Is Pharmacy First a winning formula?

With community pharmacies taking part in a national health campaign promoting Pharmacy First to the public, how is the service running so far, and what does the future hold?

Launched on 31 January 2024, the Pharmacy First scheme marked a significant shift in primary care delivery in England, with the aim of freeing up 10 million GP appointments a year. Since its inception, the service has expanded rapidly and is now available in nearly 10,000 pharmacies across England, with the latest NHBSA data showing pharmacies claimed for 254,692 consultations per month in June 2025 – up from 125,275 in February 2024.

Service updates

The latter part of this year has seen several updates to the service take effect as part of the contractual settlement for 2025/26.

From 1 June 2025 the bundling requirements for Pharmacy First came into force, with a banded approach added to the monthly payment of £500 for those providing 20-29 Clinical pathways consultations within a month; and £1,000 for pharmacies that provide 30 or more. Pharmacy owners must also be registered and able to deliver the Hypertension Case Finding Service (except distance selling pharmacy (DSP) premises), the Pharmacy Contraception Service (PCS) and the Pharmacy First service, in addition to delivering the minimum number of Clinical pathway consultations to achieve the variable monthly payment.

Clinical protocols and PGDs were similarly updated in June and became effective from October 1, 2025, including specific updated PGDs for the Infected Insect Bites pathway, including versions for flucloxacillin, clarithromycin, and erythromycin, and a new master PGD authorisation sheet for pharmacists to sign instead of signing each individual PGD, simplifying administration.

In addition, if a patient is referred from a GP and does not meet the gateway criteria for a specific clinical pathway, the pharmacist can now provide the minor illness strand of the service instead and make a claim.

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Benefits in practice

Dr Manraj Barhey is Partner at Woodland Avenue Surgery in Luton, Bedfordshire, and clinical director of Medics PCN, and says he has seen the benefit of improved access to clinical services for his patients thanks to Pharmacy First. ‘Our practice refers 25 to 30 patients a week to the service, which saves many practice appointments,’ he says, ‘and encourages better communication all round, making life easier for patients, practices and community pharmacies.’

However, he stresses that the ‘set up is important, adding: ‘You need to establish relationships, agree pathways and lines of communication, but over time the community pharmacists have gained more clinical experience and trusting relationships develop.’

Dr Barhey’s colleague, pharmacist Athif Arif – NHS Bedfordshire, Luton and Milton Keynes community pharmacy engagement lead for Medics PCN, Oasis PCN and Phoenix PCN, Bedfordshire – believes Pharmacy First has helped to elevate the professional role of pharmacists. ‘We are now able to diagnose and treat a range of common conditions which boosts our clinical standing and brings a great deal of professional satisfaction,’ he says. ‘It has also provided a much needed new income stream at a very difficult time for community pharmacy, while increasing footfall and strengthening our relationships with GP practices.’

For patients, the benefits are also becoming abundantly clear. ‘Patients gain accessible care closer to home with walk-in appointments easily available without the need to see a GP,’ says pharmacist Luvjit Kandula, Director of strategy and pharmacy transformation at Community Pharmacy Greater Manchester, ‘giving patients a better understanding of pharmacists’ capabilities and what is on offer, shifting the perception of the role of community pharmacies in supporting their care.’

Key challenges

Nonetheless, despite a recent Healthwatch survey into patients’ attitudes to Pharmacy First showing 86% of the 3,104 respondents had a positive experience of the service, the independent monitoring body believes there is room for improvement.

A snapshot of the survey results reveal that nearly three in ten people (29%) who said they were unlikely to use a pharmacy for the seven conditions were unaware pharmacies could provide treatment and advice, and almost one in three (32%) of this group would still prefer to see their GP.

Some GPs have also voiced concerns about the service bouncing patients back into general practice if they cannot be helped in the pharmacy.

‘Bounce backs happen because patients are not referred within the guidelines or, for example, the patient is allergic to the medicines that a community pharmacist can prescribe,’ says Dr Barhey. ‘Having agreed lines of communication within a time frame helps manage this, and better digital integration would be really useful – giving community pharmacists access to practice systems would mean practices can book patients in directly and see the consultation results.’

Arif agrees that ‘strong communication lines and referral pathways with local GP practices are essential’ but adds that funding concerns for the service in pharmacy continue to make provision difficult: ‘We might see ten people on the first day of month and zero for the rest of the month, but we need a certain number of referrals to trigger bonus payments for the service.’

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Kandula says the solution involves more money. ‘Core funding for community pharmacy still needs to be reviewed and further investment is needed to employ staff and for infrastructure to cope with the increasing workload to support delivery of clinical services,’ she says.

Future prospects

The London School of Hygiene and Tropical Medicine (LSHTM) is currently leading an evaluation of Pharmacy First to see whether the service is having the intended effect, and at what cost.

Ahead of the results of this study, pharmacy bodies and policy makers broadly agree that the service is going in the right direction.

Mark Dayan, policy analyst and head of public affairs at the Nuffield Trust, says: ‘I think the immediate future for the service looks pretty bright, as long as nothing difficult comes out of the LSHTM evaluation, so probably the direction of travel is towards pharmacists doing more of this kind of clinical primary care and being paid for it.’

The Company Chemists' Association (CCA) modelling shows up to 3.5 million people will receive Pharmacy First treatment in 2025, and while Malcolm Harrison, CCA chief executive, says Pharmacy First has ‘seen impressive uptake and success to date’, he believes ‘the service should be expanded to further increase access to care’.

‘Broadening eligibility criteria for the current conditions would increase the number of patients treated and reduce onwards referrals, and adding new conditions (such as eye infections, respiratory infections, or headaches) would further improve the service,’ he says, ‘However, to truly meet its potential the service must move from PGD-led to an Independent Prescribing-led service, which will allow pharmacists the ability to prescribe to patients outside of the specified criteria reducing unnecessary referrals, saving time for both patients and GPs. CCA modelling shows that a fully expanded Pharmacy First service could free up 40 million GP appointments each year.’

Amandeep Doll, RPS Director for England, agrees that: ‘Enhanced pharmacist prescribing services could build on Pharmacy First to help manage demand across the NHS and deliver more care closer to home,’ but says the RPS also wants to see ‘equity of access so that patients across all regions, socioeconomic groups and communities can benefit equally, and improved digital integration so systems work seamlessly across primary care.’

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Meanwhile, Jay Badenhorst, PDA Director of Pharmacy, also believes that ‘a commitment is needed to fully integrate pharmacy across all sectors’, citing ‘the experience in Scotland and Wales [which] shows that, with proper support and independent prescribing, community pharmacy can transform care and relieve pressure on the wider health system.’

Alastair Buxton, Director of NHS Services at Community Pharmacy England, says his organisation is ‘continually pushing DHSC and NHS England to scale up advertising and public awareness and drive referrals from GPs and other NHS providers to Pharmacy First. Labour’s manifesto referenced their desire to create a pharmacist prescribing service, and this week NHS England (NHSE) announced it will consult with the pharmacy negotiator on a national community pharmacy prescribing service from April 2026. This would be a natural extension to the Pharmacy First service and Buxton says CPE is keen to discuss the practicalities of introducing such a service with DHSC, ‘subject to appropriate funding being available’.

The results of the LSHTM evaluation will be key in shaping the next steps, yet the direction of travel already seems clear. With greater digital integration, sustained investment, and a shift towards independent prescribing, the service has the potential to move from a helpful pressure release in primary care to a fully embedded first point of contact for many common conditions.