Pharmacy First: the seven conditions and what happens in a consultation

Which conditions are included in Pharmacy First?

The NHS Pharmacy First clinical pathways cover the seven conditions below. The age range is part of the pathway, not a general statement about who can ask a pharmacist for advice. People outside a pathway can still receive self-care advice and may be directed to another service.

Guidance: NHS England, NHS

Do I need a GP referral?

For the seven clinical pathways, you can contact a participating pharmacy directly. GP practices, NHS 111 and urgent or emergency care services can also refer people into Pharmacy First.

Availability and consultation format depend on the pharmacy and the condition. Contact the pharmacy before travelling if an examination may be needed or if you need help for a child.

Guidance: NHS England

What will the pharmacist check?

The pharmacist follows a defined clinical pathway. They will ask when symptoms started, how they have changed, whether there are warning signs and what has already been tried. They may also need information about medical conditions, regular medicines, allergies, pregnancy or breastfeeding.

Some consultations require observations or an examination. The pharmacist then decides whether self-care, an over-the-counter option, a medicine supplied under the NHS pathway or referral to another clinician is the safest next step.

• Bring or prepare a list of medicines and allergies.
• Be clear about age, pregnancy and relevant health conditions.
• Describe severe, rapidly worsening or unusual symptoms first.
• Follow the safety-netting advice and seek further help if symptoms change.

Guidance: NHS England

Does Pharmacy First always mean antibiotics?

No. A consultation is an assessment, not a promise of a particular medicine. Many infections improve without antibiotics, and antibiotics do not treat viral infections. The pharmacist uses the pathway to decide whether a restricted prescription medicine is appropriate and provides self-care and safety-netting advice either way.

This protects the individual patient and supports responsible antimicrobial use. If the pathway is not suitable, the pharmacist will explain where to seek care instead.

Guidance: NHS England

When should I seek urgent help instead?

Pharmacy First is not an emergency service. Call 999 for life-threatening symptoms such as severe breathing difficulty, collapse or signs of a stroke. Use NHS 111 when you need urgent advice and are unsure where to go.

Tell the pharmacist immediately about rapidly worsening symptoms, severe pain, confusion, dehydration, a widespread or blistering rash, a very unwell child or symptoms affecting someone with a weakened immune system. The correct next step depends on the full clinical picture.