Pharmacy First — who can go, and when to keep them
The seven Pharmacy First clinical pathways with their NHS England age and sex limits, the common exclusions, the minor illness and urgent supply parts of the service, how the practice refers, and the cases that should stay with the GP. Links go to our algorithms, protocols and Ready prescriptions.
The seven clinical pathways age and sex limits set by NHS England
Patients can walk in for these, or be referred by the practice, NHS 111 or urgent care. The pharmacist follows the national clinical pathway (gateway questions and red flags), so a patient can still be sent back to you. Pathways were revised on 1 October 2025: more emphasis on red flags, a 999/A&E escalation gateway in every pathway, and clearer definitions.
| Pathway | Who is eligible | Common exclusions (check the pathway) | On this site |
|---|---|---|---|
| Acute sore throat | Aged 5 and over | Red flags (stridor, drooling, quinsy, sepsis, unable to swallow fluids), immunosuppression, suspected scarlet fever or glandular fever, suspected cancer. The pharmacist scores FeverPAIN; antibiotics only at the higher scores after shared decision-making. | Algorithm Ready Rx |
| Acute otitis media | Aged 1 to 17 | Not offered by distance-selling (online) pharmacies — needs a face-to-face otoscope examination. Excludes suspected mastoiditis or other complications, systemic illness, immunosuppression, recurrent AOM and grommets. | Algorithm Protocol Ready Rx |
| Acute sinusitis | Aged 12 and over | Symptoms for under 10 days (usually viral — self-care), periorbital swelling or visual change, severe frontal headache or neurological signs, immunosuppression, chronic sinusitis. Antibiotic only if symptoms have lasted 10 days or more and meet pathway criteria. | Algorithm Protocol Ready Rx |
| Impetigo | Aged 1 and over | Bullous impetigo, recurrent impetigo (two or more episodes in the same year), widespread lesions or systemic illness, immunosuppression, pregnant people under 16. | Protocol Ready Rx |
| Infected insect bites | Aged 1 and over | Bites or stings abroad (consider tropical infection), animal or human bites, systemic illness or spreading cellulitis with red flags, immunosuppression, pregnant people under 16. | Cellulitis protocol Ready Rx |
| Shingles | Aged 18 and over | Rash started more than 7 days ago (antivirals not supplied), involvement of the eye, nose tip or ear (Hutchinson's sign, Ramsay Hunt), severe immunosuppression, pregnancy or breastfeeding, disseminated rash. | Protocol Ready Rx |
| Uncomplicated UTI | Women aged 16 to 64 | Men, pregnancy, catheter, recurrent UTI (2 in 6 months or 3 in 12 months), antibiotics for UTI in the past 3 months, upper UTI or sepsis signs, immunosuppression, and diabetes (listed in recent pathway summaries — check the current PGD). | Algorithm Protocol Ready Rx |
Minor illness and urgent medicine supply
Minor illness consultation
For low-acuity conditions outside the seven pathways (for example coughs and colds, congestion, mild rashes, hay fever, constipation, minor aches). The pharmacist gives advice and may suggest an over-the-counter product, which the patient buys. Referral from the practice, NHS 111 or urgent care is needed — a walk-in is treated as ordinary advice, not this service.
Urgent repeat medicine supply
An emergency supply of a repeat medicine when the patient cannot reach their practice (usually out of hours). Referrals come from NHS 111, integrated urgent care or urgent and emergency care — not from GP practices. In hours, the practice should issue the repeat or an acute prescription. Usual prescription charges apply.
Other pharmacy services
Hypertension case-finding, the Pharmacy Contraception Service (oral contraception initiation and continuation), New Medicine Service and flu, COVID-19 and RSV vaccination are separate services. See the immunisation schedule for who is eligible.
How GPs refer the GP referral pathway (formerly "GP CPCS")
- Triage first. Care navigators or clinicians use a local triage protocol to spot suitable patients. Red flags and exclusions mean the patient stays with the practice.
- Agree it with the patient and let them choose the pharmacy (check it offers the pathway — AOM is not available from distance-selling pharmacies).
- Send an electronic referral through an NHS-assured referral route (integrated in EMIS or SystmOne, or a local platform such as PharmRefer or Refer-to-Pharmacy). Do not just tell the patient to "go to the chemist" — an unreferred minor-illness visit is not part of the service.
- Tell the patient what happens next: the pharmacy contacts them or they attend; the pharmacist may supply a medicine, give self-care advice or send them back.
- The outcome comes back to the GP record (GP Connect: Update Record) — code it and act on any onward referral the pharmacist makes.
When not to re-route to the pharmacy
- Red flags or a possibly serious illness — sepsis, airway compromise, suspected meningitis, mastoiditis, orbital cellulitis, pyelonephritis, eye involvement in shingles. These need same-day clinical assessment, not a pharmacy appointment.
- Outside the age or sex limits — for example a man with urinary symptoms, a woman of 65 or over with a UTI, a child under 5 with a sore throat, an adult with ear pain (until the new prescriber-only pathway is available locally), a child under 1.
- Excluded groups — pregnancy (UTI and others), immunosuppression, catheter, recurrent episodes, treatment failure, recent antibiotics.
- Possible cancer — persistent hoarseness, an ulcer or sore throat that will not settle, haematuria. Follow NICE NG12.
- Safeguarding concerns, complex multimorbidity or interacting medicines, or a patient who cannot use the service (communication, mobility, capacity).
- Patient choice. Pharmacy First is an option, not a barrier — do not refuse an appointment because a pathway exists.
Independent prescriber pathways announced September 2026
From autumn 2026, pharmacies employing an independent prescriber can work within the existing pathways and the contraception service. NHS England has named five prescriber-only Pharmacy First conditions: migraine, rhinitis, ear infections in adults, acne and scabies. Availability depends on local pharmacies having a prescriber and on the go-live date — check with your ICB or local pharmaceutical committee before referring for these.
Sources (checked October 2026)
- NHS England. Launch of NHS Pharmacy First advanced service (PRN01108), January 2024 — age ranges for the seven pathways; AOM not completed by distance-selling pharmacies. england.nhs.uk
- NHS England. Pharmacy First service specification and clinical pathways (revised pathways, PGDs and protocol in use from 1 October 2025). england.nhs.uk/pharmacy-first
- Community Pharmacy England. Pharmacy First service — GP referral pathway and minor illness / urgent supply elements. cpe.org.uk
- Community Pharmacy Surrey & Sussex. Most common exclusion criteria for the 7 clinical pathways (May 2026). surreysussex.communitypharmacy.org.uk
- The Pharmaceutical Journal. Migraine and acne included in new prescribing Pharmacy First pathways (September 2026); CPCF arrangements for 2026/27. pharmaceutical-journal.com
- NHS Business Services Authority. NHS Pharmacy First Service (PFS) — claims and service information. nhsbsa.nhs.uk