote, rural and island healthcare as an area requiring specific attention.
What could the changes mean for community pharmacy?
Community pharmacies work within nationally agreed services, but territorial health boards remain closely involved in local planning, governance, contractor support and the implementation of services.
Moving to two strategic boards could create an opportunity to reduce variation between different parts of Scotland.
Pharmacy teams currently encounter differences in local clinical pathways, referral arrangements, communication systems and service delivery. A more consistent approach could make it easier to introduce services across Scotland and provide patients with the same level of access regardless of where they live.
Larger strategic boards could also support:
- Greater consistency in pharmacy service specifications and local pathways
- More effective sharing of workforce and clinical expertise
- Improved digital integration between pharmacies, GP practices and hospitals
- More coordinated public health campaigns
- Wider adoption of successful local pharmacy services
- Simplified communication and administration for contractors operating across current board boundaries
The potential importance of community pharmacy within a reformed NHS should not be underestimated. More than 1.9 million people, representing 36% of Scotland’s population, used NHS Pharmacy First Scotland during 2024-25, according to the Scottish Government’s year of progress report.
With more than 1,200 community pharmacies operating across Scotland, the network will be central to any strategy designed to move care closer to people’s homes and reduce pressure on hospitals and general practice.
Protecting local knowledge
While greater consistency could benefit pharmacy teams and patients, the size of the proposed strategic boards creates concerns about whether local knowledge will be retained.
The needs of an urban pharmacy in Glasgow or Edinburgh can be very different from those of a pharmacy serving an island or remote rural community. Workforce availability, transport links, access to GP services and the financial sustainability of individual pharmacies can vary considerably.
The Scottish Health Council has already highlighted potential risks within sub-national planning. These include uncertainty over who is responsible for engaging with communities, duplication of consultation and the possibility that the impact of service changes on particular communities could be overlooked.
For community pharmacy, it will therefore be important that national consistency does not come at the expense of local flexibility.
Local pharmacy representatives will need meaningful involvement in decisions about service design, funding, workforce planning and patient pathways. Clear local points of contact will also be essential during the transition.
Questions still to be answered
The announcement represents a major change of direction, but much of the practical detail remains unknown.
Community pharmacy will need clarity on:
- How pharmaceutical services will be planned and governed
- Whether local pharmacy teams and committees will remain in place
- How contracts, payments and service approvals will be administered
- How rural and island pharmacies will be represented
- Whether existing local services will continue during the transition
- How the new boards will work with councils and Health and Social Care Partnerships
- What role pharmacy will have in the leadership of the new organisations
The workforce implications are also likely to attract scrutiny. Unite has warned that restructuring could result in job losses and increased pressure on services, although the Scottish Government argues that reducing duplication will direct more resources towards frontline care. Unite’s response demonstrates the debate that is likely to continue as further details emerge.
A significant opportunity for pharmacy
Structural change alone will not solve the pressures facing NHS Scotland. However, if the reform produces simpler decision-making, more consistent services and stronger investment in care delivered within communities, pharmacy could benefit.
The success of the two-board model will depend on how it is implemented and whether frontline professionals, contractors and patients are involved in shaping it.
For Scotland’s community pharmacy network, the priority must be ensuring that reform strengthens local access, supports pharmacy teams and recognises the increasingly important role pharmacies play across the NHS.
Further details are expected as the Scottish Government develops its public service reform programme and sets out the governance, legislation and timetable required to establish the two new strategic health boards.
