Most pharmacy owners know Pharmacy First exists. Fewer are getting everything out of it that they should be.

The NHS Pharmacy First scheme launched in England in February 2024, building on a model that had already been running in Scotland for years. On paper, it is straightforward: pharmacists assess and treat patients for seven common conditions, without those patients needing a GP appointment. In practice, the scheme is generating meaningful NHS revenue for pharmacies that have the right systems in place — and being significantly underutilised by those that do not.

This guide explains how the Pharmacy First service works, how pharmacies get paid, and what the real operational picture looks like.

What is NHS Pharmacy First?

NHS Pharmacy First is a commissioned service that allows trained community pharmacists to assess, advise, and in many cases prescribe treatment for seven common clinical conditions. Patients can walk in, be referred by NHS 111, or be sent across from a GP practice.

Before Pharmacy First, pharmacists could offer self-care advice and supply over-the-counter medicines. Pharmacy First changed the scope: pharmacists can now supply certain prescription-only medicines under a Patient Group Direction (PGD), without the patient ever needing to see a GP.

For patients, it means faster access to treatment. For pharmacies, it means a new NHS revenue stream — paid per completed consultation.

The service is commissioned by NHS England in England, and operates under a separate but similar framework in Scotland, where it has been running since 2020.

How does the Pharmacy First service work?

A patient presents with symptoms. The pharmacist assesses eligibility against the relevant clinical pathway. If the condition is covered and the patient meets the criteria, the pharmacist works through a structured consultation, using the appropriate PGD to supply medication where needed.

After the consultation, the pharmacist records the outcome and submits a claim. In England, claims go through the NHS Business Services Authority (NHS BSA). In Scotland, pharmacies use MYIS — the Manage Your Information System operated by Community Pharmacy Scotland — to record and claim consultations.

That claiming step is where things often break down. More on that shortly.

Patients can access the service in three ways:

• Walked in directly to a participating pharmacy

• Referred by NHS 111

• Referred by a GP surgery or other healthcare professional

  
  

What conditions does Pharmacy First cover?

The NHS Pharmacy First service covers seven conditions in England:

Each condition has its own clinical pathway. The pharmacist follows a structured assessment to determine whether treatment is appropriate, whether to refer on, or whether to signpost elsewhere.

Scotland's Pharmacy First framework covers a slightly different and in some areas, broader list of conditions under its own service specification. If you operate across both nations, the pathways are not identical — which matters operationally.

For a deeper breakdown of each condition and what pharmacists need to deliver compliantly, see our complete guide to Pharmacy First software.

How do pharmacies get paid for Pharmacy First?

Payment for each completed Pharmacy First consultation is structured as follows in England:

• A consultation fee per completed consultation

• An activity threshold payment is once a pharmacy exceeds a set volume of consultations each month

The exact payment rates are set by NHS England and updated periodically. In Scotland, payment is managed through the MYIS system and follows Community Pharmacy Scotland's remuneration framework.

The critical word is completed. A consultation only generates a payment when it is properly recorded and submitted through the correct claiming system. Assessments that are not documented correctly, consultations that are not claimed within the submission window, and recording errors all result in revenue lost — permanently. There is no retroactive claiming for missed submissions.

What does this mean for your pharmacy's workload?

Pharmacy First adds clinical volume to an already pressured operating environment. For every consultation, a pharmacist needs to:

• Assess patient eligibility against the clinical pathway

• Complete the consultation and clinical record

• Supply medication under the appropriate PGD (where applicable)

• Submit the claim through NHS BSA or MYIS

• Communicate outcome to the referring clinician where relevant

When this works smoothly, the additional workload is manageable and the revenue is real. When it does not work smoothly, the consultation takes significantly longer, staff are frustrated, patients are left waiting, and claims are missed.

Most pharmacies doing this on paper or through generic PMR notes are operating in the second category.

Why so many pharmacies are underperforming on Pharmacy First

The scheme has been running in England for over a year. The gap between pharmacies that are extracting full value from it and those that are not comes down almost entirely to workflow and admin infrastructure.

The most common problems:

No structured consultation recording. Without a digital pathway, pharmacists are free-texting notes or using paper records. These are harder to audit, slower to complete, and create risk when it comes to claiming.

Missed claims. The claiming window is fixed. If a consultation is not submitted in time, the revenue is gone. Pharmacies using manual processes miss more claims than those with automated or semi-automated submission workflows.

No visibility on performance. Most pharmacy owners have no easy way to see how many Pharmacy First consultations they completed this month, how that compares to last month, or how much revenue is outstanding. Without visibility, there is no basis for improvement.

Staff training gaps. Pharmacy First consultations require confident clinical assessment. When staff are unsure of the pathway or the documentation requirements, consultations take longer and outcomes are inconsistent.

At KinWell Pharmacy, where Cured Click was built and tested under live NHS operating conditions, structured digital workflows produced a 96% increase in consultations and 188% year-on-year consultation growth. That is not an anomaly — it is what happens when the operational infrastructure matches the clinical opportunity.

How digital systems change the picture

A purpose-built Pharmacy First system does several things that paper and generic software cannot:

Structured clinical pathways. Pharmacists follow a guided consultation flow, not a blank text field. Every required data point is captured. Every submission is formatted correctly for claiming.

Automated or streamlined claiming. Systems with MYIS integration in Scotland — or NHS BSA submission workflows in England — reduce the manual steps between consultation and claim. Fewer steps means fewer missed payments.

Analytics and volume tracking. Owners and operations leads can see consultation volumes, claim rates, and revenue in real time. That visibility enables decisions: staffing, promotion, service capacity.

Patient communication. Pre-consultation digital intake reduces chair time. Post-consultation messaging improves outcomes and patient experience.

This is not about replacing pharmacist's clinical judgement. It is about removing the administrative drag that sits around the clinical work — so pharmacists can see more patients, claim more accurately, and spend their time doing what they trained to do.

If you want to understand how to choose and evaluate a Pharmacy First system, our complete guide to Pharmacy First software covers the full picture, including what to look for, what to avoid, and how to evaluate platforms for your pharmacy type.

Is your pharmacy getting full value from Pharmacy First?

The honest answer for most pharmacies is: probably not. Not because of clinical capability — pharmacists are well-equipped to deliver the service. But because the admin infrastructure around it has not kept pace with the clinical opportunity.

Pharmacy First is not a future revenue stream. It is generating income now for pharmacies that have the right systems behind it. For those that do not, it is generating significantly less than it should.

For independent pharmacies (1–3 sites)

Create your free page at curedclick.com and see how Cured Click structures Pharmacy First consultations around the way your team actually works.

For pharmacy groups and multi-site operators

Get in touch with our team to discuss how Cured Click manages Pharmacy First across multiple branches, with centralised oversight and consistent claiming processes across every site.