The Pharmacy First Service

The Pharmacy First service launched on 31st January 2024. This means pharmacies can be the first port of call for many patients who need healthcare advice and potentially treatment for several common health conditions without needing a GP appointment.

Patients are advised that although almost all community pharmacies in Norfolk and Waveney have signed up to the service, not all pharmacies will be offering all elements of the service, and not all pharmacies are offering the service straightaway.

The ICB advises all patients to please contact your local pharmacy before you travel to find out if they offer the Pharmacy First service for the specific health condition you would like to speak to the pharmacist about.

On this webpage you can find more information about the Pharmacy First service. A list of FAQs has been provided to help answer some of the common questions about this service.

What conditions can I now get help for at a pharmacy?

Pharmacists can now provide advice and NHS-funded treatment, where clinically appropriate, for seven common conditions within certain age ranges:

EaracheAll adults and children aged 1 to 17 years
Infected insect biteAll adults and children aged 1 year and over
ImpetigoAll adults and children aged 1 year and over
ShinglesAdults aged 18 years and over
Sinusitis (sinus infection)Adults and children aged 12 years and over
Sore throatAdults and children aged 5 years and over
Uncomplicated urinary tract infections in femalesFemales aged 16-64 years

Under the Pharmacy First service, patients with symptoms that suggest one of the above conditions will be able to attend a participating pharmacy to get healthcare advice from the Pharmacist. No appointments are required.

Following a consultation, the pharmacist may decide that over-the counter treatment and/or Self Care advice are appropriate for your symptoms. Or if clinically necessary, the pharmacist will be able to offer an NHS medicine to treat it (NHS prescription charges will apply if you normally pay for medicines supplied on prescription).

Should the pharmacy team be unable to help, then you will be directed to another healthcare professional as appropriate.

Please note that certain exclusions may apply, for example patients who are immunocompromised or those with recurring or chronic symptoms. The pharmacist will ask you questions to understand if you are eligible for this service, and if you aren’t they will signpost you to the most appropriate service for your clinical needs.

Pharmacy First FAQs

Please use the dropdown menu below to get more information about the service:

About Pharmacy First and how it was developed

  • Will I receive the same level of care at the pharmacy that I would receive at a GP surgery?

    Community pharmacy teams will be working closely with local general practice colleagues as part of the wider primary care team to deliver this service.

    Pharmacies have private consultation rooms that are be used for consultations with patients and pharmacists see patients for clinical services without always needing an appointment.

    Every pharmacist trains for five years in the use of medicines and managing minor illnesses, so they are well equipped to provide health and wellbeing advice to help people stay well.

    Pharmacists are experienced in spotting warning signs, otherwise known as red flag symptoms, which may warrant a referral to another healthcare provider.

    For the seven conditions covered under Pharmacy First, the pharmacist will be managing patients in line with carefully designed clinical pathways approved by the National Medical Director at NHS England and the Chief Medical Officer for England.

  • How have the clinical pathways been developed?

    These clinical pathways have been carefully developed with input from various experts including practising GPs and pharmacists, antimicrobial resistance specialists, as well as representatives from national organisations such as NICE and UK Health Security Agency.

    This ensures that the steps we take together match the care patients would receive in General Practice and follow the latest national guidelines.

  • Will my GP know that I’ve received treatment at a Pharmacy?

    Yes. After your consultation with the pharmacist, the pharmacy will send a notification to your GP practice.

  • What measures are in place to make sure that antibiotics aren’t over-subscribed?

    Antimicrobials – which include antibiotics, antivirals, antifungals, and antiparasitics – are medicines used to prevent and treat infectious diseases in humans, animals, and plants.

    Antimicrobial resistance is when bacteria, viruses, fungi and parasites change over time, so they no longer respond to medicines, making infections harder to treat. This can result in easier the spread of disease, severe illness and even death.

    The main reason for antimicrobial resistance is the over-use of antibiotics. NHS England takes the threat of antimicrobial resistance (AMR) very seriously. All use of antimicrobials drives resistance, so it is important that they are used appropriately.

    Pharmacy teams play a key role in making sure that antibiotics are administered appropriately. A fundamental principle of the Pharmacy First service involves offering non-antimicrobial treatment options, where available and in line with NICE guidelines.

    The clinical pathway consultations were designed with responsible antimicrobial stewardship in mind, and a collaborative decision-making approach with the patient. This means pharmacists will provide patients with symptom management strategies, including allowing a self-limiting illness to run its course, as a viable alternative to antimicrobial treatment.


  • How can I access the service?

    Patients will be able to access the service via referrals from referring organisation including General Practice, Urgent and Emergency Care settings, NHS 111 (online and via telephone).

    In addition, for the seven conditions covered under Pharmacy First, patients can access the service by attending or contacting the pharmacy directly without the need for referral.

  • Is the service available on weekends and holidays?

    Yes, many pharmacies offer extended opening hours in the evenings and at weekends. Some are open until midnight or even later, even on public holidays. Details of a local pharmacy, including its opening hours can be found here: Find a local pharmacy.

