Pharmacy First: postcode lottery of provision already emerging

Analysis shows that patient engagement with Pharmacy First is quickly resembling a ‘patchwork quilt’ across the country. Patients in the highest-performing Integrated Care System (ICS) are benefitting from 7 times more Pharmacy First consultations than the lowest performing.

The Company Chemists’ Association, the trade association for large pharmacy operators across Great Britain, analysed Pharmacy First data collected from members eleven weeks into the service. As of 21st April, 3,000+ CCA member pharmacies had delivered 126,484 Pharmacy First consultations since the service’s launch.

Read the CCA’s analysis ‘Pharmacy First – local implementation’ here

The analysis found that:

  • Almost 13,000 consultations were completed across the North East and North Cumbria ICS[1] but only 948 were completed across Gloucestershire ICS.
  • If every ICS had as many consultations as the highest-performing ICS, there would have been a potential additional 600,000 Pharmacy First consultations by community pharmacies.
  • 3 in 10 GP surgeries (1,972) have referred a patient for a Pharmacy First consultation, but 7 in 10 of those referrals (69%) were from a very small minority (7%) of GP surgeries.

Despite previous analysis[2] showing electronic referrals from other parts of the NHS account for only 1 in 4 Pharmacy First consultations, there appears to be a close link between referrals and the amount of Pharmacy First consultations. The three ICSs with the highest number of Pharmacy First consultations (North East and North Cumbria, Greater Manchester, and Cheshire and Merseyside), had the highest number of electronic referrals from other parts of their local NHS[3].

As with any new NHS service, changing public and clinical behaviour requires time. A key aspect of which is ensuring strong public awareness of the service. Unfortunately, the data shows that the NHS advertising campaign[4] has had little or no impact on the volume of Pharmacy First consultations.

Patients who live in areas where ICS led engagement in Pharmacy First is low, are less likely to benefit from the increased access to NHS care that the service provides. In turn, the systems are not benefitting from the impact on GP waiting times that diverting a cohort of patients to an alternative provide can offer. A fully funded and ambitious Pharmacy First service in England could free up 30m+ GP appointments each year[5].

Therefore, the CCA is calling for policymakers to adopt a three-pronged strategy to ensure Pharmacy First’s success:

  1. Deploy high-quality and targeted public engagement campaigns over the coming months to raise awareness of Pharmacy First to patients and members of the public and ensure behaviour change is embedded before winter pressures set in.
  2. Embrace best practice from higher-performing ICSs including bespoke support and training for GP surgeries to increase referral numbers.
  3. Commit to fund Pharmacy First beyond 2025, giving patients, community pharmacies and General Practice the confidence that the service will be there when they need it.

Malcolm Harrison, Chief Executive of the CCA said: “Pharmacy First has gotten off to a very promising start but there is still a long way to go to harness its full potential.

For patients to gain the maximum benefit from this nationally available service, it is imperative that Pharmacy First is fully and equally implemented across the whole country. This requires a concerted effort to change behaviours so that patients think ‘Pharmacy First’ for common conditions.

Key to this is boosting public awareness and supporting GP surgeries refer patients into Pharmacy. It’s concerning that the NHS advertising campaign appears to have had little impact. We need a high-quality and targeted awareness campaign over the coming months to embed behaviour change well before winter pressures set in. Moreover, GP surgeries need targeted support to boost referrals and efforts to share best practice across and between ICSs.

Lastly, we need confirmation that the service will be funded beyond March 2025 so that patients, community pharmacies and General Practice all have the confidence that Pharmacy First will be there whenever they need it”.

Notes To Editors:

Pharmacy First:

  • The NHS Pharmacy First service launched on 31st January 2024. The service allows pharmacists to provide advice and where clinically appropriate, prescription-only medicines for seven common conditions: acute otitis media (earache), impetigo, infected insect bites, shingles, sinusitis, sore throat, and uncomplicated urinary tract infections in women.
  • The service is currently funded until March 2025.
  • For each of the seven conditions, a clinical pathway must be followed. A clinical pathways consultation can only be accessed when a ‘gateway point’ in one of the clinical pathways is crossed. Once a ‘gateway point’ is reached, the patient is eligible for NHS-funded care[6].
  • In many cases a Prescription-Only Medicines (POM) can be supplied by the pharmacists through a legal mechanism called a Patient Group Direction. This sets out clear criteria for which patients and under what conditions they can be provided with prescription medicine, previously only available from a GP.
  • Previous CCA analysis[7] highlighted that during the first month of the service, one in five Pharmacy First referrals to CCA members were from GP surgeries.
  • An NHS England awareness campaign called “Think Pharmacy First” ran from the 19th of February to the 31st of March to promote the service. It ran across on demand TV services, radio, bus stops and billboards as well as social media.


[1] The success of the service in North Cumbria may be because they launched an NHS pilot in 2022 called “ByeByeUTI” which might have provided a strong basis for the Pharmacy First service.

[2] CCA, Pharmacy First: Meeting Patient Need, May 2025

[3] This data has been standardised for population size and number of CCA pharmacies.

[4] The NHS Think Pharmacy First Campaign ran from 19th February to 31st March 2024

[5] CCA, Pharmacy First and Independent Prescribing, July 2023

[6] See NHS England, Community Pharmacy advanced service specification – NHS Pharmacy First Service for further information.

[7] CCA, Pharmacy First: Meeting Patient Need, May 2025

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