Pharmacy First: a clear guide to the England service in 2026

Pharmacy First is the NHS service in England that pays community pharmacies to assess and treat seven common conditions, supply urgent repeat medicines and handle minor illness referrals without a GP appointment. For pharmacy owners the question is commercial: how the fees, monthly fixed payments and caps work, what changed in each contract year, and what the independent prescribing extension from autumn 2026 adds. This guide sets out the service as officially published, the payment structure, the funding settlements for 2025/26 and 2026/27, the official consultation figures, and what the changes mean for operators and their suppliers.

What Pharmacy First is and who runs it

Pharmacy First is an advanced service within the Community Pharmacy Contractual Framework (CPCF), the national contract for community pharmacies in England. The 2026/27 arrangements are set out in a letter signed by the Department of Health and Social Care, Community Pharmacy England and NHS England. NHS England publishes the service specification, clinical pathways and patient group directions, and the NHS Business Services Authority (NHSBSA) runs the Manage Your Service (MYS) portal through which pharmacies opted in and submit claims.

The service launched on 31 January 2024. NHS England’s update on the Pharmacy First service, dated 1 February 2024, said 9,918 pharmacies had signed up as of 17 January, which it put at over 92% of all pharmacies in England. NHS England’s launch announcement said 10,265 community pharmacies, more than nine in ten, would offer the service, and set an aim of freeing up 10 million GP appointments a year.

According to Community Pharmacy England, the service was announced as part of an agreement setting out how the £645 million investment pledged within the Delivery plan for recovering access to primary care would be used to support community pharmacy services. It replaced the Community Pharmacist Consultation Service (CPCS), which had handled referrals for minor illness and urgent medicine supply. This guide covers England only; it does not cover pharmacy services in Scotland, Wales or Northern Ireland.

The three elements and seven Pharmacy First pathways

The NHSBSA service page says the full service consists of three elements:

• Clinical pathways, a new element covering seven common conditions. Community Pharmacy England says these consultations can be provided to patients presenting at the pharmacy and to those referred electronically by NHS 111, general practices and others.
• Urgent repeat medicine supply, previously commissioned as the CPCS.
• NHS referrals for minor illness, also previously commissioned as the CPCS.

The seven clinical pathways, as listed by NHSBSA, are:

1. sinusitis
2. sore throat
3. earache
4. infected insect bites
5. impetigo
6. shingles
7. uncomplicated urinary tract infections in women

Community Pharmacy England notes that age restrictions apply, and says that, where clinically necessary, a prescription-only treatment is supplied under a patient group direction (PGD), and that pharmacists providing the service must use the PGDs and clinical protocol, which NHS England publishes. This is a business guide; clinical criteria are set out in NHS England’s pathway documents and are not summarised here.

NHS England updated the clinical pathways and PGDs on 23 September 2025 after a clinical stocktake, with the changes taking effect from 1 October 2025. The earlier versions remained in place until 11.59pm on 30 September 2025. The local pharmaceutical committee for Leicestershire and Rutland summarised the October 2025 changes as including changes to the position of some clinical gateway points, eight new gateway points, and an increase in the number of consultations potentially eligible for a fee.

How Pharmacy First is paid: fees, fixed payments and caps

Pharmacy owners earn from three sources under Pharmacy First: a fee for each consultation, a monthly fixed payment for meeting an activity threshold, and, from autumn 2026, fees linked to independent prescribing.

Consultation fees

Community Pharmacy England lists the current consultation fees as follows.

Consultation type	Fee per consultation
Clinical pathway consultation	£17
Minor illness consultation	£17
Urgent supply consultation	£15

The clinical pathway fee has risen since launch. NHSBSA’s cap notices from October 2024 and January 2025 refer to a £15 per consultation service fee, while the general text above its current cap tables refers to £17. The DHSC letter setting out the 2026/27 arrangements confirms the £17 fee for clinical pathway and minor illness consultations.

The monthly fixed payment

On top of the consultation fee, a pharmacy can earn a monthly fixed payment based on clinical pathway volume:

• £500 for 20 to 29 clinical pathway consultations in a month;
• £1,000 for 30 or more clinical pathway consultations in a month.

