Pharmacy First — the NHS service that allows pharmacists to assess and treat patients for seven common conditions without a GP appointment — represents the most significant expansion of community pharmacy's clinical role in a decade. At £15 per consultation, it's also a revenue opportunity.
But revenue means nothing without the staff to deliver it. With 1,385 pharmacy vacancies nationally, which regions face the greatest workload pressure as Pharmacy First scales up?
How Pharmacy First Creates Workload
Each Pharmacy First consultation requires a registered pharmacist to:
- Clinically assess the patient (5–15 minutes)
- Determine treatment or referral
- Supply medicines under a Patient Group Direction
- Document the consultation for NHS payment
This is fundamentally different from dispensing, where pharmacists oversee but technicians handle most of the workflow. Pharmacy First consultations cannot be delegated to non-pharmacist staff — creating direct competition for pharmacist time.
The Regional Pressure Map
PharmSee's data allows us to estimate Pharmacy First pressure by region. We combine three factors:
- GP-to-pharmacy ratio: higher ratios mean more patients per pharmacy
- Pharmacist salary (proxy for recruitment difficulty): lower salaries signal harder recruitment
- Vacancy density: existing vacancies reduce capacity to absorb new workload
| Region | GP:Pharmacy (city avg) | Median Salary | Vacancy Pressure | Pharmacy First Risk |
|---|---|---|---|---|
| Brighton/South Coast | 1.29:1 | £42,631 | High | Very High |
| Leicester/East Midlands | 1.23:1 | £46,696 | Moderate | High |
| Birmingham/W. Midlands | 1.08:1 | £34,762 | High | High |
| Hastings/Sussex Coast | 1.10:1 | £42,631 | Moderate | High |
| Manchester/N. West | 0.92:1 | £34,422 | Moderate | Moderate |
| London | 0.92:1 | £51,468 | Moderate | Moderate |
| Leeds/Yorkshire | 0.81:1 | Limited data | Moderate | Moderate |
| Nottingham/E. Midlands | 0.72:1 | £46,696 | Low | Lower |
| Newcastle/N. East | 0.69:1 | £32,640 | High | Moderate |
| Bristol/S. West | 0.87:1 | £32,640 | Moderate | Moderate |
Brighton: The Pressure Epicentre
Brighton's 1.29:1 GP-to-pharmacy ratio makes it the most stressed area for Pharmacy First implementation. With 62 GP practices channelling patients towards 48 pharmacies, each pharmacy faces higher-than-average consultation demand — while competing with London (just 50 minutes by train) for pharmacist talent at lower salaries.
The West Midlands Paradox Revisited
The West Midlands combines a reasonable GP-to-pharmacy ratio (1.08:1 in Birmingham) with the second-lowest median salary (£34,762). This means pharmacies here will struggle to recruit the additional pharmacist hours needed for Pharmacy First — while facing higher demand than areas with better ratios like Leeds or Nottingham.
Estimating the Revenue Opportunity
At £15 per consultation, Pharmacy First revenue potential depends on consultation volume. NHS England projected 10–15 million Pharmacy First consultations nationally per year. Distributed across 13,147 pharmacies, that's approximately:
| Scenario | Consultations/pharmacy/week | Annual Revenue/pharmacy |
|---|---|---|
| Low (10M nationally) | 15 | £11,700 |
| Medium (12.5M nationally) | 18 | £14,040 |
| High (15M nationally) | 22 | £17,160 |
At 15 consultations per week (the low estimate), each consultation taking an average of 10 minutes, that's 2.5 hours of pharmacist time per week dedicated solely to Pharmacy First. For a pharmacy running on a single pharmacist, that's a significant chunk of the working week.
The Staffing Equation
Here's where the squeeze bites. A typical community pharmacy with one full-time pharmacist has approximately 40 clinical hours per week. Deducting:
- Dispensing supervision: 20 hours
- Medicines management: 5 hours
- NMS consultations (£31.82 each): 3 hours
- Admin and breaks: 5 hours
That leaves 7 hours for Pharmacy First — enough for 42 consultations per week at 10 minutes each. But if the pharmacy is in a high-ratio area like Brighton, demand may exceed that capacity.
The answer is either more pharmacist hours (expensive, given the locum squeeze) or ACT support (freeing pharmacist time from dispensing checks — see our pharmacy technician demand analysis).
Which Regions Should Act First
Based on our analysis, commissioners and pharmacy owners in these areas should be planning for Pharmacy First capacity now:
- Brighton and the South Coast — highest GP:pharmacy ratio, hardest recruitment from London pull
- Leicester and East Midlands — high ratio but better salaries may help
- Birmingham and West Midlands — moderate ratio but very low salaries complicate recruitment
- Hastings and Sussex coastal — high ratio, deprivation, and seasonal demand
Use PharmSee's location tool to check the GP-to-pharmacy ratio for your specific area and assess Pharmacy First feasibility.
Preparing for the Squeeze
For pharmacy owners and managers:
- Benchmark your area's GP-to-pharmacy ratio
- Check current vacancy levels near you — high vacancies mean locum competition
- Review salary data to understand what you'll need to offer to attract staff
- Consider ACT investment to free pharmacist time for clinical services
Pharmacy First is an opportunity — but only for pharmacies that can staff it.
Analysis based on PharmSee data: 13,147 pharmacies, 12,858 GP practices, 1,385 vacancies, and 384 salary samples. Updated April 2026.