This guide sets out exactly what it pays, which consultations count towards the monthly payment, how the caps work, what changed when prescribing was added on 29 October 2026, and how to claim. Every figure comes from Community Pharmacy England (CPE) or NHS England and is attributed in the text.
What Pharmacy First is
Pharmacy First is an NHS Advanced service. It started on 31 January 2024, and CPE says it was announced as part of an agreement setting out how the £645 million of investment pledged in the Delivery plan for recovering access to primary care would be used to support community pharmacy services.
The service has three strands:
- Clinical pathways: consultations for seven common conditions, with advice and, where clinically necessary, an NHS-funded supply of treatment.
- Minor illness: consultations with a pharmacist following an electronic referral from NHS 111, general practices and other authorised healthcare providers.
- Urgent medicine supply: the supply of urgent medicines and appliances following an electronic referral from NHS 111 or other authorised providers. General practices cannot make urgent supply referrals, according to CPE.
The minor illness and urgent supply strands are the two elements of the former Community Pharmacist Consultation Service. Patients cannot present to the pharmacy for those two strands without an electronic referral. For the seven clinical pathways, patients can go to or contact a pharmacy directly without a referral, according to NHS England.
The seven clinical pathways
NHS England lists the seven conditions and the patients who are eligible:
| Condition | Eligible patients |
|---|---|
| Acute otitis media | Ages 1 to 17 (distance-selling pharmacies do not complete these consultations) |
| Impetigo | Age 1 and over |
| Infected insect bites | Age 1 and over |
| Shingles | Age 18 and over |
| Sinusitis | Age 12 and over |
| Sore throat | Age 5 and over |
| Uncomplicated urinary tract infections | Women aged 16 to 64 |
Pharmacists follow a defined clinical pathway that includes self-care and safety-netting advice. Where treatment is clinically necessary, they supply it under a Patient Group Direction (PGD) or, in one pathway, supply an over-the-counter medicine under a clinical protocol, all at NHS expense. CPE publishes 23 PGDs and one clinical protocol for the service.
The pharmacy must notify the patient’s GP on the same day or the following working day, according to NHS England. Pharmacies must have a consultation room that meets the terms of service, with IT equipment accessible in the room so that records can be made in an NHS-assured Pharmacy First IT system at the time of the consultation, according to CPE.
What each consultation pays
CPE gives these consultation fees:
| Consultation type | Fee |
|---|---|
| Minor illness | £17 |
| Clinical pathway | £17 |
| Urgent supply | £15 |
CPE’s 2026/27 settlement page states that other dispensing and service fees are unchanged for 2026/27, and that the Pharmacy First budget has been merged into the core CPCF sum, removing the previous underspend risk.
For wider context on where this sits against the contract as a whole, the NHS & operations section covers funding changes as they are announced.
The monthly fixed payment
On top of the consultation fee, CPE says a monthly fixed payment of either £500 or £1,000 is paid to pharmacy owners who:
- meet the minimum activity thresholds of clinical pathways consultations; and
- are registered to provide the Pharmacy Contraception Service (PCS) and the Hypertension Case-Finding Service (HCFS). CPE calls these the “bundling” requirements.
The thresholds are:
- £500 for pharmacies providing 20 to 29 clinical pathways consultations within a month.
- £1,000 for pharmacies providing 30 or more clinical pathways consultations within a month.
Only clinical pathway consultations that cross the gateway point and reach an outcome set out in the clinical pathway, without onward referral to another pharmacy, count towards the monthly minimum, according to CPE.
Distance-selling pharmacies cannot provide the HCFS on their premises, so for them only registration for the PCS is a bundling requirement.
CPE says it had previously been announced that further bundling requirements would be introduced over time, including a minimum number of Ambulatory Blood Pressure Monitoring consultations within the HCFS and a minimum number of PCS consultations. In the 2026/27 negotiations, CPE says it gained agreement from DHSC and NHS England that these further arrangements would not be introduced.
If you are weighing up which services to add alongside it, the ranking of the most profitable private services is a useful comparison, because NHS fees are set nationally while private services are priced by each pharmacy.
What a month looks like in numbers
The table below applies the published fees to different monthly volumes of clinical pathways consultations. It is arithmetic from the CPE figures above, not a forecast, and it assumes that all consultations are within the pharmacy’s monthly cap and the bundling requirements are met.
| Clinical pathways consultations in the month | Consultation fees at £17 | Fixed payment | Total |
|---|---|---|---|
| 20 | £340 | £500 | £840 |
| 25 | £425 | £500 | £925 |
| 29 | £493 | £500 | £993 |
| 30 | £510 | £1,000 | £1,510 |
| 40 | £680 | £1,000 | £1,680 |
The step from 29 to 30 consultations adds £517: the £17 fee for the 30th consultation plus the £500 increase in the fixed payment. A pharmacy sitting at 28 or 29 consultations a month is therefore one or two consultations away from the higher payment.
To see how Pharmacy First income combines with private services, use the profit calculator, which lets you enter your own volumes.
Monthly caps and bands
CPE says that to manage spending on clinical pathways consultations, caps apply to all pharmacies providing the service:
- Each pharmacy has a monthly allocation that is updated each month to reflect its actual delivery of the service.
- Any activity above the monthly cap does not receive the £17 per consultation fee.
- Band assignments and monthly caps are published each month on the NHSBSA website.
- A pharmacy whose ODS code is not on the list is automatically considered to be in Band 1, the lowest band.
When independent prescribing was added to the service, the capping mechanism was extended, according to CPE. There are now two caps within each band: one for pharmacies signed up to provide prescribing services, and one for pharmacies that are not.
