What Is Pharmacy First and How Does It Work in 2026?

Two-and-a-half years on from its launch in England, Pharmacy First has quietly become one of the most useful unbooked services in the NHS. It lets a community pharmacist assess, advise and, for seven specified conditions, prescribe treatment, all without a GP appointment or referral.

The service exists for two simple reasons. GPs are saturated, and most of what walks through a surgery door for minor illness can safely be handled by a pharmacist with prescribing authority. Pharmacy First takes pressure off general practice, gives patients faster access, and routes complex cases on to the GP or to NHS 111 when escalation is warranted.

England launched its version on 31 January 2024. Scotland, Wales and Northern Ireland already had broader equivalents in place. The four nations now sit on a similar foundation, with meaningful local variation. This guide covers what is available where, what it costs, and how to use it.

The 7 conditions covered in England

In England the service is delivered under a Patient Group Direction (PGD), which is the legal mechanism that lets a pharmacist supply prescription-only medicines without an individual prescription. The seven conditions are:

• Sinusitis: adults and children aged 12 and over. The pharmacist can supply nasal corticosteroids or, in defined cases, antibiotics. You will be referred to a GP if symptoms are severe, recurrent or involve facial swelling.
• Sore throat: adults and children aged 5 and over. The pharmacist uses the FeverPAIN scoring tool and may issue antibiotics for a confirmed bacterial throat infection. Suspected glandular fever or quinsy is referred to a GP.
• Earache: children aged 1 to 17. The pharmacist examines the ear with an otoscope. Antibiotic ear drops can be supplied for acute otitis media. Babies under one and adults are out of scope and referred.
• Infected insect bite: adults and children aged 1 and over. Flucloxacillin is typically supplied where infection is confirmed; spreading cellulitis is referred.
• Impetigo: adults and children aged 1 and over. A topical or oral antibiotic is supplied. Widespread or recurrent cases go to the GP.
• Shingles: adults aged 18 and over. Antiviral treatment is supplied within 72 hours of rash onset where indicated. Eye involvement (ophthalmic shingles) is escalated to A&E.
• Uncomplicated urinary tract infection (UTI): women aged 16 to 64. Nitrofurantoin or trimethoprim is supplied for a straightforward lower UTI. Men, pregnant women, anyone with a fever, and suspected upper-tract infections are referred to a GP.

How the devolved nations differ

Wales: the Common Ailments Service

Wales runs the Common Ailments Service (CAS), which is broader than England’s seven conditions and covers around 27 minor ailments (including acne, conjunctivitis, mouth ulcers, threadworm, hay fever and verrucas) alongside the same conditions covered in England. Treatment is free at the point of care and prescription charges have been abolished in Wales since 2007, so any medicine supplied is also free.

Scotland: NHS Pharmacy First Scotland

Scotland launched NHS Pharmacy First Scotland in July 2020. Every community pharmacy in Scotland offers it as a core service, covering UTIs, impetigo, shingles, and a wide range of common self-limiting conditions through a single national framework. Like Wales, Scotland has free NHS prescriptions, so consultation and medicine cost nothing.

Northern Ireland: Pharmacy First NI

Northern Ireland operates Pharmacy First NI, which launched in November 2021 and has expanded its covered conditions list since (currently around 13 everyday conditions). Northern Ireland has had no NHS prescription charges since 2010, so, again, the entire encounter is free.

How to access a Pharmacy First consultation

There is no booking, no registration and no ID requirement. Walk into a participating pharmacy, ask the counter staff for a Pharmacy First consultation, and they will check pharmacist availability. Most consultations take place in a private consultation room and last 10 to 15 minutes.

With your consent the pharmacist can view your NHS Summary Care Record to check existing medicines and allergies. They will examine you where appropriate, talk you through whether medication is indicated, and either supply treatment on the spot or refer you onward.

You can use the Find a Pharmacy search to find an open pharmacy near you, then call ahead to confirm a pharmacist is on duty and free for a consultation today.

What it costs

The consultation is free in all four nations. In England, the standard NHS prescription charge of £9.90 (2026 rate) applies to any item supplied unless you are exempt: under-16s, 16- to 18-year-olds in full-time education, over-60s, pregnant women, those with a valid medical exemption certificate, or holders of a Prescription Prepayment Certificate (PPC). In Wales, Scotland and Northern Ireland NHS prescriptions are free at the point of dispensing, so no charge applies.

What pharmacists cannot do under Pharmacy First

Pharmacy First is deliberately scoped to minor, well-defined presentations. The pharmacist will refer you on for any of the following:

• Chest infections, suspected pneumonia or persistent cough
• Suspected sepsis (fever, confusion, very rapid breathing)
• UTIs in men, in pregnant women, in children, or with fever
• Sinusitis with severe facial swelling, vision changes or stiff neck
• Shingles involving the eye
• Anything outside the named conditions and age ranges

For urgent same-day advice outside normal GP hours, NHS 111 is free, 24 hours, and operates across the whole UK.

Why this matters in 2026

Pharmacy First was projected by NHS England to free up around 10 million GP appointments a year once at scale. Community pharmacists undergo specific training in clinical assessment and independent prescribing. The 2026 graduating cohort of pharmacists qualifies as independent prescribers from the point of registration, which means the prescriber base will keep growing for the rest of the decade.

For most patients the practical effect is simple: a sore throat, an earache in a child, a suspected UTI in a woman of working age. These no longer need a GP appointment that may be a week away. Walk into a pharmacy, get assessed, walk out with treatment when treatment is right.

Find a pharmacy offering Pharmacy First

Almost every NHS-contracted community pharmacy in the UK participates. Use the search below for the nearest open pharmacy in your area, or browse a few of the major cities:

• Pharmacies open in Manchester
• Pharmacies open in Birmingham
• Pharmacies open in Cardiff
• Pharmacies open in Edinburgh
• Pharmacies open in Belfast

Frequently asked questions