Two conditions apply, according to Community Pharmacy England. First, only clinical pathway consultations that cross the gateway point and reach an outcome set out in the pathway, without onward referral to another pharmacy, count towards the threshold. Second, the pharmacy must be registered to provide the Pharmacy Contraception Service and the Hypertension Case-Finding Service, a bundling requirement. Distance selling pharmacies, which cannot provide hypertension case-finding on their premises, only need to be registered for the contraception service.

Monthly caps

Pharmacy First clinical pathway payments are capped. NHSBSA says activity can be delivered above the monthly cap, but the consultation fee will not be paid for it. Since January 2025, caps have been based on actual service delivery, with each pharmacy placed in a band. NHSBSA now says caps are calculated on a monthly allocation and updated each month to reflect latest actual delivery, and it publishes the list of contractors, bands and caps as a spreadsheet. The table shows the bands NHSBSA published for November 2026.

Band	Average consultations per month, June to August 2026	Maximum clinical pathway consultations per month	Cap for approved prescribing sites
Band 1	Less than 18	32	57
Band 2	18 to 30	40	65
Band 3	31 to 35	53	78
Band 4	36 to 42	62	87
Band 5	43 to 52	75	100
Band 6	53 to 72	96	121
Band 7	73 or more	157	182

For pharmacies that have completed the prescribing pharmacy onboarding process and received approval from their integrated care board to provide Pharmacy First prescribing consultations, NHSBSA says the monthly cap is increased by 25 consultations. Community Pharmacy England says a pharmacy whose ODS code is not included in the list is automatically considered to be in Band 1.

Claiming Pharmacy First payments step by step

The process below follows NHSBSA and Community Pharmacy England guidance.

1. Register. At launch, pharmacies opted in through the NHSBSA Manage Your Service (MYS) portal. To qualify for the fixed payment, also register for the Pharmacy Contraception Service and, unless a distance selling pharmacy, the Hypertension Case-Finding Service.
2. Deliver under the current documents. Use the clinical pathways, PGDs and protocol in force, which changed on 1 October 2025.
3. Record outcomes. Only consultations that cross the gateway point and reach a pathway outcome, without onward referral to another pharmacy, count towards the fixed payment threshold.
4. Check the cap. Confirm the pharmacy’s band in NHSBSA’s monthly cap table; activity above the cap earns no fee.
5. Submit the claim. Community Pharmacy England says consultation data from the pharmacy’s IT system is submitted to the MYS portal, where the owner reviews the payment claim and submits it by the 5th day of the month following the month in which the activity was provided.
6. Use the late claim window if needed. The 2026/27 arrangements introduce a late claims process for Pharmacy First clinical pathways and the New Medicine Service, allowing submissions up to 2 months after the window closes, giving three months in total. Community Pharmacy England’s page, updated on 29 May 2026, did not give an implementation date.

The official Pharmacy First documents

NHS England’s publication page for the Pharmacy First service lists the documents an operator needs, with these dates:

• Community pharmacy advanced service specification: NHS Pharmacy First Service, published 27 November 2023;
• NHS Pharmacy First clinical pathways, published 27 November 2023 and updated 23 September 2025;
• Pharmacy First PGD master authorisation sheet, published 25 January 2024 and updated 23 September 2025;
• the letter on the launch of the NHS Pharmacy First advanced service, published 31 January 2024;
• the community pharmacy primary care network engagement role, published 28 May 2024;
• a PGD or protocol for each of the seven conditions, and guidance on GP Connect: Update Record.

The page gives no version numbers, so operators should check the update date on each document against the 1 October 2025 changeover.

Pharmacy First funding from 2024 to 2026/27

The DHSC letter on the CPCF for 2026/27, published on 29 May 2026 and signed by DHSC, Community Pharmacy England and NHS England, sets out the money. In 2025/26 Pharmacy First had its own budget of £215 million alongside the core CPCF sum. From 2026/27 that budget is fully merged into the CPCF, which Community Pharmacy England says guarantees the funding envelope to the sector and removes the previous risk of underspend.

