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Pharmacy First should be expanded to cover respiratory tract infections in adults, acute dermatology conditions and migraine and acute headache, a report published by the Company Chemists’ Association (CCA) has said.
In the report, published on 11 November 2026, the CCA said that the addition of these three conditions to Pharmacy First would offer the “clearest opportunity to improve patient access and make use of prescribing capability within community pharmacy”.
The call comes as urgent care demand continues to rise, with more than 27 million A&E attendances recorded in England in 2024/2025 alone.
In September 2026, NHS England announced that, from autumn 2026, independent prescribers in pharmacies will be able to prescribe for five more conditions, including low-frequency episodic migraine in adults and acne. The CCA’s report refers to migraine and acute headache more broadly.
“Future expansion of Pharmacy First should focus on conditions where community pharmacy can deliver the greatest patient and NHS benefit,” the report said.
In addition, the report shortlisted six urgent care conditions and scored them against five principles: patient need; clinical suitability; impact on primary care capacity; deliverability; and population access.
Lower respiratory tract conditions and acute dermatology scored ‘high’ on all five, while migraine and acute headache scored ‘high’ on four and ‘medium’ on clinical suitability, the report noted, adding that all three were rated an “immediate expansion priority”.
In its report, the CCA also marked acute lower back pain as needing further exploration. Dental pain was “not currently prioritised” because “safe management may require clearer links with dental services”, so pharmacists would need more clinical experience and improved referral pathways, the report highlighted.
The report explained that Pharmacy First was “constrained” to its existing seven clinical pathways with relatively narrow criteria. Independent prescribing would allow pharmacists to provide “more complete episodes of care”, it added.
According to the report, in time, independent prescribing would replace the need for patient group directions — although, protocol-driven pathways would still be needed to keep a core national offer.
Wales delivered more than twice as many consultations per head in 2024/2025 as Pharmacy First in England, the report noted. It also said that England “is unlikely to replicate the activity levels seen elsewhere” and should instead broaden the scope of care commissioned.
The report’s other recommendations for community pharmacy to provide capacity and support to NHS primary care included funding designated prescribing practitioner provision, widening access to funded independent prescribing training for the existing workforce, giving pharmacists access to the single patient record, and setting national service specifications and governance standards.
Malcolm Harrison, chief executive of the CCA, commented: “Pharmacy First has already shown what community pharmacy can deliver. Recent announcements are welcome, and patients are already presenting in pharmacies requesting treatment for these conditions.
“Delivering much greater benefits for patients and the NHS requires moving from pockets of activity to care at scale. With the right funding, workforce and infrastructure in place, community pharmacy can play a much bigger role in meeting urgent care needs.”
Henry Gregg, chief executive of the National Pharmacy Association, which contributed to the report, said: “In Scotland, a patient can be treated for around 30 different ailments at their pharmacy, with over one-third of the population accessing Pharmacy First last year.
“The NHS should turbo charge Pharmacy First so it can reach its full potential and provide first-class care, close to people’s homes.”
Mark Burdon, a pharmacist and a trustee of The Migraine Trust, said: “At The Migraine Trust, we welcome the inclusion of low-frequency episodic migraine into the Pharmacy First pathway. It represents a huge step toward more timely access to care closer to home, which we know makes a big difference for people living with migraine.
“While expanding this pathway to chronic migraine would be a welcome step, our current focus is on working with the pharmacy sector and the NHS to ensure that the roll out of the low-frequency episodic pathway is a success for community pharmacies and for patients.”
Darush Attar-Zadeh, a respiratory pharmacist based in north-west London, said: “Community pharmacists have already gained valuable experience in assessing and managing upper respiratory tract infections through Pharmacy First.
“Building on this experience, expanding the service to include selected lower respiratory tract infections could be explored, provided pharmacists are supported with the appropriate clinical skills, diagnostic tools and clear pathways for identifying red flags and escalating care.
“It will also be important to distinguish uncomplicated infections from exacerbations in patients with chronic lung conditions, where assessment and treatment can be more complex.”
