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The current pace of growth in Pharmacy First, dispensing and other workload requires an investment in extra workforce and premises, according to a report from the Pharmacists’ Defence Association (PDA).
In a report on community pharmacy capacity, published on 28 April 2025, the PDA drew on the latest NHS Business Services Authority data from the first two years of the Pharmacy First service in England — from February 2024 to January 2026 — noting a “consistent month-on-month growth in total volume of more than 25% with the total number of [Pharmacy First Service] consultations exceeding 6.2 million”.
“Six million consultations, with each one taking approximately 15 minutes, takes a considerable amount of time,” the report said.
Pharmacy First in England offers seven clinical pathways under the service, including acute otitis media, acute sore throat, impetigo, infected insect bites, shingles, sinusitis and uncomplicated urinary tract infections in women.
The report also highlighted that the number of pharmacy consultations has tripled since clinical services were introduced as part of the 2005 ‘Community pharmacy contractual framework’, from around 7.5 million in 2021 to over 25 million in 2025, with a marked increase since the COVID-19 pandemic.
It also suggested that the majority of consultation rooms installed then are no longer fit for purpose.
“The need for better, bigger and more appropriate consulting rooms will become even more apparent as the number of prescribing pharmacists continue to increase and with every newly registered pharmacist having independent prescriber status,” it said.
The report also noted an increase in the number of items dispensed over time, along with a reduction in the number of bricks and mortar pharmacies and in pharmacy opening hours.
“We have a situation where there are fewer pharmacies, which are open for fewer hours, but who are dispensing more prescriptions and providing more services within that condensed period,” it said.
Citing data from the ‘Community pharmacy workforce survey’, which has been published five times between 2017 and 2024, the report pointed out that pharmacies in England had the same number of full-time equivalent (FTE) staff per pharmacy (6.6) in 2024 compared with 2021.
There were also the same number of pharmacists per pharmacy in 2024 compared with 2021 (1.8 FTE in 2021 and 2024) and fewer pharmacy technicians (0.6 FTE in 2021 compared with 0.4 FTE in 2024).
The PDA said the figures were observed “despite the significant increase in services and prescription workload”.
It also called into question how total system or pharmacy premises capacity had been factored into calls for pharmacy service expansion, particularly of Pharmacy First.
The report also recommended that representatives of the pharmacist workforce must be involved in contractual negotiations, “especially when new services are introduced”.
“Any increased funding must be suitably ring-fenced to achieve staffing growth, which needs to include a two-pharmacist model and to allow for the expansion and improvement of the current clinical consultation room capacity,” it added.
Amandeep Doll, director for England at the Royal College of Pharmacy, commented: “Pharmacy First has been a significant step forward in using pharmacists’ clinical expertise to boost patient access to care. Further expansion of pharmacy services must be backed by investment in workforce, skills and infrastructure, so pharmacy teams can continue to provide high-quality care for patients.”
Leyla Hannbeck, chief executive of the Independent Pharmacies Association, said: “Community pharmacies are the front door to the NHS, we are happy to step in and support the NHS, but without a properly funded and sustainable model that addresses these systemic challenges, including ludicrous situation where pharmacies are expected to dispense at a loss at times where shortages happen, and prices rise, access will continue to shrink, and it is patients who will ultimately bear the cost.
“It is essential that in the current funding negotiations, the government offers a sustainable settlement. If the government’s offer is inadequate, the sector will reach breaking point.”
The Guild of Healthcare Pharmacists told The Pharmaceutical Journal that it agreed that the current growth in pharmacy workload is unsustainable without urgent investment in workforce and infrastructure.
“These pressures are evident in hospitals, where staffing shortages and rising clinical demand are already impacting services. Any solution must take a whole-system approach, ensuring investment strengthens the entire pharmacy workforce without shifting pressures between sectors,” a spokesperson said.
In response to the PDA’s report, the Department of Health and Social Care (DHSC) confirmed that decisions on future service provision will be informed by the 2025 ‘Community pharmacy workforce survey’, the results of which have not yet been published.
“We have given the sector a funding boost of almost £617m over two years, more than any other area of the NHS, and we are expanding the role of pharmacists and pharmacy technicians to make better use of their skills,” a spokesperson said.
“Community pharmacists are at the heart of local healthcare, which is why we’re working hard to turn around a decade of underfunding and neglect that left the sector on the brink of collapse.”
