What are the five new Pharmacy First prescribing pathways?

What has actually been announced?

A number, a fee and a shortlist, but not a list. The 2026/27 Community Pharmacy Contractual Framework was announced on 29 May 2026 by the Department of Health and Social Care (DHSC), NHS England and Community Pharmacy England (CPE). It introduces an NHS independent prescribing service from autumn 2026. Alongside prescribing within the existing Pharmacy First pathways and the contraception service, the DHSC summary promises "up to 5 new prescribing-only pathways subject to assessment by a clinical reference group". Consultations under them will be paid at £17.

The shortlist comes from CPE's briefing 009/26, published in May 2026. Its wording is careful: "options to be considered include bacterial conjunctivitis, allergic conjunctivitis, oral thrush, skin infections and respiratory tract infections. In advance of their rollout, the new pathways will need to be approved by a clinical reference group." Nothing published since has confirmed, added to or removed from that list. As of 3 August 2026 there is no approved pathway, no inclusion criteria and no launch date.

That is why this article keeps its title as a question. The five conditions are the best available guide to what is coming, and they are worth planning around. But "up to 5" means the final number could be lower, and "options to be considered" means the conditions could change. For the service as a whole, see how independent prescribing will work in Pharmacy First.

What are the five candidate conditions?

Five common, high-volume presentations that the current Pharmacy First pathways cannot complete. The table sets out where each sits today. The "why a PGD is not enough" column is our reading of the clinical position, not anything NHS England has published.

The pattern is consistent. Each candidate is a presentation pharmacies already see every day, usually ending in advice or a sale, sometimes in a referral to a GP the patient struggles to reach. Each needs either a prescription-only medicine or a clinical judgement that a patient group direction cannot accommodate. That is the gap the prescribing service is meant to close, and it is the same logic that produced the original seven pathways in January 2024.

Two of the five overlap with existing pathways, and the boundaries matter. A skin infection pathway would need to say where impetigo and infected bites stop and the new pathway starts. A respiratory pathway would need the same boundary with sore throat and sinusitis, and a clear line on lower respiratory symptoms. Expect those boundaries, and the age ranges, to be where the clinical reference group spends its time.

Why are they prescribing-only?

Because there is no patient group direction for them, and NHS England is not writing one. The existing seven pathways work because a PGD lets a non-prescribing pharmacist supply a named medicine to a patient who meets fixed criteria. The five candidates need a prescriber to assess, decide and prescribe. So a pharmacy without a prescriber cannot deliver them at all.

That is a bigger change than it sounds. Since Pharmacy First launched on 31 January 2024, every pharmacy in England has been able to offer the same clinical pathways. From autumn 2026 there will be two tiers: pharmacies that prescribe, offering up to twelve conditions, and pharmacies that do not, offering seven. CPE's own framing is that owners will decide "on an individual basis whether they want to provide the service or prioritise the use of IP skills elsewhere in their business".

For a non-prescribing pharmacy the new conditions become referral decisions. A patient with suspected bacterial conjunctivitis still walks in. The pharmacist can advise, sell an over-the-counter product where it is appropriate, or direct the patient to a prescribing pharmacy or their GP. What the pharmacy cannot do is claim £17 for completing the episode. Whether that is a problem depends on how many such patients you see. That is the question we work through in should your pharmacy offer the new NHS prescribing service.

Who decides, and when?

NHS England's clinical reference groups decide, and the timetable points to the autumn. On 31 July 2026 NHS England wrote to integrated care boards (ICBs) setting out how prescribing will be introduced into national community pharmacy services. The letter says NHS England "is convening a series of clinical reference groups to develop the criteria needed to support the introduction of independent prescribing into NHS community pharmacy services". Those criteria include the pathways.

The 31 March 2027 target is the tell. ICBs are being measured on prescribing activity within the financial year, which only works if the service and at least some pathways are live well before then. CPE's line is that "further information will be published ahead of the go-live date in the autumn". Read that as service specification, Terms of Service changes and pathway documents arriving together, close to launch.

