Which NHS pharmacy services actually pay in 2026?

How should you rank NHS services?

By contribution per staff hour, not by fee. A £50.85 ambulatory blood pressure monitoring (ABPM) fee looks generous next to a £10.06 flu jab. But the jab takes a fraction of the time, and the fridge is full of them from September. What an owner needs is the fee divided by the minutes of staff time it consumes, adjusted for fixed payments, caps and whether the patient turns up without a referral.

That is what this article does. The fees are the ones in force on 1 August 2026, taken from the Drug Tariff determinations and NHSBSA's claim guidance, and each is sourced below. The minutes are assumptions, stated in the table so you can replace them. Nobody publishes measured consultation times, so treat the per-hour figures as a way of comparing services, not as a forecast.

Three things the fee alone does not tell you. Pharmacy First carries a fixed monthly payment that changes the economics above 20 and 30 consultations. The NMS is capped by prescription volume, and two more caps are on the way. And four of the services below only exist if someone else refers the patient. The ranking accounts for the first two and flags the third. For the private side of the ledger, see whether private services are now carrying community pharmacy.

What does each service pay in 2026/27?

The 2026/27 settlement, announced on 29 May 2026, left the service fees unchanged and put the uplift into the single activity fee, which rose from £1.46 to £1.52. So the fees below are the April 2025 fees, still current. Each row names its source. Services whose 2026/27 fee we could not verify, including the smoking cessation service, are left out rather than guessed.

The Pharmacy First figures come from Part VIC of the June 2026 Drug Tariff. The hypertension, contraception, DMS and MenB fees are from NHSBSA's claim guidance for the hypertension service, the contraception service, the DMS and MenB. The NMS cap is from Community Pharmacy England (CPE), and the vaccination fees from the NHS England 2026/27 specification as summarised by CPE.

Which services pay best per staff hour?

Pharmacy First at threshold, then ABPM, then emergency contraception and flu. The table applies our time assumptions to the fees above. Minutes include the record and the claim, not just the patient contact. Where a service has a fixed payment, the table shows the fee alone and the fee with the fixed payment spread across the qualifying consultations.

Two readings of that table. First, the same Pharmacy First consultation appears at the top and near the bottom, which is the whole story of the service. Second, the spread outside Pharmacy First is narrow: most services return £50 to £80 an hour on these assumptions. Change the minutes by five either way and ranks four to ten swap places. The order within that band matters less than the volume you can get.

Why does Pharmacy First top the table at 30 a month?

Because the fixed payment is worth twice the fees. At 30 clinical pathway consultations a month you earn £510 in fees and £1,000 in fixed payment. Spread the £1,000 across the 30 and each consultation is worth £50.33, not £17. At 20 to 29 consultations the fixed payment is £500, so the 20th consultation is worth £17 plus £25. Below 20, Part VIC says you "will only be paid the service fee of £17.00 per consultation".

Three conditions apply. Only clinical pathway consultations that cross the gateway count towards the thresholds; minor illness and urgent supply referrals do not. You must be registered for the hypertension case-finding and contraception services on the last day of the month, though distance selling pharmacies are exempt from the hypertension requirement. And the claim must be in, because the fixed payment is calculated from what NHSBSA can count. The Pharmacy First deadline is the 5th of the following month, with grace only to the end of that month. Our guide to the claim window covers the two-month extension agreed for later in 2026.

The practical consequence is that the 25th to 30th consultations in a month are the most valuable work in the building. A pharmacy at 26 consultations that finds four more moves from £942 to £1,510 for the month. That is the case for putting a trained team member on the counter to spot pathway-eligible presentations. Our guide on making Pharmacy First pay sets out how.

Do vaccinations make money?

Yes, and in cash terms they are the biggest earner in most pharmacies, even though they sit fourth per hour. The reason is volume. A pharmacy giving 1,500 flu vaccinations at £10.06 earns £15,090 in fees between September and January, more than a year of Pharmacy First fixed payments. The vaccine is reimbursed, so the costs are staff time, consumables and the fridge.

The 2026/27 joint specification, published in December 2025, changed the shape. The flu fee rose from £9.58 to £10.06 from 1 April 2026. COVID-19 pays £8.70 per dose inside the flu campaign window, 1 September 2026 to 31 January 2027, and £10.06 outside it, with vaccine supplied centrally. The £10 housebound supplement went, and the specification now says you must not vaccinate housebound patients unless the commissioner asks. Pregnant women can be vaccinated from 1 September 2026 and other adult cohorts from 1 October 2026. Registration for the autumn programme closed on 31 July 2026.

