You couldn’t make it up: an NHS England press release on September 10 really did say
“people will be able to walk into their participating high street pharmacy and get on-the-spot treatment for acne.”
The latest government hype, has also promised community pharmacies will, from the Autumn, be able to offer treatment to anyone walking in with migraines, scabies, ear infections and rhinitis, in addition to the seven ailments previously covered. Apparently, this is all “helping make people’s everyday lives easier.”
NHS England goes even further, claiming that the move will also “help to ease pressure on GPs and A&E departments ahead of what could be another record-breaking winter for the NHS.”
For anyone wondering why anyone would go to A&E for acne treatment, the press release goes on to claim:
“NHS figures show there were more than 77,000 hospital admissions for diseases of the ear, 47,500 linked to migraines, 5,000 for vasomotor and allergic rhinitis, and 681 for scabies in 2024/25.”
The key words here are “admissions” and “linked to”. These are cases which should never be diverted to a pharmacist or GP: hospital doctors have decided the patients’ condition is so serious that – even with the well-known shortages of front line beds – they need to be admitted to hospital, not sent home with a tube of Germolene.
Apparently 1,000 people went to A&E with acne in England in 2023/24, out of 26.3 million cases. With a caseload this low, obviously diverting them to pharmacies will not transform A&E departments. It’s also a safe assumption that the 77,000 people who were admitted with ear problems would have been eventually advised by the pharmacist to go to A&E.
The “Pharmacy First” policy, hatched in the dying days of the Tory government, offers £17 per patient, plus up to a £1000 per month bonus for pharmacists who meet a minimum number of appointments.
GPs reaction
The plan has provoked some irritation and concern from GPs. Doctors’ Association UK told Pulse Today that moving more care to pharmacists “risks undermining the role of GPs”. Its GP spokesperson, Dr Steve Taylor, said they remain concerned about moving care to pharmacists because pharmacists “don’t necessarily have the diagnostic skills or expertise of GPs.”
An Oxfordshire LMC motion argued that redirecting funding from general practice to Pharmacy First “undermines the sustainability of primary care services”.
Overall opinion appears mixed. In a 1,000-strong survey, roughly half of GPs questioned whether Pharmacy First had improved access to general practice, while about a third thought it had little or no effect.
Different Funding and controls
Unlike Pharmacy First, most core GP funding is population-based rather than paid per consultation.
Moreover, GPs are controversially required by the latest contract to ensure that requests the GP practice deems clinically urgent are dealt with the same day. Practices are no longer allowed to ask patients to call back on another day, nor are they allowed to cap the volume of online consultations.
In stark contrast, the Pharmacy First system is strictly capped. Pharmacies are allocated to one of seven bands based on their recent Pharmacy First activity, with each band setting a maximum number of consultations for which they can claim the £17 fee.
In September 2026, the cap ranges from just 32 consultations a month for Band 1 pharmacies to 159. For Band 7, pharmacists can continue seeing patients once they reach the cap, but receive no consultation fee for additional cases; however, the cost of any medicine supplied can still be reimbursed.
There are almost 10,000 community pharmacies in England, but the sector includes some very large corporate operators. Boots alone operates around 1,300 NHS community pharmacies (now owned by Sycamore Partners, a leading American private equity firm based in New York, in partnership with Stefano Pessina and his family) and Superdrug (owned by the A.S. Watson Group, the world’s largest international health and beauty retailer, which is the retail arm of the multinational conglomerate Hong Kong-based CK Hutchison Holdings.)
On top of the £17 per consultation, pharmacies can earn a monthly payment based on consultation volume: £500 for 20 to 29 eligible consultations per month, and £1,000 for 30 or more. At the September 2026 Band 7 ceiling of 159 consultations, that could bring in £3,703. In Pharmacy First fees for the month, before any reimbursement for medicines supplied. Pharmacies can also earn additional fees from separate NHS services, such as the New Medicine Service and Contraception Service.
