On this page
About this guide
This article explains the NHS Pharmacy First service in England. It provides general information and cannot decide which treatment is right for an individual person.
Community pharmacists are trained healthcare professionals. Pharmacy First gives participating pharmacies a defined NHS route to assess and manage seven common conditions—often without you needing to contact the surgery first.
Quick answer
You can contact or visit a participating community pharmacy directly if you think you have one of the seven Pharmacy First conditions and meet the age criteria. The pharmacist will assess your symptoms, check for warning signs and then offer advice, recommend treatment, supply an appropriate NHS medicine where clinically suitable, or refer you to another service.
Pharmacy First does not mean everyone receives antibiotics. Treatment depends on the clinical pathway and what the pharmacist finds.
The seven Pharmacy First conditions
The national service applies to the following conditions and age ranges:
Acute otitis media
Ages 1–17. An in-person examination may be needed. Online-only pharmacies do not provide this pathway.
Impetigo
Age 1 and over. The pharmacist will assess the appearance, location and extent of the skin problem.
Infected insect bites
Age 1 and over. Not every red or itchy bite is infected or needs antibiotics.
Shingles
Age 18 and over. Seek prompt advice because antiviral treatment is time-sensitive for some people.
Sinusitis
Age 12 and over. Most cases improve without antibiotics; duration and severity help guide treatment.
Sore throat
Age 5 and over. The pharmacist uses a clinical assessment to decide what advice or treatment is appropriate.
Uncomplicated UTI
Women aged 16–64. The pathway is for lower urinary-tract symptoms where there are no signs of a more complicated infection.
If you fall outside these age ranges, the pharmacist can still offer advice about self-care and over-the-counter treatment, but you may need a GP or another service for assessment and prescription treatment.
How to use Pharmacy First
Use the NHS pharmacy finder and contact the pharmacy to check it offers Pharmacy First and whether you need an appointment.
Tell the pharmacy which condition you are concerned about, the person’s age and any important medical information.
The pharmacist will ask questions and may need to examine the throat, ear, skin or affected area in a private consultation room.
You will receive advice, treatment where appropriate, or a referral to the surgery, NHS 111 or urgent care.
You may also be referred into Pharmacy First by Pathfields, NHS 111 or another NHS service. A referral does not guarantee that medicine will be supplied—the pharmacist still needs to complete their assessment.
What should I take with me?
- the person who needs assessment, particularly when an examination may be required
- details of current medicines, allergies and important health conditions
- information about how long symptoms have been present and what has already been tried
- proof of prescription-charge exemption, if this applies
The pharmacist may be able to view relevant NHS information and will normally notify your GP practice of the outcome on the same day or the next working day.
Will I receive antibiotics?
Not necessarily. Many sore throats, sinus infections, ear infections and insect-bite reactions get better without antibiotics. The Pharmacy First pathways support safe use of antimicrobials and include self-care advice, symptom relief and safety-netting.
If a prescription-only medicine is clinically appropriate, the pharmacist can supply one of the medicines permitted by the national pathway without asking a GP to issue a prescription first.
Is Pharmacy First free?
The NHS Pharmacy First consultation and clinical advice are free.
If an NHS medicine is supplied through the service, normal NHS prescription-charge rules apply. It will be free if you are entitled to free NHS prescriptions; otherwise the usual charge applies. If the pharmacist recommends an over-the-counter product, you will normally need to buy it.
Check current NHS prescription charges or check whether you may be entitled to help with health costs.
When might the pharmacist refer me elsewhere?
The pharmacist will follow a national clinical pathway. They may refer you to Pathfields, NHS 111, an urgent treatment centre or emergency care if:
- the symptoms do not fit one of the Pharmacy First pathways
- the person is outside the relevant age range
- pregnancy, immune suppression, another health condition or current medicine makes the situation more complex
- symptoms are severe, unusual, recurrent or have lasted longer than expected
- an examination or test outside the pharmacy service is needed
- there are warning signs suggesting a more serious illness
This does not mean the consultation has failed. Identifying when someone needs a different level of care is an important part of the service.
Do not wait for Pharmacy First in an emergency
Call 999 for severe difficulty breathing, collapse, blue or grey lips, a seizure, signs of a stroke, or another life-threatening emergency.
Use NHS 111 for urgent advice when you are very unwell, symptoms are rapidly worsening, you are unable to swallow fluids, there are signs of severe dehydration, a painful rash is near the eye, or urinary symptoms occur with fever, vomiting or pain in the back or side.
Babies, frail people and those with a weakened immune system can become unwell more quickly. If you are worried that someone is seriously ill, use the appropriate urgent-care route rather than waiting for a routine consultation.
The key points
- Pharmacy First covers seven specific conditions with defined age ranges.
- You can usually contact a participating pharmacy directly without speaking to the surgery first.
- The pharmacist will assess you—not simply supply antibiotics on request.
- You may receive advice, treatment, an NHS medicine or referral to another service.
- Normal prescription charges and exemptions apply to NHS medicines supplied.
- Use NHS 111 or 999 when symptoms are urgent or life-threatening.
Official information
First published August 2026. Last reviewed: 2 August 2026. Planned review: February 2027, or earlier if NHS Pharmacy First guidance changes.
Written for Pathfields patients using current NHS and NHS England Pharmacy First guidance.