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Community and general practice pharmacists could be mobilised to deliver healthcare in the event of a terrorist attack or nuclear incident, NHS England has said.
In its framework — entitled ‘Concept of operations for managing mass casualties‘ — published on 21 July 2026, NHS England explained how NHS resources could be used in a “rapid onset event”, which may involve hundreds or thousands of casualties.
A “mass casualty incident” could also include transport or industrial incidents, chemical, biological, radiological or nuclear incidents and other incidents involving hazardous materials.
In such an event, community pharmacist prescribers may be utilised in general practice settings to support lower acuity patients who have been directed there from emergency departments, the framework said.
It added that community pharmacies would be able to provide support and advice to people who go directly to pharmacies with minor injuries or health concerns after an incident, as well as help issue messaging to the public, “to give reassurance following the incident”.
Community pharmacies could also be called upon to support lower priority patients and help patients transferred away from emergency departments, NHS England said.
Heidi Wright, practice and policy lead for England at the Royal College of Pharmacy, commented: “Community pharmacies are often the first place people turn to when they need healthcare advice, so it’s right that they’re recognised as part of the NHS response during a major incident. Pharmacists have the clinical expertise to assess patients, provide treatment where appropriate and help people access the right care.
“If community pharmacy is expected to play a bigger role during major incidents, pharmacists must be supported with the right planning, training and resources so they can support the wider NHS while community pharmacy services continue to be delivered safely.”
The framework applies to rapid-onset mass casualty incidents where the location, number, severity or type of live casualties requires extraordinary resources, or where available healthcare resources are overwhelmed.
However, it does not apply to “rising tide events” — for example, developing infectious disease epidemics or hospitals becoming overwhelmed owing to systemic operational pressures in the healthcare system.
Although the framework is for England, it said that “elements of this framework may be used if NHS England’s support is required for the NHS response to a mass casualty incident in Wales, Scotland or Northern Ireland”.
