Five New Pharmacy First Conditions and What the Headlines Missed
NHS England has confirmed that Pharmacy First will expand to five new conditions this autumn. It is good news for patients and a real step forward for community pharmacy. The way it has been reported, however, risks creating a problem for pharmacy teams before the service has even started.
This morning’s BBC coverage told the public they would soon be able to walk into their local chemist for treatment of twelve common conditions. For most pharmacies in England that is not true, and in some cases it will not be true at all. Patients who read the headlines will arrive at the counter expecting treatment that cannot be given, and it will be counter staff who have to explain why.
What has actually been announced
The five new pathways cover low-frequency episodic migraine in adults, seasonal allergic rhinitis in children, acute otitis externa in adults, mild to moderate acne in young people and adults, and mild skin and soft tissue infections, including scabies.
These are the first Pharmacy First pathways that involve genuine prescribing. They can only be delivered by a pharmacist-independent prescriber, working in a pharmacy that has applied and been approved as a prescribing pharmacy. NHS England expects a few hundred pharmacies to offer them at the start, with a gradual rollout to more over time.
Where the coverage went wrong
The first problem is the claim that pharmacists already prescribe for the existing seven conditions. They do not. The existing pathways run under Patient Group Directions, which allow supply of set medicines to patients who meet set criteria. That distinction is exactly what separates the existing service from the new one.
The second problem is that those criteria were left out. The existing pathways all have age limits and exclusions. The UTI pathway covers women aged 16 to 64 only, and the earache pathway covers children and young people aged 1 to 17 only. A reader in their seventies with a suspected UTI, or an adult with an earache would reasonably assume from the coverage that they are covered.
The third problem is scope. The new ear pathway treats infections of the outer ear canal in adults. It does not cover middle ear infections, which means an adult with a middle ear infection is covered by neither the old pathway nor the new one. Similarly, the new rhinitis pathway is for children with hay fever only. Adults with hay fever are not included.
The fourth problem is timing. The service is not live. The service specification, the legal directions, the application process, and the start date have not yet been published. Community Pharmacy England expects October.
What this means at the counter
For now, the priority for every pharmacy is making sure the whole team gives patients the same clear, accurate message. The new services have not started. When they do, only some pharmacies will offer them. The existing seven services are unchanged and still have their usual criteria.
Counter staff should never promise a patient treatment. Every request should go to the pharmacist, who can check whether an existing NHS service applies, recommend an over-the-counter option, or direct the patient to the right place. No patient should be turned away without that check.
The bigger question for pharmacy owners
Participating pharmacies will receive a £500 setup payment and £525 a month, alongside the standard consultation fees. There is no higher fee when the consultation is carried out by a prescriber. That monthly payment has to cover prescribing software, clinical governance, supervision, and the added responsibility that prescribing brings. Community Pharmacy England and the Company Chemists’ Association have both said publicly that the funding is not enough.
For pharmacy owners, this should be a business decision, not a reflex. Anyone who employs, or plans to employ, an independent pharmacist prescriber should read NHS England’s guidance now, speak to their system supplier about electronic prescribing, and model the costs before applying.
What happens next?
The expansion is the right direction for patients and for the profession. Its success will depend on pharmacies being funded properly to deliver it and on the public understanding of what is actually on offer. PharmaPlus will publish full details for members as soon as the service specification is released.
Sources:
BBC News, Got a migraine, acne or ear infection? Go to your chemist first, 10th September 2026. https://www.bbc.co.uk/news/articles/ce8e7431nmno
NHS England, Patients to get quicker treatment for migraines, acne and 3 other everyday conditions at pharmacies, 10th September 2026. https://www.england.nhs.uk/2026/09/patients-to-get-quicker-treatment-for-migraines-acne-and-3-other-everyday-conditions-at-pharmacies/
NHS England, Pharmacy First. https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/
Community Pharmacy England, Prescribing within the CPCF, updated 4th August 2026. https://cpe.org.uk/national-pharmacy-services/advanced-services/prescribing-within-the-cpcf/
NHS England, Preparing for prescribing in national community pharmacy services. https://www.england.nhs.uk/long-read/preparing-for-prescribing-in-national-community-pharmacy-services/