Antimicrobial resistance (AMR) remains one of the most pressing public health threats globally. In the UK, an estimated 12,000 deaths per year are associated with drug-resistant infections, according to the UK Health Security Agency. Community pharmacists, who handle the majority of antibiotic dispensing in England, have a stewardship role that extends well beyond the Pharmacy First clinical pathway.

The landscape of antibiotic dispensing in community pharmacy

Community pharmacies in England dispense the majority of primary-care antibiotic prescriptions. NHSBSA data indicates that GP-prescribed antibiotics account for approximately 74% of all antibiotic items dispensed in the community. Since January 2024, the Pharmacy First service has added a direct supply route for uncomplicated UTIs, impetigo, infected insect bites, sinusitis, sore throat, shingles and acute otitis media — but this represents a small fraction of total antibiotic volume.

The stewardship opportunity for pharmacists lies not only in how antibiotics are supplied through Pharmacy First, but in the broader dispensing, counselling and public health interactions that happen every day at the counter.

Key stewardship interventions

1. Delayed (back-up) prescriptions

NICE guideline NG15 (Antimicrobial Stewardship) recommends delayed prescribing as a strategy for conditions where antibiotics may not be needed immediately. In this model, a GP issues a prescription but advises the patient to fill it only if symptoms worsen or do not improve within a specified timeframe.

Community pharmacists can support this by:

• Explaining the rationale when patients present a delayed prescription — many patients do not understand why they have been told to wait
• Reinforcing self-care advice for the interim period
• Documenting whether the prescription was dispensed immediately or after the recommended delay

Research published in the BMJ suggests that delayed prescribing strategies reduce antibiotic use by approximately 50% compared to immediate prescribing, without increasing complication rates for most self-limiting infections.

2. The TARGET toolkit

The TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools) antibiotic toolkit, developed by the Royal College of General Practitioners in partnership with Public Health England (now UKHSA), provides resources for primary care. Although primarily designed for GPs, several TARGET resources are directly relevant to community pharmacy:

3. Counselling on prescribed antibiotics

Every antibiotic dispensed is a counselling opportunity. Key messages that pharmacists can reinforce:

• Complete the course as prescribed — though the traditional "finish the course" advice is being reconsidered by infectious disease specialists, current NHS guidance still recommends completing prescribed courses unless told otherwise by the prescriber
• Do not share or save antibiotics — a 2022 YouGov survey found that 7% of UK adults reported keeping leftover antibiotics for future use
• Report side effects — particularly for broad-spectrum agents like co-amoxiclav, where antibiotic-associated diarrhoea is common and Clostridioides difficile infection is a serious risk in older patients

4. Public health messaging at the counter

The pharmacy counter is one of the most frequent healthcare touchpoints in the UK. According to NHS England data, community pharmacies handle over 1.1 billion patient contacts annually. Each interaction is an opportunity to normalise stewardship messages:

• "Most coughs and colds do not need antibiotics — they're caused by viruses"
• "Antibiotic resistance means common infections could become untreatable"
• "Good hand hygiene is one of the most effective ways to prevent infections that need antibiotics"

5. Monitoring repeat antibiotic prescriptions

Pharmacists who conduct Structured Medication Reviews (SMRs) or manage repeat dispensing can identify patients receiving frequent or prolonged courses of antibiotics. Recurrent UTIs, chronic skin infections and prophylactic antibiotic use (e.g. for recurrent cellulitis) are common patterns that warrant clinical review.

Pharmacy First and stewardship alignment

The Pharmacy First service includes built-in stewardship safeguards: clinical pathways require pharmacists to assess against specific criteria before supplying an antibiotic, safety-netting advice is mandatory, and referral to the GP is required when symptoms do not meet the clinical pathway.

However, the stewardship challenge within Pharmacy First is ensuring that the availability of a direct supply route does not inadvertently increase total antibiotic use. NHSBSA is expected to publish first-year Pharmacy First supply data in mid-2026, which will provide the first national picture of how the service has affected antibiotic volumes.

The pharmacist workforce and stewardship roles

PharmSee's tracking of 1,715 active pharmacy vacancies across 11 public sources identifies one current NHS listing specifically mentioning antimicrobial stewardship — a "Lead Antimicrobial Stewardship and Critical Care Pharmacist" role. While dedicated stewardship posts remain concentrated in hospitals and CCGs, every community pharmacist exercises stewardship judgement daily through dispensing, counselling and Pharmacy First consultations.

Pharmacists looking to develop stewardship expertise can explore NHS pharmacy roles with a clinical or infectious disease focus, or use PharmSee's salary data to compare specialist and generalist pay bands.

Caveats

Antibiotic prescribing and supply decisions are clinical judgements. The stewardship strategies described here are drawn from NICE guidance and published evidence but must be applied in the context of individual patient assessment. The 12,000 AMR-associated deaths figure is a UKHSA estimate and includes healthcare-associated infections. Pharmacy First antibiotic supply data is not yet publicly available; the expected mid-2026 publication date is based on NHSBSA's stated timeline. Vacancy data is drawn from PharmSee's 11-source tracker as at 15 April 2026.

Sources

• NICE NG15: Antimicrobial Stewardship — Systems and Processes for Effective Antimicrobial Medicine Use (2015)
• UKHSA: English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) 2024
• RCGP TARGET Antibiotic Toolkit
• NHS England: Community Pharmacy Contractual Framework
• PharmSee vacancy database, 1,715 active roles as at 15 April 2026