The staffing point is what makes vaccination rank where it does. The specification requires "a registered healthcare professional trained in vaccination", not a pharmacist specifically. A pharmacy that runs a vaccination clinic with a second registered professional keeps the pharmacist on Pharmacy First, which is where the pharmacist's hour is worth most.

MenB is the newcomer. The service runs from 20 July 2026 to 31 March 2027 at £10.06 per dose, with £300 paid after your first vaccination and £400 once you reach 100. At 12 minutes a dose for an infant appointment with a parent, the per-hour figure is modest, but the £700 in bonuses is worth about 70 doses on its own. Our guide to the MenB service covers eligibility and setup.

Is the hypertension service worth it?

Only if you do the ABPMs. The clinic check pays £10, which is £60 an hour on a ten-minute assumption and less if the record takes longer. The ABPM pays £50.85 and is the highest single fee in the NHS pharmacy offer. On 30 minutes of staff time across fitting, return and interpretation, it is about £100 an hour, second only to Pharmacy First at threshold.

The service has a £440 set-up fee and a claim rule of the 5th of the following month, with late claims accepted within three months. The economics turn on conversion: a clinic check that finds a raised reading should lead to an ABPM, and the ABPM is where the money is. A pharmacy doing 40 clinic checks and two ABPMs a month earns £501.70; one doing 40 checks and eight ABPMs earns £806.80. The devices cost money, so the second pharmacy needs enough of them.

The point most owners miss is that registration is not optional. The Pharmacy First fixed payment requires you to be registered for hypertension case-finding, distance selling pharmacies excepted. So the question is not whether to offer it, but whether to run it properly. The settlement also agreed a high-level cap for the service, aimed at the highest-volume outliers, with details to be agreed during the year. Our hypertension case-finding guide covers the conversion problem.

Where do NMS and contraception sit?

In the middle, and both are limited by something other than the fee. The NMS pays £14 for a completed intervention and £14 for a completed follow-up. A full episode at 25 minutes is about £67 an hour; an intervention with no follow-up is £56. Around half of NMS episodes nationally stop after the intervention, so most pharmacies are earning the lower figure. The cap is 0.9 per cent of monthly prescription items from June 2026 consultations, or 18 consultations per 1,000 items. Our New Medicine Service guide has the full cap table.

The contraception service pays £25 for an initiation or ongoing consultation and £20 for emergency contraception, the latter since 29 October 2025. Both are walk-in and both are quick, which is why they rank above the NMS per hour. Set-up is £400 on sign-up plus £250 after five consultations and £250 after ten. Late claims are accepted within three months of the deadline, which is more forgiving than Pharmacy First. Like hypertension, registration is compulsory for the Pharmacy First fixed payment.

Which services pay worst?

The ones you cannot generate yourself. The Discharge Medicines Service pays £35 for a completed three-stage episode, and £12, £11 or £12 for stages completed alone. At 45 minutes across the three stages it is about £47 an hour, and every patient arrives by hospital referral. Pharmacies near a trust that refers well do fine; the rest wait. Our guide to the DMS covers the referral flow.

Pharmacy First urgent medicine supply pays £15, the one fee in the service that did not rise in April 2025. It only follows an NHS 111 or integrated urgent care referral; general practices cannot refer for it. Minor illness referrals pay £17 but depend on GP practices and NHS 111 sending patients. Neither counts towards the fixed payment thresholds. They are worth taking, and worth chasing your local practices for, but they are not worth staffing around.

Two services are not ranked. The smoking cessation service's 2026/27 fee could not be verified from a current determination, so it is left out. The NHS independent prescribing service, with its £500 set-up payment and £525 monthly infrastructure payment, does not start until autumn 2026. When it does, the £525 a month will change the Pharmacy First arithmetic for pharmacies with a prescriber, and this table will need redoing.

How do caps and claim windows change the ranking?

They lower the ceiling on the services in the middle and add risk to the one at the top. The NMS cap moved from 1.0 to 0.9 per cent of monthly items for June 2026 consultations. The Pharmacy First fixed payment has thresholds rather than caps. But the settlement agreed "high level caps for the hypertension case-finding service and Pharmacy First minor illness service to restrict highest volume outliers". The details are to be agreed during the year. For a typical pharmacy neither will bite; for a high-volume site they set the limit.

Claim windows are the hidden variable. Hypertension, contraception, flu, MenB and DMS claims are due by the 5th of the following month, with late claims accepted within three months. Pharmacy First gives you until the end of the following month. The NMS has no grace period at all. A pharmacy that claims weekly never notices; one that claims at month-end can lose a whole month of the top-ranked service. The numbers to check every week include claimed against delivered consultations for this reason.

The table below shows what the same 10 hours of staff time returns in each service on our assumptions. That is the comparison that matters when you are writing the rota.

Key takeaways

FAQs