What does the NHS actually pay?
£500 once, £525 a month, and the same consultation fees you already get under the PGDs. That is the whole offer. The figures below come from the DHSC summary of the 2026/27 settlement, published on 29 May 2026, and from Community Pharmacy England's (CPE) prescribing page.
| Payment | Amount | Condition |
|---|---|---|
| Set-up payment | £500, one-off | Paid once you have signed up and have a confirmed go-live date with an NHS-assured EPS IT system. |
| Infrastructure payment | £525 a month | Paid monthly while you provide the service, on top of consultation fees. |
| Pharmacy First clinical pathway consultation | £17 | Same fee whether delivered under a PGD or by a prescriber, including the new prescribing-only pathways. |
| Contraception initiation or ongoing supply | £25 | Same fee as the PGD service. |
| Emergency hormonal contraception | £20 | Same fee as the PGD service. |
| Pharmacy First monthly fixed payment | £500 or £1,000 | £500 for 20 to 29 clinical pathway consultations, £1,000 for 30 or more. Prescribing consultations count. |
| Cap allowance | Not yet published | Each cap band gets a second, higher cap for pharmacies signed up to prescribing. |
Over a full year the infrastructure payment is worth £6,300. Add the set-up fee and the first year is worth £6,800 before a single consultation. CPE asked for more during the negotiation. It argued that a prescribing consultation should pay more than a PGD consultation, because the governance and infrastructure cost more. It lost that argument. On 29 May it said it was "not persuaded that sufficient investment is being made to enable the full and effective introduction of IP within the CPCF". For how the service is designed, see how independent prescribing will work in Pharmacy First.
What does the £525 not cover?
Almost everything that makes the service work. The table lists the cost lines that fall on the owner, with what the published documents say about each. Where no figure has been published, the table says so rather than guessing.
| Cost line | What the documents say | Who pays |
|---|---|---|
| Prescriber time | No funding for the prescriber's hours. The £525 equals 31 pathway consultations at £17. | You. |
| Clinical supervision | NHS England's framework expects regular access to a named clinical supervisor or prescribing mentor. It gives one session a month as an example, plus a prescribing appraisal at least once a year. | You, unless the prescriber is on the NHS-funded pilot pathway for newly qualified prescribers. |
| Training a pharmacist to prescribe | NHS England funds course fees for eligible community pharmacists, including locums, on courses starting up to March 2027. It does not pay the designated prescribing practitioner or backfill. Unfunded fees run to about £1,900 per 30 credits at one university for 2026 entry. | NHS England for fees; you for time. |
| Indemnity | Staff must hold appropriate professional indemnity for the service, through employer cover, professional body membership or individual arrangements. The pathfinder evaluation found some insurers unfamiliar with community pharmacy prescribing. | You or the prescriber; check the policy wording. |
| IT | An NHS-assured EPS IT system that can create prescriptions is a condition of the £500. No separate IT funding. | You, through your system contract. |
| Records and governance | Records of registration, indemnity and scope-of-practice checks kept for at least five years and available to commissioners on request. Clinical governance requirements to come through the Terms of Service. | You. |
The prescriber's time is the line that decides the case. A pharmacist prescriber costs more than a non-prescriber to employ or to book as a locum, and the £525 a month does not close that gap. The Pharmacists' Defence Association has argued that safe delivery needs a minimum two-pharmacist model, so the responsible pharmacist is not also the prescriber in a consultation room. That doubles the staffing question rather than answering it.
Training time is the other hidden cost. An accredited prescribing course takes about six months part time and includes at least 90 hours of learning in practice under a designated prescribing practitioner. From October 2026 pharmacies can close for up to four hours a month for learning and development. That helps with study time, not with the DPP's hours. We cover the routes and their costs in how to become a pharmacist independent prescriber.
Where does the extra income come from?
Not from the consultations you already deliver. A sinusitis consultation pays £17 under the PGD and £17 when a prescriber does it. Moving existing Pharmacy First activity to a prescriber earns nothing extra and costs more in time. The new money comes from four places, and only the first is guaranteed.
- The £525 a month itself, worth £6,300 a year.
- Consultations in the up-to-five prescribing-only pathways, at £17 each, which a pharmacy without a prescriber cannot deliver at all.
- Patients who fall outside the PGD criteria today and are referred on, but whom a prescriber could treat within the existing pathways.