Funding line	2025/26	2026/27
CPCF	£3.073 billion	£3.636 billion
Pharmacy First	£215 million	Included in CPCF
Digital developments	£8 million	Included in CPCF
Total available	£3.296 billion	£3.636 billion
Funding growth	Not applicable	£340 million (10.3%)

The letter says all other fees will be maintained at the 2025/26 level to prioritise an uplift in the single activity fee, which rises from £1.46 to £1.52 (4.1%). For Pharmacy First, that means the £17 consultation fee and the £500 and £1,000 fixed payments are unchanged in 2026/27.

Pharmacy First contract changes since launch

Pharmacy First has been adjusted in each contract year. The main published changes are:

• October 2024: NHSBSA moved caps to a basis of actual service delivery, allocated quarterly but operating monthly.
• January 2025: NHSBSA says caps from January 2025 are based on actual service delivery; from April 2025 it has published a new cap table each month.
• By 2025/26: the clinical pathway fee was £17 and the monthly fixed payment was tiered at £500 and £1,000, the levels the 2026/27 letter says will remain.
• 1 October 2025: revised clinical pathways, PGDs and protocol took effect after NHS England’s clinical stocktake.
• May 2026: the 2026/27 settlement merged the Pharmacy First budget into the CPCF, kept cap arrangements, counted the new prescribing consultations towards fixed payment thresholds and announced independent prescribing from autumn 2026.
• September 2026: NHS England named the five new prescribing-only pathways.

The 2026/27 letter also says high-level caps will be introduced for the hypertension case-finding service and the Pharmacy First minor illness service to restrict the highest volume outliers, with details to be agreed and implemented during the year.

Other 2026/27 changes in the same letter affect pharmacy cash flow alongside Pharmacy First. The New Medicine Service contractor cap is adjusted down to 0.9% of monthly prescriptions, applying to activity in June 2026. The Pharmacy Quality Scheme commences in June 2026, with its aspiration payment made on 1 September 2026. The single activity fee uplift is backdated to May 2026.

Outside the contract, NHS England has pushed commissioners to use Pharmacy First. The Pharmaceutical Journal reported that NHS England’s planning framework for 2026/27 to 2028/29, published on 24 October 2025, told integrated care boards to maximise Pharmacy First and to introduce prescribing-based services into community pharmacies during 2026/27. The Healthcare Daily covers NHS commissioning in its policy and payers section.

Pharmacy First consultation volumes

Two official figures were published on 29 May 2026, and they measure slightly different periods and activity.

• The DHSC letter says that between April 2025 and January 2026, over 2.75 million Pharmacy First clinical pathways consultations were delivered.
• The government press release says over 3.3 million Pharmacy First consultations were delivered between March 2025 and February 2026, an increase of 43% on the previous 12 months.

The press release also says almost nine in ten, 86%, of people using the service reported a positive experience of visiting their pharmacy for one of the seven conditions. The DHSC letter put activity in the related services over April 2025 to January 2026 at nearly one million pharmacy contraception service consultations and 3 million hypertension case-finding consultations.

The most recent cumulative figure came from NHS England in September 2026, when it said the service had delivered 14 million consultations since its launch, including 2 million for acute sore throats and more than 1.7 million for urinary tract infections.

No official figure for the number of GP appointments actually freed by Pharmacy First was found in the sources reviewed for this guide. The 10 million a year figure from January 2024 was stated by NHS England as an aim, not a measured result.

Independent prescribing: the autumn 2026 extension

The largest change in 2026/27 is a national NHS independent prescribing (IP) offer, introduced from autumn 2026 as an extension of Pharmacy First and the Pharmacy Contraception Service. Community Pharmacy England says that from the autumn of 2026 pharmacist independent prescribers will be able to use their skills to complete episodes of care within the service, without the need for a PGD. Until then, it says, all pharmacists providing the service must use the PGDs and clinical protocol.

According to the DHSC letter and Community Pharmacy England, the offer includes:

• prescribing within the existing Pharmacy First pathways and the Pharmacy Contraception Service;
• up to five new prescribing-only pathways, each subject to assessment by a clinical reference group;
• a one-off £500 set-up fee, payable once a pharmacy has signed up to deliver the relevant services and has a confirmed go-live date with an assured electronic prescribing service system provider;
• a £525 monthly infrastructure fee;
• the same £17 item of service fee as other Pharmacy First clinical pathway and minor illness consultations, with IP pathway consultations counting towards fixed payment thresholds;
• an additional allowance in each capping band, which Community Pharmacy England says gives two caps within each band, one for pharmacies signed up to provide prescribing services and one for those who are not.

