Patients will be able to get 5 more conditions treated at a pharmacy without a GP appointment first

What's happened

Pharmacy First lets you walk into a pharmacy and get treated for 7 common conditions without seeing a GP: sore throat, sinusitis, earache, infected insect bites, impetigo, shingles and uncomplicated UTIs in women. It has done 14 million consultations since it launched in February 2024.

From this autumn it covers 5 more:

• Migraine in adults, where the attacks aren't frequent
• Hay fever in children
• Outer ear infections in adults
• Mild to moderate acne
• Mild skin infections, including scabies

Here's what changes. For the existing 7, the pharmacist follows a set of written rules, agreed in advance by a doctor and a pharmacist, that say exactly which medicine to give, how much, for how long, and which patients they must refer to a GP instead. They can't change any of it. For the new 5, the pharmacist has to be an independent prescriber, a pharmacist qualified to assess patients and write prescriptions. They decide the treatment for you and sign the prescription themselves. A pharmacy needs one on its staff and has to sign up before it can offer the new 5. Once it has, its prescriber will also prescribe for the existing 7, instead of following the written rules. NHS England's estimate is that the 5 could add 2 to 3 million consultations a year once it's fully rolled out.

There's a case for it and there's a worry, so here's both.

The case for it

• It's closer, it's quicker, and people are using it. 4 in 5 people in England live within a 20-minute walk of a pharmacy, and a GP appointment is hard to get. Walking in and walking out with treatment the same day beats the 8am phone queue, and 2 million sore throats have gone that way since 2024. For the simple version of a simple condition, the model works.
• People with migraine want another door. The Migraine Trust surveyed 2,208 people living with migraine in 2024 and headed one of its findings "support is patchy". Over half said shorter waits for treatment would help. A pharmacy on the high street is a shorter wait.
• It's reaching people who often get less. In the GP records of the service's first year, Pharmacy First users were more often younger, female and from more deprived areas than the population as a whole.
• The prescribers exist. From this summer, most new pharmacists join the register as independent prescribers from day 1, and the ones already behind the counter have been taking the prescribing course for years. The workforce that can run these pathways is being trained whether the NHS uses it or not.

The case against it

• A quarter leave without a medicine. Of the 6.7 million clinical pathway consultations to May 2026, 3 in 4 ended with a medicine, down from about 80% in 2024 to 72% now. That can still be good care: advice, self-care or referral may be the right outcome. But these published figures don't show what happened next.
• You don't always know it's simple. Simple is only simple in retrospect. To be fair to the pathways, they're built for exactly this: each one has a gateway, a list of exclusions and red flags that send the patient on, and pharmacists are trained on them. The gap is the case that passes the gate and still isn't what it looks like. A practice sees that person again; a walk-in gets 1 visit, and the follow-up isn't in the published figures.
• Migraine training deserves attention. In a survey of 304 pharmacists by The Pharmaceutical Journal in mid 2025, 47% of those asked had under an hour of teaching on migraine in their degree and 49% had between 1 and 5 hours, and the trainees and students in the same survey said that hadn't changed. That is undergraduate teaching on 1 of the 5 conditions. The survey doesn't measure the training pharmacists have done since, or how competent today's prescribers are.
• Pharmacies are under pressure too. Their own contract settlement talks about the strain of keeping medicines supplied. The pharmacists' own union, the PDA, has raised the staffing: one pharmacist may be expected to oversee dispensing while also providing longer consultations. It has asked for a 2-pharmacist minimum before prescribing services expand, and says many premises don't have a private room fit for a longer consultation.

Where the money goes

Because this is the bit that gets said loosely, here are the figures. Community pharmacy's contract went up £340 million this year, which is 10.3%, with the Pharmacy First budget folded into it for good. The GP contract went up £485 million, which is 3.6%. A pharmacy gets £17 a consultation, but not without limit: every pharmacy has a monthly cap on the consultations it gets paid for, set from its own recent volume and reset every month, and above the cap it does not receive the £17. Those caps were roughly halved in April, the busiest band's from 234 a month to 120, and it's 159 now. A pharmacy that signs up to prescribe also gets a £500 set-up payment and £525 a month towards the infrastructure.

What nobody knows yet

The data stops at the counter. It counts who came in and whether a medicine went out. These activity figures alone cannot tell us whether patients got better, whether they came back or went to their GP anyway, or whether GP appointments were avoided. A national evaluation, funded by the NIHR and led by the London School of Hygiene and Tropical Medicine, is examining the wider impact: how the service is used, prescribing, GP, A&E and hospital use, equity and cost.

What do you think?

Will this help patients get the right care sooner and free up GP appointments, and do pharmacies have the resources to make it work? If you work in a pharmacy or a practice, I'd like to know how it's landing where you are.