NHS Pharmacy First is moving towards independent prescribing, but will pharmacies be able to deliver?

From autumn 2026, community pharmacists in England with an independent prescribing qualification will be able to assess patients and prescribe directly within National Health Service-commissioned services. This represents a substantive evolution of Pharmacy First, moving participating pharmacists beyond supplying specified medicines under Patient Group Directions towards prescribing independently within defined National Health Service pathways^1,2.

It also signals a broader shift in primary care delivery, with community pharmacy expected to play a greater role in patient assessment, prescribing and treatment initiation.

Under the current Pharmacy First model, pharmacists can assess patients presenting with a range of common conditions and, where appropriate, supply certain prescription-only medicines under nationally defined Patient Group Directions. While this has enabled patients to access treatment without first visiting a general practitioner, prescribing decisions remain limited to pre-defined protocols. The introduction of independent prescribing will allow qualified pharmacists to make prescribing decisions themselves within approved clinical pathways, representing a significant expansion of their clinical role.

Participating pharmacist prescribers will be able to continue prescribing within existing Pharmacy First pathways, which currently cover acute otitis media, impetigo, infected insect bites, shingles, sinusitis, sore throat and uncomplicated urinary tract infections in women³. Up to five additional prescribing-only pathways are also under consideration, potentially covering bacterial and allergic conjunctivitis, oral thrush, skin infections and respiratory tract infections².

To support implementation, participating pharmacies will receive a £500 one-off setup payment and a £525 monthly infrastructure payment, alongside the usual Pharmacy First consultation fee. The current fee for a Pharmacy First clinical-pathway consultation is £17².

The 2026/27 Community Pharmacy Contractual Framework provides the broader funding platform for this change. Under the nationally agreed settlement between the Department of Health and Social Care, National Health Service England and Community Pharmacy England, total funding increases by £340 million to £3.636 billion, while the Pharmacy First budget is incorporated into the core contractual framework, guaranteeing that funding stream to the sector⁴.

The activity base is already substantial. More than 2.75 million Pharmacy First clinical-pathway consultations were delivered between April 2025 and January 2026⁴. This level of utilisation suggests strong patient demand and demonstrates the growing role of community pharmacy in managing common conditions. However, whether pharmacies have the capacity and resources to support a further expansion of responsibilities through independent prescribing remains uncertain.

A June 2026 survey of Independent Pharmacies Association members found that only 12.6% currently intended to deliver the proposed independent prescribing services. A further 57.5% did not intend to participate, while 29.9% remained undecided. Respondents cited the costs of recruiting or training independent prescribers, uncertainty around how the services would operate in practice and insufficient funding among their concerns⁵.

That gap between policy ambition and provider intent brings the underlying economics into focus.

The available funding must be weighed against the costs of recruiting or training prescribers, releasing them from dispensing responsibilities, creating capacity for consultations and meeting the associated clinical governance and infrastructure requirements.

The pharmacy sector's response reflects this tension. Community Pharmacy England accepted the settlement subject to a shared reform programme but said it was not persuaded that sufficient investment was being made for the full and effective introduction of independent prescribing [6].

The Pharmacists' Defence Association described independent prescribing as a substantial increase in clinical responsibility and raised concerns about delivery in pharmacies already facing staffing, workload and premises constraints⁷.

The policy question has therefore moved on from whether community pharmacists should prescribe. It is whether enough pharmacies have the funding, workforce and infrastructure to deliver the service consistently at scale.

For pharmaceutical manufacturers, two implications are particularly relevant: the growing role of community pharmacists within patient pathways and the potential for local variation in implementation.

• Participating community pharmacist prescribers may become an increasingly relevant stakeholder group for companies operating in affected therapy areas, prompting consideration of whether existing engagement strategies adequately cover the breadth of stakeholders relevant for optimal access and uptake.

• Although the service sits within the national Community Pharmacy Contractual Framework, implementation may still vary locally, depending on ICB readiness, pharmacy participation, governance arrangements and integration between community pharmacy and general practice.

Article by Murtaza Shahid

References:

1. National Health Service England (2026). Commissioning guidance for community pharmacy prescribing-based services. Available at: https://www.england.nhs.uk/long-read/commissioning-guidance-for-community-pharmacy-prescribing-based-services/ [Accessed: 12 August 2026]

2. Community Pharmacy England (2026). Prescribing within the Community Pharmacy Contractual Framework. Available at: https://www.england.nhs.uk/long-read/commissioning-guidance-for-community-pharmacy-prescribing-based-services/https://cpe.org.uk/national-pharmacy-services/advanced-services/prescribing-within-the-cpcf/ [Accessed: 12 August 2026]

3. National Health Service England. Pharmacy First. Available at: https://www.england.nhs.uk/primary-care/pharmacy/pharmacy-services/pharmacy-first/ [Accessed: 12 August 2026]

4. Department of Health and Social Care (2026). Community Pharmacy Contractual Framework: financial year 2026 to 2027. Available at: https://www.gov.uk/government/publications/community-pharmacy-contractual-framework-financial-year-2026-to-2027/community-pharmacy-contractual-framework-financial-year-2026-to-2027 [Accessed: 12 August 2026]

5. Warner, E. (2026). Six-in-10 pharmacies do not plan to deliver new prescribing services. The Pharmacist. Available at: https://www.thepharmacist.co.uk/news/six-in-10-pharmacies-do-not-plan-to-deliver-new-prescribing-services/ [Accessed: 12 August 2026]

6. Community Pharmacy England (2026). Community Pharmacy England secures 10% funding rise, but pushes for reform. Available at: https://cpe.org.uk/our-news/cpe-secures-10-funding-rise-but-pushes-for-reform/ [Accessed: 12 August 2026]

7. Pharmacists’ Defence Association (2026). Pharmacists’ Defence Association responds to expansion of Pharmacy First to include independent prescribing. Available at: https://www.the-pda.org/pda-responds-to-expansion-of-pharmacy-first-to-include-independent-prescribing/ [Accessed: 12 August 2026]

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