When NHS England launched Pharmacy First on 31 January 2024, the promise was straightforward: patients with seven common conditions — from sore throats to urinary tract infections — could be treated by a community pharmacist instead of visiting a GP. Two years and two months later, the service is embedded in England's primary care landscape. But the workload consequences for community pharmacy teams are still unfolding.
The scale of Pharmacy First
PharmSee's register covers 13,147 community pharmacies in England. Under Pharmacy First, each is eligible to provide clinical consultations for the seven specified conditions, receiving a fee of £15 per consultation from NHS England.
The theoretical ceiling, based on PharmSee's earlier analysis, is approximately £6,000 per pharmacy per year — assuming around 400 Pharmacy First consultations annually. Across all 13,147 pharmacies, that represents a maximum national revenue pool of approximately £79 million.
In practice, uptake varies. PharmSee's analytical estimates — based on workforce data and referral patterns — suggest capture rates of 55–65% in urban pharmacies and 35–45% in rural or seasonal catchments. These are estimates, not measured figures, and the true capture rate will not be clear until NHSBSA publishes detailed service-level data for the 2024/25 and 2025/26 financial years.
What Pharmacy First means for pharmacy staff
The workload impact extends beyond the pharmacist. A single Pharmacy First consultation typically involves:
- Patient triage (often by a dispenser or counter assistant)
- Clinical assessment by the pharmacist (5–15 minutes)
- Documentation in the pharmacy's clinical system and the NHS Referral Platform
- Supply of medicine if treatment is prescribed under a Patient Group Direction
For a pharmacy averaging one Pharmacy First consultation per hour during peak times, this adds approximately 15–20 minutes of additional clinical work per hour to the pharmacist's existing dispensing and supervisory responsibilities.
The staffing implications are significant. PharmSee tracks 1,383 live pharmacy vacancies across England in April 2026. Of these, community chains — which bear the Pharmacy First workload — account for the majority. Boots alone has 543 vacancies, with 136 of the 200 sampled listings being for dispensers. This pattern suggests that chains are hiring support staff to free pharmacist time for clinical services including Pharmacy First.
The GP pressure connection
Pharmacy First does not exist in isolation. The Health Secretary's letter to the BMA Resident Doctors Committee on 12 April 2026 highlights ongoing pressures on primary care. GP practices continue to report record appointment volumes, and the Pharmacy First pathway is one mechanism designed to redirect lower-acuity consultations away from general practice.
PharmSee's location data illustrates why this matters: across the five largest English cities, the GP-to-pharmacy ratio ranges from 0.89:1 (Leeds, Bristol) to 1.1:1 (Birmingham). In cities where GP practices significantly outnumber pharmacies — as in Birmingham — Pharmacy First demand per pharmacy is likely higher, concentrating workload on a smaller pharmacy estate.
| City | GP Practices | Pharmacies | Ratio |
|---|---|---|---|
| London (3mi from EC1A) | 262 | 292 | 0.90:1 |
| Manchester (3mi from M1) | 106 | 116 | 0.91:1 |
| Birmingham (3mi from B1) | 156 | 142 | 1.10:1 |
| Leeds (3mi from LS1) | 78 | 88 | 0.89:1 |
| Bristol (3mi from BS1) | 62 | 70 | 0.89:1 |
Revenue versus workload: the tension
At £15 per consultation, Pharmacy First is not a high-margin service. For a pharmacy managing 400 consultations per year, the additional revenue is £6,000 — a meaningful but modest sum relative to typical dispensing revenue, which for an average urban pharmacy runs to six figures.
The concern voiced by pharmacy bodies and professional organisations is that Pharmacy First adds clinical workload without proportionate staffing support. A pharmacist conducting Pharmacy First consultations is not simultaneously checking prescriptions or supervising dispensing. In single-pharmacist branches — which represent the majority of community pharmacies — this creates a direct trade-off.
What the next year should reveal
NHSBSA is expected to publish detailed Pharmacy First activity data for the 2024/25 financial year during 2026. This will, for the first time, show which pharmacies delivered how many consultations, at what cost, and in which regions. Until then, the workload picture relies on workforce proxies — vacancy data, staffing models, and the qualitative reports from pharmacy teams on the ground.
For pharmacists and pharmacy owners tracking the evolving landscape, PharmSee's pharmacy analytics provides dispensing and service data for all 13,147 English pharmacies, while PharmSee's job tracker monitors hiring trends across the 11 largest public sources.
Data: PharmSee register (13,147 pharmacies, NHSBSA prescription data); PharmSee job tracker (1,383 vacancies, 11 sources, last scraped 12 April 2026); PharmSee location analysis (3-mile radius). Pharmacy First capture-rate estimates are PharmSee analytical judgements, not measured rates. The £15 consultation fee and £6,000 per-site ceiling are based on published NHS England fee schedules and an estimated 400 annual consultations. Actual activity data awaits NHSBSA publication.