The DHSC letter did not name the new conditions. NHS England named them in September 2026 as five Pharmacy First prescribing-only clinical pathways:

• low frequency episodic migraine in adults;
• seasonal allergic rhinitis in children;
• acute otitis externa in adults;
• mild to moderate acne in young people and adults;
• mild skin and soft tissue infections and scabies.

NHS England said the prescribing service would start from autumn 2026 for the initial small number of community pharmacies that become a prescribing pharmacy in 2026/27, and that pharmacies employing a pharmacist with a prescribing qualification will be able to apply to become a prescribing pharmacy. Community Pharmacy England said on 10 September 2026 that further details on the pathways would be published by DHSC and NHS England shortly.

The government press release said independent prescribing would be rolled out nationally from autumn 2026, and NHS England’s September 2026 announcement said hundreds of pharmacies in England would offer the new treatments from autumn. NHS England’s letter on preparing for prescribing in national community pharmacy services asked integrated care boards to put in place a process by August 2026 to identify, approve and onboard pharmacies. NHSBSA’s November 2026 cap notice sets higher caps for contractors that have completed the prescribing pharmacy onboarding process and received approval from their integrated care board. The sources reviewed do not give a count of approved sites.

What Pharmacy First means for operators and suppliers

For pharmacy owners, the economics turn on volume against the thresholds and caps. Assuming it meets the bundling condition and stays within its cap, a pharmacy delivering 30 qualifying clinical pathway consultations in a month earns £510 in fees at £17 each plus a £1,000 fixed payment, while one delivering 29 earns £493 plus £500. The bundling rule means the fixed payment also depends on registering for contraception and hypertension case-finding. Caps limit the upside for high-volume sites, and the gateway rule means consultations that end in onward referral to another pharmacy do not count towards the threshold.

Independent prescribing adds recurring income of £525 a month plus a one-off £500 for pharmacies that can staff it with pharmacist independent prescribers and run an assured electronic prescribing system. It also raises cap headroom by 25 consultations a month for approved sites. NHS England says a pharmacy needs to employ a pharmacist with a prescribing qualification to apply, and the official documents reviewed for this guide do not say how many community pharmacists hold the qualification.

For suppliers, Pharmacy First runs on electronic referrals, consultation data sent from pharmacy IT systems to the NHSBSA Manage Your Service portal for claims and, from autumn 2026, an assured electronic prescribing service system, the condition attached to the IP set-up fee. These are the points where pharmacy IT vendors are involved. NHS England’s publication page lists GP Connect: Update Record among the service documents and says it is being introduced to support the delivery of Pharmacy First and other pharmacy services. The separate £8 million digital developments line in 2025/26 is folded into the CPCF from 2026/27.

Vendors serving pharmacies are profiled in The Healthcare Daily’s Suppliers Guide, and medicines supply news is in our pharma section.

For investors, the 2026/27 settlement gives a 10.3% increase in total available CPCF funding, with Pharmacy First money now inside the core sum. The government says the IP changes will reduce the number of referrals back to GPs and lessen the burden on hospitals; whether activity grows enough to support pharmacy margins is not addressed in the official documents.

What to watch next

As of November 2026, these are the points that will shape Pharmacy First over the next year.

• Independent prescribing take-up. How many pharmacies complete Pharmacy First prescribing onboarding and gain integrated care board approval, and how quickly.
• New prescribing-only pathways. Publication of the detailed documents for the five pathways NHS England named in September 2026, which Community Pharmacy England said DHSC and NHS England would publish shortly.
• Minor illness and hypertension caps. The details of the high-level caps the 2026/27 letter says will be agreed during the year.
• The late claims window. When the two-month late claims process is implemented.
• Activity data. Whether the 43% annual growth in consultations reported in May 2026 continues, and how NHS England reports it.
• The 2027/28 negotiations. Community Pharmacy England accepted the 2026/27 offer on condition of a shared programme of reform with government and NHS England, according to its settlement page.

Contract and policy milestones for community pharmacy can be followed in The Healthcare Daily’s Tracker.