Pharmacy First payments and thresholds for 2026/27

Where the 2026/27 settlement leaves contractors

The Community Pharmacy Contractual Framework (CPCF) settlement for 2026/27 was agreed and published on 29 May 2026. Total funding is £3.636bn, an increase of £340m (about 10.3%) on the £3.296bn combined 2025/26 base. The separate Pharmacy First budget has now been merged into the single CPCF envelope rather than sitting alongside it.

The advanced-service fees were held rather than increased. The dispensing Single Activity Fee rose from £1.46 to £1.52, while the per-consultation fees for Pharmacy First and the other advanced services stayed at their 2025/26 levels. In practice, the case for adding consultation capacity in 2026/27 rests on the same fees as the year before, not on a mid-contract fee rise.

The £17 Pharmacy First consultation fee

Each completed Pharmacy First consultation pays a £17 fee, unchanged for 2026/27. This applies to the seven clinical pathways: sinusitis (12+), sore throat (5+), infected insect bites (1+), impetigo (1+), shingles (18+), uncomplicated urinary tract infection in women aged 16–64, and acute otitis media, or earache (1–17). It also applies to the minor-illness and urgent-medicine-supply referral routes.

The fee is per consultation, so income scales with the number of eligible patients you can see and record contemporaneously in the NHS-assured Pharmacy First IT system. For many contractors the constraint is not demand but the pharmacist time to deliver consultations without pulling the Responsible Pharmacist away from the dispensary. Our Pharmacy First overview sets out how the service is structured.

The fixed monthly payment and its thresholds

On top of the £17 per consultation, Pharmacy First pays a fixed monthly payment that rewards consistent activity. The thresholds are unchanged for 2026/27 and reset each month:

• £500 for 20 to 29 clinical-pathway consultations completed in a calendar month
• £1,000 for 30 or more clinical-pathway consultations completed in a calendar month
• Nothing extra below 20 consultations in the month, and the count does not carry over

An illustrative capacity and income calculation

Suppose you added ten extra Pharmacy First consultations a week. At £17 each that is £170 a week, or roughly £8,800 a year in consultation fees alone, before the fixed monthly payment. Ten a week works out at around 40 or more a month, which in a typical month would clear the 30-consultation threshold and add the £1,000 monthly payment on top.

These figures are illustrative and rounded, not a forecast. Actual income depends on eligible patient volumes in your area, how many consultations you complete and claim each month, whether you hit the monthly threshold consistently, and your own delivery costs. The monthly payment resets every month, so a quiet month that falls below 20 consultations earns no fixed payment. You can model your own numbers with our capacity and income calculator rather than relying on a single example.

What the other NHS services pay

Pharmacy First is one of several funded services, and most can be delivered remotely, which affects how you staff them. The current fees are:

• New Medicine Service (NMS): £28 in total per patient (£14 for the intervention and £14 for the follow-up), deliverable by phone or video
• Pharmacy Contraception Service (PCS): £25 per initiation or continuation consultation, plus £20 per oral emergency contraception consultation (added 29 October 2025); by phone or video but from the pharmacy premises, with a £400 one-off set-up fee
• Hypertension Case-Finding: £10 per clinic blood-pressure check and £50.85 per ambulatory monitoring (ABPM), with a £440 set-up fee; there has been no ongoing annual incentive since 31 March 2024
• Discharge Medicines Service (DMS): an essential service paying £35 per completed service, staged £12/£11/£12, deliverable by phone or video

How remote delivery fits the payment rules

The fees above do not change when a consultation is delivered remotely, but the rules on how you deliver do. Six of the seven Pharmacy First clinical pathways can be delivered by good-quality video. The exception is acute otitis media, which needs an otoscope and stays in person. Telephone or audio-only delivery is not permitted for the clinical pathways, though minor-illness and urgent-medicine-supply referrals may be by phone or video.

Crucially, the pharmacist delivering a remote consultation must be physically at a registered pharmacy premises, and the consultation room needs the IT to record contemporaneously in the NHS-assured system. The on-site Responsible Pharmacist always stays on the premises and is never replaced. Our guide on delivering Pharmacy First remotely covers the delivery conditions in full.

What is coming: independent prescribing

A national NHS independent prescribing offer has been announced for autumn 2026 (likely October), extending Pharmacy First and the Pharmacy Contraception Service with up to five new prescribing-only pathways. The specific conditions have not been finalised, as a clinical reference group is still deciding, and contractor payments are set at a £500 one-off set-up fee plus £525 a month for infrastructure.

This is planned, not yet operational, so it should not be built into 2026/27 income assumptions as live. It does, though, point to where consultation capacity is heading. Our explainer on independent prescribing and Pharmacy First in 2026 tracks what has been confirmed.