From September 2026, Pharmacy First may expand to cover additional conditions. Five options are currently being considered for inclusion. For pharmacies already offering the service, this expansion represents an opportunity. For pharmacies not yet prepared, the timeline is tight and the financial consequences significant.
A single Pharmacy First consultation pays your pharmacy £15 to £20 in NHS funding per patient, depending on complexity and your local integrated care board agreement. A pharmacy handling even 10 consultations a week leaves on the table £8,000 to £10,000 per year if they are not set up to deliver.
Most pharmacy teams are clinically prepared. They know the conditions, they know the patient pathways, and they know when to refer to a GP. What stops them from converting awareness into consistent revenue is not clinical knowledge. It is digital setup, patient workflow, and the ability to communicate what the service actually is to the patients walking through the door.
This post walks through the four areas where pharmacies lose Pharmacy First revenue. Fix these, and you are ready for September. Miss them, and you will see the referrals come in but struggle to actually capture them.
- The obvious one: clinical preparation
- The one nobody plans for: digital setup
- The one that kills your conversion: patient awareness
- The one that breaks every day: workflow
- The September expansion and what changes
- Getting ready before September
Clinical preparation
This is the one area most pharmacies get right, so I will keep it brief.
Your team needs to know the Pharmacy First criteria. For each condition in scope — currently sore throat, cough, sinusitis, uncomplicated UTI, and impetigo, with five more added in September — your pharmacy needs to understand the inclusion criteria, the exclusion criteria, and the red flags that mean "refer to GP immediately".
A member of your team should complete the official NHS Pharmacy First training module. It takes two hours and covers the clinical pathway for each condition. Once that is done, your team knows the clinical side well enough.
What matters more is test runs. Role-play a consultation. A patient walks in saying their ear hurts. Your pharmacist asks the screening questions. Does it fit Pharmacy First criteria? Should they refer? Is there a red flag? If your team can answer these confidently in a real conversation, not just a training module, you are clinically ready.
Most pharmacies are. This is rarely the blocking issue.
Digital setup
This is where pharmacies start to fail.
Pharmacy First requires recording. Every consultation needs to be documented: the patient's history, the condition, the advice given, and the reason for any referral. The NHS expects this to sit in a patient record, not in a notebook or an email thread.
Here is what this actually requires:
A patient record system that captures Pharmacy First consultations. This means either your existing pharmacy management system has a consultation module, or you are using a separate tool to record the consultation, or you have a paper form that gets scanned into a secure record.
Many community pharmacies use legacy systems — software bought five years ago that does dispensing and repeat prescriptions but has no consultation module. If that is you, you have three options: upgrade your system (expensive), use a separate digital form tool (cheaper), or use paper forms with scanning (slowest).
The cheapest option that actually works is a simple Google Form or Typeform that captures the patient's details, their symptoms, your assessment, and your action taken. The form submits to a shared drive or email, creating a record you can retrieve if needed.
The ability to send correspondence to GPs or patients digitally. If you refer a patient to their GP, your pharmacy should send a summary of the consultation directly to the GP surgery. This means email access to GP practices in your area, or access to an NHS portal that lets you submit referrals electronically.
Most GP surgeries now have a secure email system or a referral inbox. Ask your local practices what method they accept. If none exist, you are back to printing and posting, which defeats the point.
A booking or time management system if consultations are by appointment. Some pharmacies offer Pharmacy First consultations on a walk-in basis. Others book them like a clinic. If you are booking them, you need a way for patients to see availability and you need a way to reserve time.
This can be as simple as a Google Calendar that you share with your front desk, or as structured as a booking widget on your website. The key is that patients should not queue for an unknown wait time. They should know when the pharmacist is available.
Without these three things, you will struggle to deliver Pharmacy First at scale. You will handle one or two consultations a day fine. At three or more, your system breaks and your team spends half their time chasing records and phone calls.
Patient awareness
Your team knows about Pharmacy First. Your patients do not.
A patient with a sore throat walks into your pharmacy. They assume they need a GP appointment. They do not know that your pharmacy can see them, assess them, advise them, and prescribe if needed — often on the same day, without waiting weeks for a GP slot.
Your pharmacy needs to communicate this actively. Passively, 70% of eligible patients will never discover the service exists.
Put it on your signage. A simple A4 poster in the window or on the consultation room door listing the conditions you treat: sore throat, cough, ear pain, sinusitis, UTI, and (from September) the five new additions. Make it visible.