That may sound a nice little earner, but it also comes with a substantial workload. A survey of independent pharmacy owners found that most recorded pharmacy first consultations took around 20 minutes or more. At that rate, 159 consultations would occupy more than 50 hours of pharmacist time a month. That is before allowing for patients assessed but not qualifying for a paid clinical pathway consultation, and adds to the pharmacist’s existing workload of dispensing, checking prescriptions, and providing other NHS services.
Shortage of staff
The new system will come on stream just as industry experts warn of a growing shortage of qualified pharmacists to work at the community level. Last year’s Company Chemists’ Association Community Pharmacy Workforce Review found the NHS was unlikely to meet its own target to expand the community pharmacy workforce by over 16,000 full-time equivalent (FTE) pharmacists: indeed “on current trajectories, the workforce will be smaller in 2036/37 than it is today.”
One factor in this shortage is the growing number of pharmacists being lured away to work in primary care, especially through the controversial Additional Roles Recruitment Scheme (ARRS), which has concentrated on recruiting almost anyone other than GPs:
“Over 5,600 FTE pharmacists are employed by Primary Care Networks using ARRS funding. We calculate that ARRS has directly led to approximately 3,600 FTE pharmacists leaving community pharmacy to work in Primary Care, equivalent to 20% of our current FTE workforce.” [emphasis added]
There have been plenty of complaints that it is inappropriate to expect pharmacists to substitute for GPs, whose training and expertise is completely different: one GP from Kingston won applause for a pithy summation in a short letter to The Times.
“It is no more appropriate to suggest that a pharmacist treat a sick patient than it is to suggest that a carpenter install a new gas boiler.”
GPs are not the only ones cheesed off by the new system. The increasing use of pharmacists to deliver part of the GP caseload has already led to longer queues and delays, especially in smaller pharmacies across England.
That’s because the lone pharmacist, regardless of the numbers waiting, has to break off their main job – dispensing and checking prescriptions – to devote their time to assessing patients who drop in with one of the seven common conditions that were included on the initial list when the Pharmacy First scheme first launched in 2024, or now one of the additional five issues.
Even where small pharmacies have established an appointment system, they still wind up having to switch away from customers to consultations at the agreed time, regardless of how many customers are left waiting.
Now the additional five health issues have been added to the starting seven (sinusitis, sore throat, earache, infected insect bites, impetigo, shingles, and uncomplicated urinary tract infections (UTIs) in women under 65.)
To make matters worse, the government description of the service suggests people with one of the expanded list of ailments can just rock up at any time that suits them, and effectively hijack the attention of a pharmacist:
“The expansion of the Pharmacy First Scheme allows people to get care for certain common conditions from qualified pharmacists, meaning they can walk into a high street pharmacy at a time that fits with their everyday schedule rather than having to book an appointment with a GP in order to get treatment.”
Statistics from the NHS Business Services Authority (NHSBA) show 3.4million consultations with pharmacists were claimed for in 2025/26, when only 7 ailments were covered. The largest numbers were for sore throat and uncomplicated UTIs; an average of 73% were dispensed medicine.
Since its launch in February 2024, new NHSBA figures show the service has delivered 14 million consultations, including 2 million appointments for acute sore throats, and more than 1.7 million for urinary tract infections.
It’s another idea that is not necessarily bad in principle, but which understandably annoys GPs, disrupts busy smaller pharmacies, and creates further confusion among the public who just want to see a GP.
Dear Reader,
If you like our content please support our campaigning journalism to protect health care for all.
Our goal is to inform people, hold our politicians to account and help to build change through evidence based ideas.
Everyone should have access to comprehensive healthcare, but our NHS needs support. You can help us to continue to counter bad policy, battle neglect of the NHS and correct dangerous mis-infomation.
Supporters of the NHS are crucial in sustaining our health service and with your help we will be able to engage more people in securing its future.
Please donate to help support our campaigning NHS research and journalism.
