Pharmacy First in England: the seven clinical pathways explained
6 November 2026 · 3 min read · By the PharmacySkills team
Pharmacy First launched in England on 31 January 2024. It lets community pharmacists assess and treat seven common conditions, including supplying some prescription-only medicines such as antibiotics, without the patient seeing a GP.
For trainees, it matters twice over. It is part of daily work in community pharmacy, and the conditions themselves are core material for the registration assessment.
The seven conditions and age ranges
| Condition | Who is eligible |
|---|---|
| Acute sinusitis | Adults and children aged 12 and over |
| Acute sore throat | Adults and children aged 5 and over |
| Acute otitis media | Children aged 1 to 17 |
| Infected insect bites | Adults and children aged 1 and over |
| Impetigo | Adults and children aged 1 and over |
| Shingles | Adults aged 18 and over |
| Uncomplicated urinary tract infection | Women aged 16 to 64 |
Each condition has its own clinical pathway. The pharmacist works through it step by step, and any supply of a prescription-only medicine is made under a patient group direction (PGD).
How a consultation works
- Gateway point. Each pathway starts with checks that decide whether the patient is eligible at all. If they fail, they are referred or given self-care advice.
- Red flags. The pharmacist looks for signs of something more serious, such as signs of sepsis, and refers urgently if they are present.
- Assessment. The pathway uses recognised scoring tools, for example FeverPAIN for sore throat.
- Decision. Self-care advice, an over-the-counter medicine, a supply under the PGD, or referral.
- Record and notify. The consultation is recorded and the patient's GP practice is informed.
A worked example: sore throat
A 24-year-old has had a sore throat for three days. She has a fever, pus on her tonsils and came in quickly after it started. She has no cough or runny nose.
Using FeverPAIN she scores 4: fever (1), purulence (1), attended within 3 days (1) and no cough or coryza (1). Severely inflamed tonsils would add one more. A higher score means a bacterial cause is more likely, so the pathway may support an antibiotic supply, alongside advice on pain relief, fluids and when to come back.
A score of 0 or 1 points towards self-care, because most sore throats are viral and get better on their own within a week.
Why it matters for antibiotic stewardship
Pharmacy First is not a way to hand out more antibiotics. Each pathway follows NICE antimicrobial guidance, and for many patients the right answer is reassurance and self-care. Explaining why someone does not need an antibiotic, without them feeling dismissed, is one of the most important skills in the service.
Revision tips for trainees
- Learn the age ranges in the table above. They are easy marks.
- Learn the red flags for each condition, because "refer" is often the correct exam answer.
- Know the scoring tools: FeverPAIN and Centor for sore throat.
- Remember the other parts of the service: referrals for minor illness and urgent repeat medicine supply still sit alongside the seven pathways.
Service details can change, so always check the current NHS England service specification and clinical pathways.
Sources: NHS England: Community Pharmacy Pharmacy First service specification and clinical pathways; NICE guideline NG84: Sore throat (acute): antimicrobial prescribing; NICE CKS: Sore throat, acute.
This article is for revision and education. Always check the current BNF, NICE guidance and your local policies before applying it in practice.