Train your front desk to mention it. When someone asks about a GP appointment or mentions they have a cough, the front desk staff should say: "We can actually see you for that today with our pharmacist. Would that help?" Most patients say yes if given the option.
Put it on your website. A short page listing the conditions, the price if you charge (some pharmacies bundle it into the NHS payment, some charge patients a copay), and how to book or ask.
Tell patients after consultations. Every dispensed prescription, every consultation, every interaction is an opportunity to mention it. "Next time you have a sore throat, just ask for a Pharmacy First consultation rather than struggling to get a GP appointment."
Patient awareness is not a one-time job. It is a weekly reminder until it becomes part of your pharmacy's culture.
Workflow
This is where pharmacies break.
Imagine it is Tuesday at 11am. Your pharmacy has three patients in the queue for dispensing. A fourth walks up and asks about a sore throat. Your pharmacist is in the consultation room with a patient. Your pharmacy technician is processing a large order. Your front desk staff member is on the phone with a GP surgery.
What happens to the patient with the sore throat?
In a pharmacy that has not thought about workflow, they wait 45 minutes and then leave frustrated. In a pharmacy that has, the front desk asks them to book a consultation slot with the pharmacist at 1pm, or offers them an immediate 10-minute slot if the pharmacist can be freed.
You need a way to triage Pharmacy First patients separately from dispensing.
Ideally, Pharmacy First consultations happen in a separate space with a separate schedule, so they do not interfere with dispensary throughput. If you do not have a separate consultation room, you need a clear protocol: a specific time block reserved for consultations, or a fast-track system that gets them in and out without waiting.
You need to protect the pharmacist's time. A Pharmacy First consultation takes 10 to 15 minutes. If your pharmacist is constantly interrupted by dispensing questions, answering phone calls, or stock checking, they cannot deliver the service consistently.
You need a handoff process for referrals. When a patient needs a GP referral, your team should know exactly what happens next: you send the summary, the patient gets a follow-up text, and you follow up if they have not been seen within three days. Without this, referrals fall into a black hole and patients feel abandoned.
Most pharmacy workflow problems arise because Pharmacy First was added to the existing routine without changing the routine. You cannot squeeze consultations into the gaps left by dispensing. You need dedicated time and a dedicated process.
September expansion and what changes
Pharmacy First currently covers seven conditions. From September, the Department of Health and Social Care is considering expansion.
Current conditions (confirmed in scope):
- Sore throat
- Shingles
- Sinusitis
- Uncomplicated urinary tract infection
- Impetigo
- Earache (acute otitis externa)
- Infected insect bite
Five conditions under consideration for September expansion: The following conditions are currently being evaluated for inclusion, but have not yet been officially confirmed:
- Bacterial conjunctivitis
- Allergic conjunctivitis
- Oral thrush
- Skin infections
- Respiratory tract infections
If these conditions are confirmed, they would significantly expand the scope. Conjunctivitis, skin infections, and respiratory tract infections are all high-volume presentations that many patients currently see a GP for. If your pharmacy is ready and these additions are approved, September brings a major uplift in consultation volume and revenue opportunity.
Regardless of whether all proposed conditions are confirmed, it makes sense to prepare now. The current seven conditions alone represent untapped revenue for many pharmacies, and being ready for any expansion means you can capitalise on it immediately.
Getting ready before September
Start now, not in August.
By end of July: Audit your current setup. Do you have a way to record consultations? Do you have a referral process? Are your team trained? Is your signage up? Document the gaps.
In August: Fix the gaps. Upgrade your system, set up referral email with local GPs, train your team, put signage in place, and test your workflow with a few consultations.
In September: You launch properly, with the confidence that your systems work.
A Pharmacy First consultation that is handled well builds trust. A patient gets seen the same day, their condition is managed or they are appropriately referred, and they have a record of what happened. That patient tells two friends. In a month, your consultation volume grows through referrals alone.
A Pharmacy First consultation that is handled poorly — no record, no follow-up, patient confused about next steps — damages your reputation. That patient tells everyone their experience was worse than if they had just gone to a GP.
The difference between success and failure is not clinical knowledge. It is preparation.
Work through the Pharmacy First Readiness Checklist to assess your pharmacy across clinical, digital, awareness, and workflow dimensions. You get a score and a prioritised action list. Spend two weeks on the action list and you are ready for September, and ready to capture the revenue that comes with it.
If you need help setting up the digital or workflow side of Pharmacy First — patient record systems, GP referral pathways, or consultation scheduling — book a free 20-minute discovery call and we will walk through what the setup looks like for your pharmacy.
