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Pharmacy First

The Pharmacy First service enables community pharmacists to assess and treat patients for a range of common condi􀆟ons, without the need for a GP appointment. This ini􀆟a􀆟ve is designed to reduce pressure on general practice and streamline access to care for patients with minor ailments and illnesses. Patients can walk in to access the clinical pathways element of the service, and we continue to encourage GP practices to refer patients who have been directed by the practice via the Pharm Refer digital system.
There are 3 elements to the pharmacist first service: Urgent medicine supply, Minor Illness and Clinical Pathways. General Practice can only refer for minor illness and clinical pathways, but not urgent medicines supply.

Clinical Pathways

Patients can access the clinical pathways via electronic referral or self-referral. The conditions are as follows:
• Acute otitis media (Ages 1–17)
• Impetigo (Ages 1+)
• Infected insect bites (Ages 1+)
• Shingles (Ages 18+)
• Sinusitis (Ages 12+)
• Sore throat (Ages 5+)
• Uncomplicated urinary tract infections (Women Ages 16–64)

What Pharmacists Do:

• Diagnose and treat the 7 clinical conditions, including supplying prescription-only medications under Patient Group Directions (PGDs) where clinically appropriate
• Conduct clinical assessments using nationally approved treatment pathways which consider key guidance such as NICE and antimicrobial guidelines
• Provide self-care advice and guidance on Over the Counter (OTC) medicines where necessary
• Provide safety-netting and refer to general practice or urgent care if necessary
• Record consultations on the NHS clinical IT systems with integrated notifications to the patient’s GP.

Minor Illness

In addition to treating the 7 clinical conditions, pharmacists can support patients with minor illnesses and ailments via electronic referral by their GP prac􀆟ce.

What Pharmacists Do:

• Provide self-care advice and guidance on Over the Counter (OTC) medicines where necessary
• Provide safety-netting and refer to general practice or urgent care if necessary
• Record consultations on the NHS clinical IT systems with integrated notifications to the patient’s GP.

Oral Contraception Service

This service allows pharmacists to initiate or continue the supply of oral contraceptive pills, enhancing access to contraception, par􀆟cularly for patients who may face barriers in accessing GP services. Patients can walk in to access the service, and we encourage GP practices to use the Ardens search to identify patients and notify them of the service available in community pharmacy via text message or similar signposting. Consider routine signposting of postpartum people and young people (16+) to pharmacy contraception services for easier access.

What Pharmacists Do:

• Offer both initiation and ongoing supply of combined oral contraceptive pills (COCP) and progestogen-only pills (POP).
• Conduct full clinical assessments including blood pressure, BMI, and risk factors
• Discuss contraceptive choices, compliance, and safeguarding issues
• Supply contraception under a PGD where clinically appropriate
• Refer complex cases or those requiring long-acting reversible contraception (LARC) to general practice or sexual health services
• Supports Make Every Contact Count (MECC)

From October 2025, pharmacists will be able to offer Emergency Hormonal Contraception (Levonorgestrel and Ulipristal) as part of the Pharmacy Contraception Service.
Hypertension Case-Finding Service
This service aims to detect undiagnosed hypertension and support diagnosis and early intervention, a key priority in preventing cardiovascular disease. In addition, GP practices are also able to refer patients with diagnosed hypertension to request BP checks and ABPMs for patients within their practice lists. Please liaise with your local pharmacy on how best to refer these patients.

What community pharmacy teams do:

• Identify eligible adults (40 years or older) without a hypertension diagnosis
• Perform blood pressure screening and, where needed ambulatory blood pressure monitoring (ABPM)
• Refer patients with elevated readings to general prac􀆟ce for formal diagnosis and management
• Provide lifestyle advice and signposting to local services
• Provide safety-netting and follow urgent protocols should a high reading be recorded to ensure patient is managed appropriately
• Record consultations on the NHS clinical IT system with integrated notifications to the patient’s GP.