Five new Pharmacy First pathways: what’s changing for community pharmacy

“No appointment, no long wait” was the promise at the centre of the Prime Minister’s announcement of five new Pharmacy First pathways this month.

The announcement sets out the government’s aim to make treatment for common conditions more accessible through community pharmacy, while helping to ease pressure on general practice and urgent care. Pharmacy representative bodies have also long called for pharmacists’ clinical skills to be used more fully within the NHS.

From this autumn, Pharmacy First will expand to cover five new prescribing-only clinical pathways: acute otitis externa in adults; seasonal allergic rhinitis in children aged four to 11; mild to moderate acne in young people; low-frequency episodic migraine in adults aged 18 to 64; and mild skin and soft tissue infections and scabies.

These sit alongside the seven existing Pharmacy First conditions, which include sore throat, sinusitis, shingles, impetigo and uncomplicated urinary tract infections. Once fully rolled out, NHS England estimates that pharmacies could provide two to three million consultations a year for the new conditions alone.

The expansion introduces a new national NHS prescribing service in community pharmacy. The five additional pathways will be delivered by participating pharmacies with an independent prescriber in place, rather than automatically becoming available from every pharmacy.

The service builds on the existing Pharmacy First model, under which pharmacists can supply certain medicines through defined clinical pathways. It also extends the role of pharmacist prescribers within NHS-commissioned services.

For patients, NHS England says the new pathways could offer quicker access to advice and treatment for common conditions that may otherwise require a GP appointment. Community Pharmacy England has described the expansion as a route towards pharmacists becoming “core community clinicians”, with a more established place in neighbourhood health services.

NHS figures show that Pharmacy First has delivered 14 million consultations since launching in January 2024, including seven million for the original clinical pathways. NHS England says the service can provide another route for patients with common conditions, while supporting general practice and urgent care services to focus on people with more complex needs.

Delivering prescribing services requires pharmacies to meet a range of clinical governance requirements. These include appropriate systems, access to records, clinical supervision and clear referral routes. Pharmacists must assess patients, recognise red-flag symptoms and make decisions about whether treatment, advice or onward referral is appropriate.

The five new pathways include conditions that may require more detailed assessment. The clinical pathways will set out the relevant eligibility criteria, treatment options and circumstances in which a patient should be referred for further care.

There is a commercial reality too. Pharmacies providing the new prescribing service will receive a £500 setup payment and a monthly infrastructure payment of £525, subject to a minimum level of prescriber availability. Community Pharmacy England has welcomed prescribing as a strategically important development, while questioning whether the funding fully accounts for the workload, enhanced clinical responsibility, governance and infrastructure involved.

That concern has been echoed elsewhere in the sector. The Company Chemists’ Association has said that success will depend on implementation at scale, while the National Pharmacy Association has called for the government to go further in rolling out prescribing services. Both bodies have highlighted the need for sustainable funding and for enough pharmacies to be able to participate in the service.

The announcement has also prompted discussion about public messaging. The government has promoted the convenience of accessing care without an appointment, while pharmacists have noted that individual pharmacies will still need to manage demand according to their staffing, premises and existing workload. Eligibility criteria and clinical exclusions will also apply.

The expansion places additional prescribing pathways within Pharmacy First and introduces a national NHS prescribing service for participating community pharmacies. Its rollout will be shaped by pharmacy uptake, workforce capacity, funding, clinical governance and patient awareness of how and when the service can be used.