One scenario deserves planning for: a staggered launch. Nothing requires all five pathways to be approved at once. If the reference groups clear conjunctivitis and oral thrush quickly but need longer on respiratory infections, the service could go live with fewer pathways and add others later. The phrase "up to 5" leaves room for exactly that.

How will the new pathways be paid?

At £17 a consultation, on the same terms as the existing pathways. The DHSC summary is explicit that consultations under the new pathways will be paid at £17, matching the other Pharmacy First clinical pathways. CPE's briefing adds that they "will count towards the monthly clinical pathways minimum activity requirement". The table brings the money together.

The consultation fee is the point CPE lost. It argued that a prescribing consultation should pay more than a PGD consultation because the governance costs more, and the settlement kept them equal. What the new pathways do offer is volume that did not exist before. A pharmacy hovering at 25 clinical pathway consultations a month needs only a handful of conjunctivitis or thrush consultations to cross into the £1,000 fixed payment. For that arithmetic, see how to make Pharmacy First actually pay.

How the claims will flow has not been published. Existing pathway claims go through the NHSBSA Manage Your Service portal, with the Pharmacy First claim window being extended to give owners three months in total. A prescribing consultation also generates an electronic prescription, so expect the specification to say how the consultation record, the prescription and the claim connect. Our explainer on the three-month claim window covers the current rules.

Will the existing seven pathways change?

The list stays the same; what changes is who can prescribe within it. The seven pathways remain acute otitis media in children aged 1 to 17, impetigo, infected insect bites and shingles in adults. The other three are sinusitis from age 12, sore throat from age 5, and uncomplicated urinary tract infection in women aged 16 to 64. The DHSC summary says the fixed payment arrangements for clinical pathways "will be maintained", and the cap arrangements too.

In a signed-up pharmacy, a pharmacist prescriber can prescribe within those pathways rather than supply under the PGD. In practice that means a patient who fails a PGD criterion, but whom the prescriber judges suitable for treatment, can still be treated in the pharmacy. How wide that latitude will be depends on the prescribing versions of the clinical protocols, which have not been published. The NHSBSA hosts the current PGDs and pathway documents, which were last revised in 2025; expect prescriber versions to sit alongside them.

Two other 2026/27 changes touch the existing pathways. The settlement introduces high-level caps for the Pharmacy First minor illness service and the hypertension case-finding service to restrict the highest-volume outliers. And a prescriber's consultations in the existing pathways count towards the fixed payment thresholds. A pharmacy that adds a prescriber therefore gains twice: from the new pathways and from patients the PGDs used to exclude.

How should a pharmacy prepare?

By getting the three things every pathway will need, whatever the final list says: a prescriber, a clinical record and a claims process. The pathway documents will tell you the criteria. They will not give you a prescriber, an assured EPS system or an ICB approval, and those take longer.

The count in the fourth item is the one that turns a guess into a forecast. If you see twenty of those presentations a month, the new pathways are worth £340 in fees and might lift your fixed payment. If you see five, they are worth £85, and the prescriber's time is better spent elsewhere. If you have no prescriber, the count tells you whether it is worth training one; we set out the route in how to become a pharmacist independent prescriber.

What should you watch for before launch?

Five documents, in roughly this order. The clinical reference group outcome, which names the pathways and their criteria. The service specification and the prescribing versions of the clinical protocols. The changes to the Terms of Service on clinical governance, which CPE says will come with supporting documentation. The legal Directions, which fix the go-live date and trigger ICB onboarding. And the NHSBSA claim guidance and per-band cap numbers for prescribing pharmacies.

Watch also for whether the pathways carry age limits and exclusions as tight as the current PGDs. If a bacterial conjunctivitis pathway excludes children under a certain age, or a respiratory pathway excludes anyone with a chronic lung condition, the volume you counted shrinks. The point of prescribing is clinical latitude; the point of a national pathway is consistency. Where NHS England lands between the two will decide how much the five pathways are worth. We will update this article when the list is published.

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