Pharmacy First expanded to include independent prescribing and ‘ease pressure on GPs’
Pharmacists who hold an independent prescribing qualification will be able to assess patients and prescribe medicines directly for specific conditions in an expansion of Pharmacy First, the Government has announced.
The Department of Health and Social Care said that the move will ‘reduce referrals back to GPs’ and that the changes, announced today as part of the 2026/27 community pharmacy contractual framework, will be rolled out from this Autumn.
Pharmacy First has aimed to shift of workload to pharmacies from GP practices, by allowing direct prescribing for seven common conditions, but has attracted criticism due to some pharmacies directing patients back to general practice for a variety for reasons, and GPs believing that the Pharmacy First money would be better off spent in general practice.
Now independent prescribing will be introduced into the contract framework as an extension of Pharmacy First and the Pharmacy Contraception Service (PCS), with community pharmacist prescribers
enabled to:
- Prescribe within the existing Pharmacy First clinical pathways and the PCS
- Provide up to five new Pharmacy First prescribing-only pathways – options to be considered include bacterial conjunctivitis, allergic conjunctivitis, oral thrush, skin infections and respiratory tract infections. In advance of their rollout, the new pathways will need to be approved by a clinical reference group. These consultations will count towards the monthly clinical pathways minimum activity requirement.
- Prescribe an alternative item where there is a need to meet the needs of an individual patient, where there is a supply chain issue relating to the original prescription, and there are arrangements in place with the original prescriber to allow such an approach.
Over 3.3 million Pharmacy First consultations were delivered between March 2025 to February 2026, an increase of 43% on the previous 12 months, according to the Government.
In response to the expansion, the RCGP told Pulse that community pharmacy can make ‘an important contribution to patient care’, but it complements rather than replaces the ‘comprehensive, continuous and holistic care’ provided by general practice.
The college also said that although Pharmacy First ‘may improve access for some patients’, further evidence is needed on its impact on overall demand and system-wide pressures.
Primary care minister Stephen Kinnock said the move will ‘ease pressures on GPs’, helping patients get the right care closer to home.
He said: ‘We are making the most of our highly skilled pharmacists, while boosting access to services and giving patients more care right on their doorstep.
‘Independent prescribing will play a major part in delivering this shift – easing pressures on GPs, cutting unnecessary red tape and helping patients get the right care closer to home.’
NHS England primary care director Dr Amanda Doyle said: ‘Community pharmacies already play a vital role in delivering NHS care closer to home, and this agreement will make it easier for patients to get advice, treatment, and medicines through their local pharmacy.
‘Expanding independent prescribing will help make better use of the clinical expertise within our community pharmacy teams, helping patients get the right care in the right place while helping reducing pressure on other NHS services.’
The £340m funding package attached to the contract framework and rollout of independent prescribing has been agreed with Community Pharmacy England. The settlement will see the pharmacy funding budget increased by 10.3% this financial year, to £3.636bn, alongside the introduction of independent prescribing into Pharmacy First.
However, Community Pharmacy England said that throughout the negotiations, they raised concerns that with the proposed funding, the addition of independent prescribing to the contract ‘risked being set up to fail’.
It will be down to pharmacy owners to ‘decide on an individual basis whether they want to provide the service or prioritise the use of independent prescribing skills elsewhere’, Community Pharmacy England added.
RCGP president Professor Victoria Tzortziou Brown said: ‘For any expansion of Pharmacy First to work well, GP practices and pharmacies will need robust IT systems, clear referral and escalation pathways, appropriate training, and reliable mechanisms for sharing information safely and efficiently.
‘Any expansion should be properly resourced and independently evaluated, including its impact on patient outcomes, patient experience, continuity of care, antimicrobial stewardship, and workload across both pharmacy and general practice.
‘Community pharmacy can make an important contribution to patient care, but it complements rather than replaces the comprehensive, continuous and holistic care provided by general practice. The wider pressures facing general practice will only be addressed through sustained investment in GP services, recruiting and retaining more GPs, and ensuring practices have the resources they need to deliver safe, timely and high-quality care for patients.’
