How NHS Pharmacy First Works: Conditions, Eligibility and What to Expect

This guide explains the established NHS Pharmacy First clinical pathways, the age ranges that apply, what usually happens during a consultation and when you may be referred to another healthcare service.

What Is NHS Pharmacy First?

NHS England launched Pharmacy First in January 2024. The service expanded the role of community pharmacies by allowing pharmacists to manage seven common conditions through defined clinical pathways. It also incorporates NHS referrals for minor illness and urgent repeat medicine supply within the wider Pharmacy First service.

For the seven clinical pathways, eligible patients can attend or contact a participating community pharmacy directly without first needing a GP referral. The pharmacist follows an NHS clinical pathway, checks for symptoms that may need a different level of care and decides the most appropriate next step.

Which Conditions Are Covered by the Seven Clinical Pathways?

The established NHS Pharmacy First clinical pathways cover seven conditions, with specific age criteria:

• Acute otitis media (earache): children aged 1 to 17 years.
• Impetigo: patients aged 1 year and over.
• Infected insect bites: patients aged 1 year and over.
• Shingles: adults aged 18 years and over.
• Sinusitis: patients aged 12 years and over.
• Sore throat: patients aged 5 years and over.
• Uncomplicated urinary tract infection (UTI): women aged 16 to 64 years.

Age alone does not guarantee treatment. The pharmacist must still assess symptoms, medical history, medicines and other clinical factors before deciding whether the Pharmacy First pathway is suitable.

If you are specifically concerned about a bite, Biscot Pharmacy also has a separate guide to Pharmacy First and infected insect bites.

What Happens During a Pharmacy First Consultation?

A Pharmacy First consultation is a clinical assessment, not simply a request for a particular medicine. The pharmacist will usually ask questions about your symptoms, when they started, how severe they are and whether they are improving or getting worse.

Depending on the condition, the pharmacist may also ask about:

• your age and relevant medical history
• current prescription and over-the-counter medicines
• allergies
• pregnancy or breastfeeding where relevant
• previous treatment or self-care you have already tried
• symptoms that could indicate a more serious problem

For some conditions, the pharmacist may need to examine the affected area or carry out relevant clinical checks. The purpose is to decide whether the NHS pathway applies and whether pharmacy treatment is safe and appropriate.

Does Pharmacy First Always Mean You Will Receive Medicine?

No. A consultation can result in self-care advice, an over-the-counter recommendation, a prescription-only medicine where the NHS pathway supports it, or referral to another healthcare professional.

NHS England states that pharmacists follow defined clinical pathways that include self-care and safety-netting advice and, only where appropriate, the supply of a restricted range of prescription-only medicines. This helps ensure treatment is based on clinical need rather than an expectation that every consultation ends with medicine.

Can Pharmacy First Include Antibiotics?

Some Pharmacy First pathways can include an antibiotic when the clinical criteria indicate that it is appropriate, but antibiotics are not automatically supplied. The pharmacist must follow the relevant NHS pathway and antimicrobial guidance.

If an antibiotic is not clinically indicated, the pharmacist may recommend self-care, another treatment option or referral instead. This is important because antibiotics do not work for viral infections and unnecessary use contributes to antimicrobial resistance.

Do You Need a GP Referral?

For the seven clinical pathway conditions, patients can access a participating pharmacy directly as well as through referrals from services such as general practice, NHS 111 and urgent or emergency care settings.

Other parts of the wider Pharmacy First service, including some urgent repeat medicine supply and minor illness referrals, may operate through NHS referral routes. The route you use therefore depends on why you need help.

Do You Need an Appointment?

A pre-booked GP appointment is not required for the seven Pharmacy First clinical pathways. Many community pharmacies accept direct approaches, but local availability can vary, so it can be sensible to contact the pharmacy before travelling if you need a particular service.

What Should You Bring or Know Before the Consultation?

You usually do not need to arrive with a diagnosis. It is more useful to be ready to explain your symptoms accurately.

• Know when your symptoms started and how they have changed.
• Bring or know the names of medicines you currently take.
• Tell the pharmacist about allergies.
• Mention important medical conditions.
• Explain any treatment or self-care you have already tried.
• Have your NHS number available if you know it, although not knowing it should not stop you asking for help.

What Happens If Pharmacy First Is Not Suitable?

If the pharmacist identifies symptoms outside the clinical pathway, warning signs, an excluded age group or another reason that pharmacy treatment is not appropriate, they can advise on the next step. This may include contacting your GP, using NHS 111, attending urgent care or seeking emergency help.

Being referred elsewhere does not mean the consultation was unsuccessful. Part of the pharmacist’s role is recognising when a condition needs assessment or treatment that cannot safely be provided through the pharmacy pathway.

When Should You Use NHS 111 or 999 Instead?

Use NHS 111 when you need medical help now but are not sure which service is appropriate. NHS 111 can assess the situation and direct you to suitable care.

Call 999 for a life-threatening emergency, such as signs of a heart attack, stroke, severe breathing difficulty or another situation requiring immediate emergency help. Pharmacy First is intended for appropriate common conditions and is not an emergency service.

Will Your GP Record Be Updated?

NHS guidance states that information from a Pharmacy First consultation can be added to your GP health record. This supports continuity of care and helps other NHS professionals understand what advice or treatment has been provided.

How Pharmacy First Fits With Everyday Pharmacy Advice

Pharmacists can help with more than the seven Pharmacy First pathways. They can also provide advice about many minor illnesses, medicines, side effects and self-care. If your symptoms do not fit one of the seven pathways, a pharmacist may still be able to advise you even if NHS Pharmacy First treatment is not appropriate.

Frequently Asked Questions

Is Pharmacy First available everywhere in England?

Most community pharmacies in England participate in Pharmacy First, but service availability can vary. Contacting the pharmacy before travelling can help confirm whether the service you need is available.

Can children use Pharmacy First?

Yes, for certain pathways and age groups. For example, acute otitis media is covered for children aged 1 to 17 years, while sore throat applies from age 5 and sinusitis from age 12.

Can Pharmacy First treat a UTI?

The established UTI pathway applies to uncomplicated urinary tract infections in women aged 16 to 64 years, subject to the pharmacist’s clinical assessment and the NHS pathway criteria.

Will I definitely receive prescription medicine?

No. The pharmacist may provide self-care advice, recommend another treatment, supply a medicine when clinically appropriate or refer you to another healthcare service.

Can I use Pharmacy First if my symptoms are severe?

Severe, rapidly worsening or potentially serious symptoms may need a different healthcare service. A pharmacist can assess whether the Pharmacy First pathway is appropriate and refer you when necessary. For life-threatening symptoms, call 999.

Accessing Pharmacy First in Luton

If you are in Luton and need help with one of the eligible conditions, Biscot Pharmacy provides the Pharmacy First service in Luton. The service page explains local availability, access and the conditions the pharmacy can assess.

Pharmacy First can make it easier to get appropriate help for common conditions, but the pharmacist’s assessment determines whether treatment through the service is suitable for you.

Information note: This article provides general information about NHS Pharmacy First and does not replace individual medical advice. Eligibility and treatment depend on the relevant NHS clinical pathway and pharmacist assessment.