Pharmacy First in England: the 7 conditions, age limits and cost

What Pharmacy First covers

Pharmacy First started in England on 31 January 2024. It lets a community pharmacy complete a full episode of care for seven common conditions, following a set clinical pathway for each. Where the pathway allows, the pharmacist can supply prescription medicine without you seeing a GP. Each condition has its own age range:

The NHS website says most pharmacies offer it and advises you to contact the pharmacy before visiting to check. Outside these age ranges a pharmacist can still help you decide on self-care with over the counter medicines.

In September 2026 NHS England reported 14 million consultations since launch, including 2 million for sore throats and more than 1.7 million for urinary tract infections.

What you pay

The NHS England service specification sets one payment from patients. When NHS medicines are supplied under the service, the pharmacy collects the NHS prescription charge for each item unless you are exempt. In England the charge is £9.90 an item. The specification lists no fee for the consultation itself.

Three situations change the bill:

• If you are exempt from prescription charges, or hold a prepayment certificate, the NHS medicine costs you nothing. The free prescriptions page lists who qualifies.
• If the pharmacist recommends an over the counter product instead, you buy it at the shop price. NHS guidance for GP reception teams in south west London states this plainly.
• If you use an online pharmacy registered under the distance-selling rules, it must deliver any item promptly at no cost to you. These pharmacies cannot carry out earache consultations, because the pathway needs an otoscope to look in the ear.

How to use it

1. Check the condition and your age against the table.
2. Contact a local pharmacy to confirm it provides Pharmacy First. You do not need a referral for the seven conditions.
3. Take proof of any exemption or your prepayment certificate, so you are not charged £9.90 by mistake.
4. The pharmacist may give advice, supply an NHS medicine or refer you to a GP or another health professional.
5. If your GP practice or NHS 111 refers you, the pharmacy can also deal with a minor illness or an urgent supply of a repeat medicine.

Scotland and Wales

Scotland launched NHS Pharmacy First Scotland on 29 July 2020. The Scottish Government describes free access to a consultation with a qualified member of the pharmacy team, open to anyone registered with a GP practice in Scotland or ordinarily resident there. Pharmacists can treat conditions such as urinary tract infections, shingles and impetigo without a prescription or a doctor's visit. Scotland abolished prescription charges on 1 April 2011, so medicine carries no charge.

Wales runs the Common Ailments Service. NHS 111 Wales describes a free NHS consultation and free medication, as an alternative to a GP or out-of-hours appointment. The Welsh Government says 99% of pharmacies in Wales offer it and more than 400,000 people used it in a year. It covers 28 conditions, a wider list than England's: acne, athlete's foot, acute backache, chickenpox, cold sores, bacterial conjunctivitis, colic, constipation, dermatitis, diarrhoea, dry eye, hay fever, haemorrhoids, head lice, intertrigo, indigestion, ingrowing toenail, nappy rash, mouth ulcers, oral thrush, ringworm, scabies, sore throat, teething, threadworm, urinary tract infections, vaginal thrush and verruca.

What it saves against a private GP

The cheapest private GP appointment on the private GP prices page is Superdrug's 10-minute video consultation. Superdrug (GPhC 9010126 for its online pharmacy) charges £49 for it, and any private prescription costs extra.

For one of the seven conditions the sums run like this:

Someone who pays prescription charges saves at least £39.10 by using Pharmacy First for a single-item treatment. Someone who is exempt saves at least £49.

Changes from autumn 2026

In September 2026 NHS England announced a pharmacy prescribing service for five more conditions: low frequency episodic migraine in adults, seasonal allergic rhinitis in children, acute otitis externa in adults, mild to moderate acne in young people and adults, and mild skin and soft tissue infections and scabies. It starts from autumn 2026 in an initial small number of prescribing pharmacies, not across all of them.

Mistakes that cost money

Booking a private GP for a sore throat or an earache. The appointment fee is £49 before any medicine.

Leaving proof of exemption at home. If you pay by mistake, the prescription refund page explains how to claim the charge back.

Choosing an online pharmacy for a child's earache. Distance-selling pharmacies cannot take on the earache pathway.

Expecting over the counter products to be free. Pharmacy First covers NHS medicines on the pathways, not shelf items the pharmacist suggests.

Checking the wrong age range. The urinary tract infection pathway covers women aged 16 to 64 only.

Where the figures come from

The seven conditions and age ranges are from the NHS website and NHS England's Pharmacy First page, which also gives the launch date and the direct access and referral rules. The charging rule is paragraph 4.43 of the NHS England service specification, and the distance-selling rules are paragraphs 3.6, 3.10 and 4.45. The over the counter rule is from the NHS South West London FAQ. The 14 million consultations and the autumn 2026 changes are from NHS England's September 2026 announcement. Scotland's service is from the Scottish Government's November 2021 news release and its help with health costs guide. Wales's service is from NHS 111 Wales and the Welsh Government's January 2025 release. The £49 video GP price is from Superdrug, read on 22 October 2026.