The Doctors’ Association GP spokesperson Dr Steve Taylor told Pulse: ‘If both pharmacies and GP practices were funded in proportion to the need, then there would be no need for Pharmacy First as access to GPs would be there.
‘Even the 3.3 million Pharmacy First consultations over the past 12 months needs to be put in context. This represents less than 1% of GP practice consultations. The broader question is whether pharmacies are the best place to provide diagnosis and prescribing, or whether this is better in GP practices.’
Following the launch of Pharmacy First in 2024, GP leaders urged the Government to urgently review why pharmacies are paid ‘more than double’ per consultation compared with GPs.
The BMA and the RCGP recently raised concerns around the contractual requirement for GP practices to allow community pharmacy access to the GP record, warning that the technology is currently not ‘fit for purpose’.
Last year Mr Kinnock said that take-up of Pharmacy First was not where the Government ‘would like it to be’.
And earlier this year, the pharmacists’ regulator raised concerns that antibiotics had been supplied inappropriately through Pharmacy First.
According to a recent review, GPs received ‘inadequate’ funding to supervise independent pharmacy prescribers, with the programme also increasing GP workload.
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READERS' COMMENTS [10]
Please note, only GPs are permitted to add comments to articles
Pharmacy first is great in deflecting patient and offering great access and then back to Gp in complicated ways.We have GP surgery who have only pharmacies triaging from neonates to centurions with great access. Antibiotics resistance is a joke as they can prescribe even without clinical exam..Of best treatment for wax is antibiotics-new political medicine. No need to worry about great quality ab=nd care.
Respiratory tract infections prescribing is tricky and not sure how it can be done without auscultation and examination of chest.
Will be good if community pharmacists can be trained atleast up to the PA level to examine patients and then decide on antibiotics.
It took me years before I would be confident to say I had the requisite skills to be an independent prescriber- I have my doubts that this is a terribly sensible way forward I’ve heard too many stories from colleagues where patients have been treated for tonsillitis and, in fact, they’ve had tonsil cancer. Even as an experienced GP, things are quite often not as straightforward as one would first think.
As ever, government intent on spending money on anyone but GPs to provide general practice services in England. None of the continuity they harp on about with this scheme and they’re happy to spend (allegedlt) £340m on this versus the £20m in new money (£372m of the £485m GP ‘uplift’ was NOT NEW and approx £90m was to cover inflationary DDRB pay uplifts. Good luck to the LPC negotiators if they got what they were after but nonsensical if this is at the expense of properly funding general practice.
Agree with above. You walk into boots and sign BP check for all FREE. So duly BP checked and raised .Back to GP no mention HT stable on current meds and recent QOF to target. Wish we were paid per patient contact. This all you can eat buffet is the end of traditional GP practice . Moan over .
30 years in FT practice, approximately 250,000 consultations. Number of times I have thought I wish someone could have eased the pressure on me by prescribing antibiotics for this patient with sinusitis =0
Not sure that Prescribing without wholistic Physico-Psycho-Social Diagnosis is good Practising of Medicine.
But that is not what the private insurers want, is it?
Chest infections in pharmacy is a shocking idea, I took my 9 year old to the chemist for some otigo when paracetamol and ibuprofen hadn’t done the trick, he’d had pain for less than 12 hours and didn’t have a fever, the pharmacist tried to give me amoxicillin, I didn’t want antibiotics, he was pain free 2 days later
Had a patient who had 3 UTIs in 3 successive months and had just so happened to go directly into 3 separate pharmacies. None of them seemed to make any concern about underlying predisposition, 2 gave the same antibiotic and I suspect all were unaware of each others roles. Paying a pharmacy more money to cream of (at times) easy picking only leaves us with more time consuming complexities. Finally once a pharmacy has met their minimum “quota” I suspect they then quickly turn to ask opener questions to be able to deflect back to us and decline to see. On a strange medication? Present for slightly longer than our terms? Oh no back to your GP it is
The problem is that pharmacists may be able to prescribe but they cannot assess and diagnose.
Why is it that suddenly everyone seems to think than non doctors can do this? Even doctors