‘Pharmacy First’ could be a game-changer for primary care if Government and the NHS demonstrate ambition

Company Chemists’ Association (CCA) analysis shows an ambitious Pharmacy First service in England could free up 30m+ GP appointments each year. inews covered our paper:

The recent ‘Delivery plan for recovering access to primary care’ announced a Pharmacy First service for England, mirroring similar approaches in Scotland and Wales.  

The NHS has previously estimated1 that 6% of all GP consultations (20.4m appointments per year) could be safely transferred to a community pharmacy. Our analysis of the Government’s plans indicate an intention to free up approximately 6m GP appointments annually – which falls well short of what pharmacies could deliver.

The CCA urge the Government and NHS to be even bolder in their ambition and go further and faster.

We estimate that with the added capability to supply non-prescription medicines and prescribe additional prescription-only medicines, an ambitious Pharmacy First service could free up 30m+ GP appointments annually.

Harnessing community pharmacies to deliver care for minor health conditions will effectively create 11,000 urgent care centres in England. With nearly 90%2 of the population located within a 20-minute walk of a local pharmacy, and pharmacies open for evenings and extended hours, patients will be able to seek care and advice closer to their home and at a time that is convenient for them.

The CCA believes that Pharmacy First should be the launchpad for pharmacies delivering more and more clinical services. Ambitious commissioning could position pharmacies as the ‘go-to’ place for urgent and emergency care.

Unlocking this potential requires ambition underpinned by, amongst other things:

  • A fairer funding framework for community pharmacies. Community pharmacy is chronically underfunded. The current annual funding shortfall equates3 to more than £67,000 per pharmacy in England. The funding announced in the recent Delivery Plan is new money for new activity and does not address the historic underfunding of the sector.
  • A bold approach to harnessing Pharmacist Independent Prescribing. All pharmacists registering after 2026 will be independent prescribers (IP). There are an estimated 23,000 pharmacists currently in England without IP qualifications. Under current plans, it will take until 2040 to train the entire workforce.
  • A flexible and future-looking legal and regulatory framework that enables pharmacists and pharmacies to deliver and safe and effectively of medicines and to provide appropriate clinical care directly to patients.

Malcolm Harrison, Chief Executive of the CCA said:

“Government plans to rollout Pharmacy First are welcome, but are only a drop in the ocean. Under current plans, pharmacies are expected to free up 6m GP appointments annually – but our analysis shows pharmacies could do five times this number.

Action to address the historic underfunding of pharmacies and a roadmap to utilise the clinical skills of pharmacists are essential to achieving this.

The Covid-19 vaccination programme showed what pharmacies can do when the Government places its faith and investment in pharmacies.

An investment in community pharmacy, is an investment in greater capacity for the NHS, enhanced resilience in primary care and better patient outcomes”.


Delivery plan for recovering access to primary care

  • The ‘Delivery plan for recovering access to primary care’, published on 9th May 2023, outlined a £645m financial package for community pharmacy to expand the pharmacy oral contraception and blood pressure services this year, improved IT system connectivity between general practice and community pharmacy, and a Pharmacy First service in England.
  • This plan sets out how it “could save 10 million appointments in general practice a year, once scaled”. Later the plan explains this funding provide for “a further 2.5 million blood pressure checks” and “a quarter of women taking oral contraceptives”. A Public Health England document4 estimated 3.4 million women use oral contraceptives, 25% of which is 850,000 women. Combining these two figures gives 3.35 million. Subtracted from the 10 million ambition is 6.65 million remaining for Pharmacy First.
  • Pharmacy First is expected to launch in England some time before the end of 2023.
  • It will allow pharmacists to supply prescription-only medicines, including antibiotics and antivirals where clinically appropriate, to treat seven common health conditions (sinusitis, sore throat, earache, infected insect bite, impetigo, shingles, and uncomplicated urinary tract infections in women) without needing to visit a GP.
  • Pharmacy First is currently the subject of DHSC-led consultation with the Pharmaceutical Services Negotiating Committee.

Independent Prescribing

  • From 2026, all new pharmacist registrants will have an IP qualification upon registration. 
  • Based on current NHS plans, we estimate it will take until 2040 for the current pharmacist workforce to be trained as Independent Prescribers.
  • At present, only 5%5 of employed and relief community pharmacists in England are IP qualified – and even fewer are likely to use these qualifications regularly as there are no NHS commissioned opportunities to do so.
  • Health Education England (HEE) and NHSE have confirmed funding6 for approximately 3,000 community pharmacists to train as prescribers. Whilst this is a positive first step itleaves more than 20,000 pharmacists who will remain without the IP qualification.


1 – Todd A, Copeland A, Husband A, et al The positive pharmacy care law: an area-level analysis of the relationship between community pharmacy distribution, urbanity and social deprivation in England BMJ Open 2014;4:e005764. doi: 10.1136/bmjopen-2014-005764, available here

2 – CCA, Funding gap in England equates to more than £67,000 per pharmacy, January 2023, available here

3 – Public Health England, Contraception: Economic Analysis Estimation of the Return on Investment (ROI) for publicly funded contraception in England, June 2018, available here

4 – Community Pharmacy Workforce Development Group, ‘A review of the community pharmacy workforce: 2021 and beyond’, July 2021, available here, see page 11

5 – Health Education England, HEE announces funding for another year of independent prescribing courses, February 2023, available here

6 – Health Education England, HEE announces funding for another year of independent prescribing courses, February 2023, available here

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