Pharmacy First is the NHS England clinical service that lets community pharmacists assess and treat patients for seven minor conditions without the patient needing to see a GP first. Patients self-refer or are referred by NHS 111, their GP, or another healthcare professional.
The seven clinical pathways
Each pathway has age limits, exclusions, and a specific protocol. A pharmacist may supply medicines under a Patient Group Direction (PGD) if the assessment supports it.
- Sinusitis (12+) — antibiotic supply if criteria met
- Sore throat (5+) — FeverPAIN score guides treatment
- Earache / acute otitis media (1–17) — phenazone/lidocaine drops or antibiotic
- Infected insect bites (1+) — flucloxacillin or alternative
- Impetigo (1+) — topical hydrogen peroxide or fusidic acid
- Shingles (18+) — antiviral if within 72 hours of rash onset
- Uncomplicated UTI in women (16–64) — nitrofurantoin
The patient journey
A typical consultation runs:
- Patient walks in or is referred by NHS 111. Reception or technician triages.
- Pharmacist takes the patient into a private consultation room.
- Brief history, focused exam (look in throat, ears, examine the bite), and the pathway-specific clinical decision tool guides the consult.
- If criteria are met, the pharmacist supplies under PGD. If criteria aren't met, signpost to GP, A&E, or self-care.
- Record the consultation in the clinical system (Sonar, PharmOutcomes, or whatever your pharmacy uses).
What you actually do day to day
The clinical side is straightforward once you've done a few. The harder work is:
- Identifying eligible patients efficiently. Counter staff need to ask the right questions to spot people who would benefit.
- Managing flow when the room is busy. A typical consultation takes 15–25 minutes including documentation.
- Onward referral discipline. The service only works if you confidently refuse when criteria aren't met.
Payment model
Pharmacy First pays a £15 consultation fee per completed referral, plus the cost of any PGD medicine supplied. To unlock the monthly payment you must hit a minimum threshold of completed consultations. The threshold has changed twice since launch — check the current month's contract framework directly with NHSBSA rather than relying on memory.
What pharmacists need to deliver it
- A consultation room (or fit-for-purpose private area)
- Pharmacy First training, completed through CPPE or your employer's equivalent
- NHS smartcard with the correct role-based access
- An IT system that supports the service (most do; check yours)
- A signed PGD per pathway you provide
Indemnity is included via the NHS service contract — your personal indemnity covers the rest.
Common pitfalls
- Recording incomplete consults as completed. The contract audits these. Be honest in the system — incomplete consults don't pay, but logging a "complete" one without medicine supply when criteria weren't met is a red flag.
- Not signposting properly. If a patient doesn't meet criteria for one pathway, check whether they meet criteria for another before sending them elsewhere.
- Counter staff not knowing the pathways. Have a one-page summary visible at the counter.