Prescribing: five new pathways and two extra payments
From 29 October 2026, approved pharmacist prescribers working in a pharmacy approved to provide prescribing can complete episodes of care within Pharmacy First without a PGD, according to CPE. It is an optional part of the service. Pharmacists who are not prescribers continue to provide the service under PGDs.
Community pharmacist prescribers can:
- prescribe within the original seven clinical pathways instead of using PGDs; and
- provide five new prescribing-only pathways: acute otitis externa (adults aged 18 and over), seasonal allergic rhinitis (children aged 4 to 11), mild to moderate acne (young people), migraine (low frequency, episodic, adults aged 18 to 64) and mild skin and soft tissue infections and scabies.
CPE says consultations for the new pathways count towards the monthly Pharmacy First minimum activity requirement for the £1,000 or £500 payment.
The 2026/27 settlement sets two payments for independent prescribing, according to CPE: a one-off £500 set-up payment, paid once a pharmacy owner has signed up and has a confirmed go-live date with an NHS-assured electronic prescription service system, and a £525 monthly infrastructure payment, paid on top of the usual consultation fees. The full detail, including the go-live date and the NHS England letter to integrated care boards, is in the news report on independent prescribing going live.
CPE also reports that NHS England published an updated Pharmacy First service specification on 29 October 2026. Among the changes, CPE lists new requirements preventing pharmacy owners from generating, submitting or otherwise creating referrals on behalf of patients, except in very exceptional circumstances, and expanded monitoring and post-payment verification requirements.
What an owner needs in place first
CPE’s implementation guidance for the service lists the following:
- Registration: the owner registers their intent to provide the service electronically through the NHSBSA Manage Your Service (MYS) portal.
- Consultation room and IT: a consultation room that meets the terms of service, with IT equipment accessible in the room so records can be made in an NHS-assured Pharmacy First IT system.
- Signposting details: pharmacy owners must have available signposting details for other local services, contact details for local out-of-hours and urgent care providers, and contact details for the integrated care board (ICB).
- PGD authorisation: pharmacists working under the PGDs and the clinical protocol, and an authorising manager, need to sign them before use. CPE provides a master authorisation sheet that covers all 23 PGDs and the one clinical protocol in a single document.
- Remote consultations: in most circumstances the service requirements allow a pharmacist who is at the pharmacy premises to provide consultations remotely, with exceptions and specific requirements set out in CPE’s guidance.
The updated service specification published by NHS England on 29 October 2026 adds enhanced guidance on urgent medicines supplies, which CPE says reflects the emergency supply requirements of the Human Medicines Regulations that already applied. CPE also reports expanded standard operating procedure, business continuity and governance requirements, covering training, record keeping and equipment maintenance, and clarified requirements for face-to-face, remote and distance-selling consultations, including video consultations.
How to claim
CPE sets out the claiming process:
- Consultation data from your IT system is submitted to the NHSBSA Manage Your Service (MYS) portal through an application programming interface, and NHSBSA uses it to populate a payment claim.
- You review the claim in MYS and submit it by the 5th day of the month following the month in which the chargeable activity took place.
- Where one or more bank holidays fall in the first five days of the following month, the deadline is the 6th.
Late claims are accepted only if made by the final day of the month following the month of the consultation. CPE’s example: claims for consultations provided in June 2026 must be submitted by 11.59pm on 31 July 2026.
CPE says later claims are not paid unless the submission was delayed by IT issues outside the pharmacy owner’s control, such as issues with the NHS-approved API system or the MYS portal. Those claims are accepted within twelve months of the date the claim should have been submitted, subject to NHSBSA receiving evidence of the IT issue.
CPE also says it gained agreement in the 2026/27 negotiations for a later claim period to be reintroduced later in 2026, giving a 2-month late claim window and a total of 3 months to claim.
What can get a claim withheld
According to CPE, NHSBSA may withhold payment while it investigates claims where the data indicates the service was not provided in accordance with the PGD or the service specification. The examples CPE gives:
- an excessive quantity of medicine was supplied, for example outside what the PGD allows;
- a patient was outside the PGD age range, for example a woman aged 65 or over for an uncomplicated urinary tract infection; or
- an acute otitis media pathway was provided by a distance-selling pharmacy.
After an investigation, payment is made only if the pharmacy owner provides sufficient evidence that the supply followed the PGD and the service specification.
Where Pharmacy First sits in your pharmacy’s income
Pharmacy First fees are set nationally, and the fixed monthly payment rewards volume. Private services work differently: you set the price, and income depends on how many patients book. The two can share the same consultation room and the same trained team.
Pharmacies weighing up their private options can compare the economics in these guides:
- How much a pharmacy travel clinic makes, and how to start one.
- Ear wax removal as a pharmacy service, including how to choose a training course.
- Launching a private weight management service.
The private services section lists all of them. The latest changes to NHS funding appear in the news section.
How patients find your Pharmacy First service
NHS England says patients can go to or contact a pharmacy directly for the seven clinical pathways without a referral. A clear Google listing, service page and booking route is how those patients find your pharmacy.
The practical steps are covered by Pharmapresence, which publishes the marketing side of this topic. Its Pharmacy First marketing guide covers how to promote the service, and its guide to marketing NHS clinical services covers Pharmacy First extensions and blood pressure checks. For a done-for-you setup, see Google Business Profile optimisation, pharmacy websites and the Bookings Booster service.
To follow changes to the funding and rules as they happen, the newsletter carries the main updates.