NHS Pharmacy First in 2026: what it is, how it works, and who can use it

If you've got a sore throat, a UTI, earache, or shingles, there's a good chance you don't need to wait for a GP appointment — you can walk into a pharmacy and be seen today, for free, under the NHS Pharmacy First scheme.

Pharmacy First launched in England on 31 January 2024 (NHS England). The idea is straightforward: community pharmacists assess and, where clinically appropriate, treat seven common conditions under nationally agreed clinical pathways, so patients can get that care directly at the pharmacy — without a GP referral and without a GP appointment. The consultation itself is free.

This article explains what Pharmacy First covers, what happens during a consultation, how it protects antibiotics, and who needs to be seen somewhere else.

What is Pharmacy First?

Pharmacy First is an NHS-funded advanced service that allows accredited community pharmacists to assess, diagnose, and treat patients presenting with seven specific conditions. Before it existed, a patient with a UTI or an ear infection would typically have to book a GP appointment (often days away), be prescribed antibiotics over the phone or in person, then collect them from the pharmacy — a process that could take days.

Under Pharmacy First, the same patient can walk into their local pharmacy, have a face-to-face clinical assessment with a pharmacist, and leave with a prescription or supply of medicine if clinically appropriate — all in a single visit.

The service is commissioned and paid for by NHS England, so there is no charge for the consultation. If the pharmacist supplies a medicine, the standard NHS prescription charge applies unless you are exempt — for example under-16s, people aged 60 or over, and people with certain medical conditions or on certain benefits — the same as any NHS prescription. Our prescription cost checker shows the current charge and whether a prepayment certificate would save you money.

The seven conditions Pharmacy First covers

Here's a brief breakdown of each condition and the key eligibility rules:

One thing worth flagging on shingles: antivirals must be started within 72 hours of the rash appearing to be most effective. If you think you have shingles, come in that day — don't wait for a GP appointment that might be days away. This is exactly the kind of situation Pharmacy First was designed for.

How Pharmacy First works alongside your GP

Pharmacy First is part of NHS care, not a separate private route. Your GP practice (or NHS 111) can refer you to a pharmacy for it, and you can also walk in without a referral. After the consultation, the pharmacist sends a record of it to your GP practice, so your GP knows what was assessed and anything that was supplied.

Each of the seven conditions follows a national clinical pathway built on NICE guidance — the FeverPAIN score for sore throat (NICE NG84), the symptom-based approach for uncomplicated UTI in women (NICE NG109), and set criteria for when shingles antivirals are appropriate. If your symptoms fall outside a pathway, the pharmacist refers you on rather than treating you.

For patients, the practical difference is being seen the same day, without waiting for a GP appointment, and leaving with either advice, a medicine or a clear next step.

What about antimicrobial stewardship?

A fair question is whether a pharmacy route makes antibiotics easier to get — which would be bad news for antimicrobial resistance.

The pathways are written with antibiotic stewardship in mind, and an antibiotic is only supplied where the pathway's criteria are met. For sore throat, a low FeverPAIN score means self-care advice rather than an antibiotic (NICE NG84). For sinusitis, NICE advises that most people get better without antibiotics and that an immediate antibiotic is not recommended unless someone is very unwell, has signs of a more serious illness or is at high risk of complications; an antibiotic may be considered when symptoms have lasted around 10 days or more without improving (NICE NG79). The pharmacist's assessment is not a rubber stamp for antibiotics.

How to access Pharmacy First

You don't need a GP referral. You can simply walk into any pharmacy displaying the Pharmacy First logo and ask to be seen. The pharmacist will:

1. Take a short medical history and ask about your symptoms
2. Conduct a clinical assessment — this may include looking in your ears, throat or at a skin condition, and going through your symptoms in detail for a suspected UTI
3. Apply the appropriate clinical protocol for your condition
4. Either supply medicine directly, recommend OTC products, or — if your presentation is outside the Pharmacy First criteria — refer you onward to your GP or elsewhere
5. Send a summary of the consultation to your GP electronically (with your consent)

The whole process typically takes 15–25 minutes. You don't need to bring anything specific, though it helps if you know the names of any regular medicines you take.

GPs can also directly refer patients to Pharmacy First via the NHS referral pathway — so if your surgery calls and suggests you pop to the pharmacy, that's a referral under this scheme.

Who can't be seen under Pharmacy First?

Not everything falls within the scheme. Some presentations that look like Pharmacy First conditions are actually outside scope:

• UTI in men — refer to GP
• UTI in women under 16 or over 64 — refer to GP
• Symptoms suggesting a more serious infection (high fever, signs of sepsis, neck stiffness, rash that doesn't fade under a glass) — refer to 999 or urgent care
• Recurrent UTI — which NICE defines as 2 or more UTIs in the last 6 months, or 3 or more in the last 12 months (NICE NG112) — may need GP investigation of an underlying cause
• Patients who are pregnant — some pathways have modified criteria
• Insect bite allergic reactions — Pharmacy First covers infected bites, not anaphylaxis; that is a 999 emergency

If you come in and your presentation is outside Pharmacy First, we won't just send you away. We'll point you to the right next step and, where possible, give you useful advice in the meantime.

If you think a medicine supplied under Pharmacy First has caused a side effect, tell us or your GP, and report it through the MHRA Yellow Card scheme.

This article is general information from a registered pharmacy team and does not replace personal medical advice. Clinical decisions under the Pharmacy First scheme are made by the pharmacist at the time of consultation, based on individual presentation. Always seek urgent medical attention for serious or worsening symptoms. Last updated: 16 June 2026.