Two Years of Pharmacy First, strengthening pharmacy’s role at the front door of care

Two years into Pharmacy First in England, the conversation feels different.

The first year was understandably focused on the practicalities. Pharmacies had to embed new pathways, train teams and absorb additional clinical activity into already pressured environments. From where I sit, what stands out about year two is not just continued growth, but how expectations of community pharmacy have shifted alongside it.

Consultation volumes continue to rise. Across our systems, Pharmacy First activity has almost doubled over the past year. That kind of sustained growth suggests something more fundamental than early promotion. It reflects a steady change in where people first look for help with common acute conditions.

For many in the sector, this is something we have talked about for years, the idea of pharmacy as a true front door to care rather than primarily a point of supply. What is different now is that this is becoming routine practice. Sore throats, sinusitis, ear infections and uncomplicated urinary tract infections are being managed at scale in community pharmacy. That shift from policy ambition to day to day reality is significant.

The wider impact is also becoming clearer. When activity moves safely from general practice into pharmacy, capacity is better balanced across the system. In practical terms, that means more room in general practice for complexity, continuity and prevention, and better use of the clinical skills already present in pharmacy teams. Pharmacy First is not just improving access, it is quietly reshaping how primary care workload is shared.

We are also seeing changes in behaviour. In 2025 we tracked a 191 per cent increase in patients choosing to present directly to pharmacy for eligible conditions. With digital referral routes also becoming a more established part of local pathways. That reflects growing confidence, both from the public and within the system, that pharmacy is an appropriate setting for defined episodes of acute illness.

At the same time, the service is maturing, and with that come new expectations. As volumes rise, consistency of clinical approach, quality of record keeping and clarity of patient communication matter more. Variation that feels manageable at small scale becomes more visible when services are delivered at national volume. The next phase of Pharmacy First has to focus as much on consistency and support as on further growth.

It is also important to acknowledge the pressure behind the progress. Feedback from across the sector continues to highlight the administrative workload linked to delivering and claiming for the service. For teams already balancing dispensing, other services and workforce challenges, this is not a small issue. If Pharmacy First is to remain sustainable, processes must support efficient delivery rather than take time away from patient care. Simplifying recording and claiming is central to protecting clinical capacity.

Digital systems have an important part to play here. Tools that support structured consultations, accurate records and clear communication with patients and the wider system are part of the foundation that allows services like Pharmacy First to operate safely at scale. As pharmacy’s clinical role grows, the visibility and quality of consultation information matter more, both locally and nationally.  From my perspective at Cegedim Rx, working closely with pharmacy teams across England, the direction of travel is clear. Demand for clinically focused consultations in pharmacy continues to grow, and teams are steadily adapting their ways of working. The challenge now is to make sure operational, contractual and digital arrangements keep pace with that reality.

Two years on, Pharmacy First is showing what community pharmacy can deliver when it is supported to work at the top of its clinical capability. The next stage is about consolidation. Embedding referral behaviours and strengthening day to day collaboration between general practice and community pharmacy will be key, particularly in areas where roles and clinical responsibility are still being worked through in practice. Making sure the service is supported by proportionate, well designed processes will also shape how far and how sustainably this model develops.

From where I sit, one of the most encouraging parts of this journey has been seeing how pharmacy teams have stepped into this expanded clinical role. The professionalism, adaptability and patient focus shown across the sector over the past two years should not be underestimated. At Cegedim Rx, we are proud to support pharmacies as Pharmacy First continues to grow and evolve, and to play a part in helping teams deliver safe, effective care at the front door of the NHS.