NHS Pharmacy First launched in England on 31 January 2024, letting trained community pharmacists assess and treat seven common conditions without a GP appointment. Almost every pharmacy in the country signed up. But signing up and actually delivering the service turned out to be two different things, and NHS claims data shows London’s boroughs sit on opposite ends of that gap. For a capital where clinic capacity and access already diverge street by street, Pharmacy First is a useful case study in how a nationally uniform scheme can still produce a very unequal city.
What Pharmacy First actually covers
The scheme builds on the earlier NHS Community Pharmacist Consultation Service, which has referred patients into pharmacies since October 2019. Under Pharmacy First, a pharmacist can assess and, where clinically appropriate, supply prescription-only medicines, including antibiotics and antivirals, for seven conditions: sinusitis (age 12 and over), sore throat (age 5 and over), earache or acute otitis media (children aged 1 to 17), infected insect bites (age 1 and over), impetigo (age 1 and over), shingles (age 18 and over), and uncomplicated urinary tract infections in women aged 16 to 64. Patients can walk in, contact a pharmacy virtually, or be referred by a GP receptionist, NHS 111, or another emergency care provider.
Nearly universal sign-up, uneven delivery
As of 17 January 2024, 9,918 pharmacies had signed up nationally, more than 92 percent of all pharmacies in England. By June 2025 that figure had reached 98 percent, with over two million consultations delivered for the seven conditions. On paper, that looks like near-total coverage. The claims data tells a more uneven story: around 3.5 percent of pharmacies, roughly 370, still had not signed up as of October 2024, and 15 percent of pharmacies that were submitting claims to the NHS Business Services Authority recorded zero Pharmacy First consultations in June 2024. A pharmacy can be listed as a participating site and still, in practice, not be somewhere a patient can reliably get seen.
Why London looks different from the rest of England
Regional variation in uptake has been striking, and London’s pattern is distinctive rather than simply better or worse. People in London were more likely than those anywhere else to say they had visited a pharmacy for help with one of the seven conditions, 56 percent, compared with 35 percent in the East of England. Yet London also contains some of the weakest delivery on record: North West London’s Integrated Care Board had one of the highest proportions of non-claiming pharmacies nationally, 24 percent, in June 2024, and once population size is accounted for, pharmacies in the Black Country delivered over two and a half times more consultations than pharmacies in North Central London. London also shows a distinct usage pattern beyond the volume gap: more patients self-refer rather than arrive via GP or NHS 111, pharmacists supply medication less often relative to consultations, and a higher share of visits end in referral onward to another part of the health system rather than resolution at the counter.
| Signal | What the data shows |
|---|---|
| Patient awareness | 56% of Londoners report using a pharmacy for one of the seven conditions, the highest of any English region |
| Pharmacy-level delivery | North West London ICB: 24% of pharmacies recorded no Pharmacy First claims in June 2024 |
| Consultation volume, population-adjusted | Black Country pharmacies delivered over 2.5x the consultations per head of North Central London |
| Referral pattern | London shows higher self-referral and higher onward referral than the national pattern |
The consultation-room bottleneck
Part of what separates a pharmacy that signs up from a pharmacy that delivers is physical space. To offer Pharmacy First, a pharmacy needs a consultation room that is clearly designated for confidential conversations, separate from the public shop floor, with seating for both patient and pharmacist and IT equipment on hand to record the consultation. Remote consultations by video are permitted, but the pharmacist still has to be on the premises. In a city where retail rents are high and many community pharmacies operate from compact, decades-old units, that single structural requirement can be the difference between a pharmacy that can staff and equip a functioning consultation service and one that, despite signing the paperwork, cannot consistently offer it. It is a small-scale version of the same capacity constraint that shows up across London’s clinics more broadly: the service exists on the commissioning list, but the room, staff time, or equipment to deliver it at volume does not always follow.
What the gap means for people trying to use it
Two other factors compound the borough-by-borough variation. GP engagement with the scheme has been inconsistent, with some GPs reportedly reluctant to refer patients for minor ailments into a pathway they are less familiar with, and public awareness of exactly which conditions a pharmacist can treat remains patchy, which shapes who tries the service at all. Supply has its own limits too: in a 2025 poll, one in four respondents said they had been unable to get medication they needed because their pharmacy had run out. None of this makes Pharmacy First a failed scheme; the national consultation numbers say otherwise. It does mean that whether a Londoner actually experiences same-day, GP-free treatment for a sore throat or a urinary tract infection still depends heavily on which pharmacy happens to be nearest, and which borough that pharmacy sits in.
Conclusion
Pharmacy First was designed as a uniform national offer, and in terms of sign-up it very nearly is one. But sign-up was never the same question as delivery, and London’s claims data shows both ends of that distinction at once: a population more likely than any other region to know the service exists and try it, alongside boroughs where a quarter of participating pharmacies recorded no activity at all. That combination, high demand meeting inconsistent supply, is precisely the kind of access and provision gap that a citywide health picture needs to track pharmacy by pharmacy, not just borough by borough.