  • Will every pharmacy provide the service?

    No, pharmacies can choose whether they wish to provide this service. However, most pharmacies in Norfolk and Waveney have signed up to provide this service.

    Please contact your local pharmacy to find out if they are providing this service. Find contacts details of a local pharmacy, including its opening hours, at Find a local pharmacy.


  • Will pregnant and breastfeeding individuals be eligible for this service?

    Yes, to ensure equity of access to healthcare, pregnant and breastfeeding individuals will be eligible to access the service.  The pharmacist will assess the patient and determine whether it would be appropriate to treat the individual or refer them to another provider.

    Please note for some of the seven common conditions pregnancy may be an exclusion for the service for clinical reasons so you may not be eligible for the full consultation. For the best advice please speak to your pharmacist.

  • Will children under 18 years be able to use the Pharmacy First Service?

    Yes, children under 18 years will be able to use the Pharmacy First Service.

    Pharmacists are experienced in managing young children, and the service ensures that parents with young children can access healthcare advice and necessary treatment promptly. This includes addressing conditions like impetigo and earache, which commonly affect children.

    However, please note that age restrictions do apply to some conditions for clinical reasons. If a patient, including a child under 18, is not eligible for the service based on their condition, the pharmacist will refer them to another healthcare provider if needed.

  • What if I am immunosuppressed?

    Immunosuppression means the immune system is not working as well as it normally would, this leaves people more vulnerable to infection. Immunosuppression can be caused by certain health conditions but can also be induced by medication that suppress the immune system such as chemotherapy drugs.

    For certain infections, including some of the conditions to be managed under the Pharmacy First services, patients who are immunosuppressed or severely immunosuppressed may be at higher risk of complications and may require treatment in hospital settings or need to be seen by a general practitioner.

    During the consultation, the pharmacist will ask the patient about their medical history to assess whether the patient may be immunosuppressed or severely immunosuppressed. The pharmacist will provide clear definitions for both terms to aid patient understanding. Following this, the pharmacist will offer guidance on the most suitable course of action, which could include referring the patient to another healthcare professional as appropriate or providing treatment within the pharmacy. The appropriate approach will be determined by the specific condition for which the patient is seeking assistance from the pharmacy.


  • What happens during a consultation?

    In a confidential consultation, the pharmacist will ask questions about your health. This may include asking about your previous medical history, including any allergies or any medications you’re currently taking.

    If you are dealing with a minor issue like a cold, the pharmacist will provide self-care advice or recommend an over-the-counter medicine for you to buy.

    If you happen to have symptoms of one of the seven conditions covered by Pharmacy First, the pharmacist will follow a clinical pathway to decide on the best way to help you. This could include offering self-care advice and reassurance or offering symptomatic relief over the counter or providing certain medicines, in the same way as your GP, as well as advice on what to if your symptoms persist or worsen.

    However, if the pharmacist thinks your condition is more serious, they might suggest you see another healthcare expert who can provide the right care.

  • Will diagnostic tests be used as part of the Pharmacy First Service?

    Pharmacists are experienced in managing common conditions and will diagnose patients through comprehensive history-taking, visual inspection, physical examination and, if necessary, use instruments like otoscopes for diagnosing ear infections.

    Currently, pharmacists will not utilise diagnostic tests such as urine dipsticks or sore throat swabs as part of the service as there is not enough evidence that they help with decisions about your health.

  • How will consultation notes and prescriptions be added to my record?

    NHS England are working with IT systems providers to ensure it is possible that both a copy of the consultation and prescribed medication is sent to your GP so that they have an accurate record.

  • Why have I been asked to come back to the pharmacy?

    At the end of the consultation, the pharmacist may provide advice and ask you to come back if symptoms do not resolve. This is the correct course of action as many of these conditions are self-limiting and can be managed with over-the-counter medication or with self-care advice.

    The pharmacist will provide information on what to do if symptoms persist or get worse and this can include revisiting the pharmacy for another assessment.

Medicine Supply

  • Why haven’t I been supplied with antibiotics?

    Many mild infections get better on their own without using antibiotics. For some conditions, antibiotics make little difference to how long symptoms last and withholding antibiotics is unlikely to lead to complications. Antibiotics do not work for viral infections such as colds and flu.

    Antibiotic resistance is a significant concern, and using antibiotics when they are unnecessary may make them ineffective for future use. The pharmacist will be able to advise on an individual patient basis after following the clinical pathways as to whether antimicrobials (which include antibiotics and antifungals) are appropriate or not.

  • Do I need to pay for medicines supplied under Pharmacy First?

    If the pharmacist recommends an over-the-counter medicine for your minor illness, you will need to buy it yourself.

    If you receive an urgent repeat medicine supply or an NHS medicine as part of a clinical pathways consultation normal NHS prescription charges and exemption rules apply. You can check if you are eligible for free prescriptions here.

    If you don't qualify for free prescriptions, you might need to pay a fee for the medicine. This is the same fee as the current prescription charge. The pharmacist will guide you on this and help you understand what you need to do.