Pharmacy First has been running in England community pharmacies for just over two years. It lets a pharmacist assess, and where appropriate treat, seven common conditions without a GP appointment. Supply can include a prescription-only medicine where the clinical pathway allows it.
The rules, though, are more specific than the headlines suggest. Each of the seven pathways has its own age limits, exclusions and red-flag criteria that trigger a referral back to the GP or to urgent care. This guide walks through what each one covers in 2026, drawing on the published clinical pathways from NHS England and Community Pharmacy England.
The service in one paragraph
Pharmacy First sits alongside the older minor-illness referral service and runs in any community pharmacy that has signed up to the advanced service. Patients can walk in or be referred by NHS 111, a GP receptionist, urgent treatment centres or A&E. The pharmacist runs a structured clinical consultation, documents it against the published pathway, and either supplies an over-the-counter product, issues a prescription-only medicine under a patient group direction, gives self-care advice, or refers the patient on. The seven pathways cover sinusitis, sore throat, earache, infected insect bite, impetigo, shingles and uncomplicated urinary tract infection in women.
The seven pathways, age by age
| Condition | Eligible ages | Typical supply | Common exclusions |
|---|---|---|---|
| Acute sinusitis | 12 years and over | Self-care advice; phenoxymethylpenicillin if criteria met | Severe facial swelling, systemic illness, immunocompromise |
| Sore throat | 5 years and over | Paracetamol/ibuprofen; phenoxymethylpenicillin if FeverPAIN ≥4 | Difficulty breathing, drooling, unable to swallow saliva |
| Acute otitis media (earache) | 1 to 17 years | Analgesia; amoxicillin if criteria met | Discharge from ear with perforation suspected, systemic illness |
| Infected insect bite | 1 year and over | Flucloxacillin or clarithromycin where appropriate | Face or genital involvement, rapid spreading, systemic signs |
| Impetigo | 1 year and over | Hydrogen peroxide 1%; topical antibiotic if non-bullous | Widespread, bullous, or recurrent disease |
| Shingles | 18 years and over | Aciclovir or valaciclovir within 72 hours of rash | Eye involvement, pregnancy, severe immunosuppression |
| Uncomplicated UTI | Women 16 to 64 | Nitrofurantoin or trimethoprim | Pregnancy, recurrent UTI, catheter in place, men |
The age bands are deliberate. Shingles antiviral cover is confined to adults because the evidence base for community treatment of childhood zoster is thin. The UTI pathway explicitly excludes men and pregnant women because both groups need investigation rather than empiric antibiotics.
What triggers a referral
Every pathway includes a list of clinical features that mean the pharmacist will stop the consultation and send the patient on. These are not optional. They are designed to catch the small proportion of presentations that look minor but are not — meningitis masquerading as a sore throat, cellulitis masquerading as an insect bite, herpes zoster ophthalmicus masquerading as facial shingles.
Expect a referral if any of the following appear in the consultation: fever above 38°C with confusion or stiffness; a rash that is not blanching; swelling that crosses the midline of the face; a sore throat that prevents swallowing of saliva; earache with new-onset hearing loss after trauma; shingles affecting the tip of the nose or the eye; UTI symptoms with loin pain, fever or vomiting. Pregnancy is itself a referral trigger for most of the pathways.
Who pays and who records what
The service is free to the patient. The pharmacy is paid a £15 consultation fee per completed assessment, with additional fees for supply of a prescription-only medicine. Every consultation must be documented on the pharmacy's clinical system and, where consent is given, pushed back to the patient's GP record via the GP Connect update service.
The consultation fee is what makes the service economically viable for pharmacies, but it also explains why pharmacists will not use Pharmacy First as a workaround for an obvious minor self-care issue — the pathway requires a structured assessment, not just handing over paracetamol.
What Pharmacy First is not
It is not a replacement for the GP. The pathways are narrow by design. A persistent cough, a rash that doesn't fit impetigo or shingles, a child under one year old with almost any infection, chronic symptoms, and anything with red-flag features all sit outside the service. In those situations the pharmacist will advise where to go next — usually the GP, NHS 111, or an urgent treatment centre.
It is also not a diagnostic service. The pharmacist is working to a clinical pathway that assumes the presentation matches one of the seven conditions. If the symptom picture is ambiguous or atypical, the pathway ends at referral rather than supply. That is a feature, not a failure.
Finding a participating pharmacy
Almost every English community pharmacy has signed up, but not all. PharmSee's pharmacy finder lists the branch location, opening hours and chain for pharmacies in any postcode, and the NHS.uk pharmacy directory flags Pharmacy First participation explicitly.
For patients who want to understand the clinical reasoning behind a particular pathway — what nitrofurantoin is versus trimethoprim, why aciclovir has to start within 72 hours — the PharmSee library has separate explainers on UTI treatment, shingles treatment and sore throat.
Caveats
The eligibility rules above summarise the published clinical pathways as of April 2026. Individual pharmacists may, within clinical judgement, decline to supply even where a patient technically meets the criteria — for example, where the patient has declined a full history, or where supply would overlap with another treatment. The final decision rests with the clinician conducting the consultation.