Pharmacy First England
Pharmacy First payments and thresholds for 2026/27
The clinical-pathway fee is £17, but the monthly payment depends on more than consultation volume. This guide separates the fees, eligibility conditions and costs that belong in an England pharmacy's business case.
Three routes, two consultation fees
Pharmacy First combines clinical pathways with two referral services. A clinical-pathway consultation pays £17 when the patient passes the relevant gateway and the service and claim conditions are met. An eligible minor-illness referral also pays £17. The urgent-medicine-supply referral fee is £15. A general conversation at the counter is not automatically a payable consultation.
For management reporting, record each route separately. A total labelled 'Pharmacy First contacts' can hide enquiries that did not reach a pathway gateway, referrals awaiting completion and activity outside the payment rules. Start your income forecast with completed, eligible activity rather than all patient contacts or the number of appointments offered.
The monthly payment has conditions
The fixed payment is £500 for 20–29 qualifying clinical-pathway consultations in a calendar month and £1,000 for 30 or more. Minor-illness and urgent-medicine referrals do not count towards those thresholds. The October Tariff also requires registration for Pharmacy First, the Pharmacy Contraception Service and Hypertension Case-Finding Service on the month's last day, with the required ability to provide hypertension checks. Distance-selling pharmacies have the specified hypertension exception.
Keep a separate eligibility check beside the activity total. Opening more appointments does not resolve a missing service registration, and signing up to a service without the required ability to deliver it is not a sound funding plan. Check the current Tariff wording whenever a site changes ownership, service registration or operating arrangements.
A worked example without a profit promise
Assume a pharmacy completes 30 eligible clinical-pathway consultations in one month, all within its payment cap, and meets every condition for the £1,000 monthly payment. The consultation fees are 30 × £17 = £510. Together, those two components total £1,510 before delivery costs. Any eligible medicine reimbursement is a separate calculation.
If the same pharmacy was already receiving the £1,000 payment before adding capacity, extra consultations would not earn that payment again. The relevant benefit would be the additional eligible consultation fees and any other justified changes in income. Subtract clinician time, on-site support, premises, technology, training and administration before assessing the contribution to the business.
Caps, records and payment timing
Pharmacy First clinical-pathway payments are subject to pharmacy-specific caps. Check the allocation that applies to each contractor rather than extending a per-consultation calculation indefinitely. A group dashboard should therefore show completed consultations, qualifying threshold activity, the cap and submitted claims for each site.
Reconcile the assured clinical system with Manage Your Service before the monthly submission deadline. Give one person responsibility for resolving missing records and another a clear route to review disputed eligibility. A completed clinical record, a submitted claim and a payment received are separate events. Investigate differences while the details are still available, and use the current Tariff for late-claim rules.
Compare other services on their own terms
A wider service plan can improve use of the consultation room, but each service has its own eligibility, staffing and payment rules. NMS pays for completed intervention and follow-up stages; contraception distinguishes routine and emergency consultations; hypertension includes physical measurements; DMS follows a hospital discharge referral. They should not be treated as interchangeable video appointments.
Our separate guides explain NMS funding, contraception funding and hypertension requirements. Use these to allocate staff and room time before combining the figures into a site budget. One-off startup payments should remain separate from recurring service income.
Remote delivery and prescribing need separate decisions
Permission to use video for an appropriate consultation does not establish that every external staffing arrangement meets the NHS contract. Confirm the particular service, premises, clinician and contractor responsibilities before assigning income to a remote model. The remote Pharmacy First guide explains that distinction.
The 2026/27 settlement also describes new prescribing arrangements. As checked on 1 October, CPE's implementation page still identifies outstanding specifications and sign-up documentation. Keep prospective prescribing income out of the committed base case until the relevant service is available and your pharmacy has met its requirements. Review the prescribing update when planning future capacity.
Frequently asked questions
Does every Pharmacy First consultation pay £17?
No. Eligible clinical-pathway and minor-illness referral consultations pay £17. Eligible urgent-medicine-supply referrals pay £15. Gateway, referral and claim conditions still apply.
Do 30 consultations automatically earn the £1,000 monthly payment?
No. They must be qualifying clinical-pathway consultations, and the pharmacy must meet the current service-registration and delivery conditions. Check pharmacy-specific payment caps separately.
Is the monthly payment additional profit?
It is income before delivery costs. If a pharmacy already receives it, adding capacity does not earn it a second time.
Sources & further reading
Checked against the following sources on 1 October 2026. Service rules and payments can change; use the current specification and Drug Tariff when making decisions.
- NHSBSA: October 2026 Drug Tariff, England service payments
- NHSBSA: current Drug Tariff and amendments
- Community Pharmacy England: Pharmacy First service
- DHSC: Community Pharmacy Contractual Framework 2026 to 2027
- Community Pharmacy England: prescribing within the CPCF
This is business and service-planning information. It does not assess an individual patient, authorise a delivery model or replace local clinical and contractual decisions. Source checking is not a claim of independent clinical review.
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