- A higher cap in your band if you are a high-volume pharmacy that currently hits it, and help reaching the 30-consultation threshold for the £1,000 fixed payment.
The second source is the one to model. The candidate pathways are bacterial conjunctivitis, allergic conjunctivitis, oral thrush, skin infections and respiratory tract infections, subject to a clinical reference group. Nothing about their inclusion criteria has been published, so estimate volume from what you already see and refer on. If your team turns away twenty of those presentations a month, that is £340 of new fees. If it turns away five, it is £85.
The DHSC press release for the settlement reported 3.3 million Pharmacy First consultations between March 2025 and February 2026, up 43 per cent on the year before. That growth is the reason the fixed payment thresholds matter. A prescriber's consultations count towards the 20 and 30 thresholds. A pharmacy that hovers around 25 clinical pathway consultations a month could find the extra pathways push it into the £1,000 band. For the mechanics of the fixed payment, see how to make Pharmacy First actually pay.
Which pharmacies gain most?
Pharmacies that already employ a prescriber and already deliver 30 or more clinical pathway consultations a month. For them the £525 is close to pure margin. The prescriber is on the payroll and the consultation room is in use. The governance can be built on the Pharmacy First procedures they run today. The new pathways are extra fees on top.
Three other groups have a case. High-volume pharmacies that hit the Pharmacy First cap gain from the higher cap band for prescribing pharmacies. Pharmacies with a private prescribing clinic, in weight management, travel health or elsewhere, already carry the indemnity, supervision and record-keeping the NHS service asks for. Their marginal cost is low. And there is a new pool of prescribers: an estimated 1,000 newly registered prescribers joined the community workforce from 1 August 2026. A pharmacy taking one on can use the service to give that pharmacist a supervised scope of practice.
The weakest case is the single-pharmacist pharmacy with no prescriber and fewer than 20 clinical pathway consultations a month. Recruiting or training a prescriber costs far more than £6,300 a year, and the consultation volume does not exist to cover it. For that pharmacy the better question is how to grow the PGD-based service first. Our ranking of which NHS pharmacy services actually pay in 2026 shows where the return is higher.
What are other owners planning?
Most are holding back. A survey of Independent Pharmacies Association members was reported on 18 June 2026. It found that 12.6 per cent intend to deliver the prescribing services, 57.5 per cent do not, and 29.9 per cent are undecided. The IPA has about 3,500 members across England and Wales; the response count was not published. Respondents cited the cost of recruiting or training prescribers, uncertainty about how the services will operate and insufficient funding.
The representative bodies split on predictable lines. The Company Chemists' Association has lobbied for a national prescribing service and published its own case for one in April 2026. CPE accepted the deal while saying the money is not enough. In August its spokesperson told The Pharmaceutical Journal that the settlement "would not close the gap between NHS funding and pharmacies' costs". The Royal College of Pharmacy warned of "a postcode lottery for patient access" if new services are not properly supported. The PDA's line is that "prescribing is not simply an extension of existing activity; it brings additional clinical responsibility".
One more fact belongs here. In August 2026 DHSC answered a Freedom of Information request on the point. It confirmed it carried out no impact assessment for the 2026/27 changes, because they "did not reach the threshold for an impact assessment". There is no published government estimate of how many pharmacies will sign up or what the service will cost them. Your own numbers are the only numbers.
What do the assurance rules ask of you?
Documented checks, named supervision and an annual review of each prescriber. NHS England published two documents on 31 July 2026. One is a professional assurance framework for all NHS community pharmacy clinical services. The other is commissioning guidance for integrated care boards (ICBs) on prescribing-based services. The framework is written for pharmacy owners as much as for commissioners. Its main requirements for a prescribing pharmacy are below.
| Requirement | What the framework says |
|---|---|
| Who may prescribe | Pharmacists qualified as independent prescribers, as annotated on the GPhC register. Each completes a declaration of fitness for purpose that states their prescribing scope of practice. |
| Supervision | Regular access to a named clinical supervisor or prescribing mentor, for example one supervision session a month, and a prescribing appraisal at least once a year. |
| Development | Structured development plans for pharmacists new to prescribing, with mentorship, and no expansion of scope without development support. |
| Indemnity | Appropriate cover for the service through the employer, a professional body or individual arrangements. |
| Records | Records of registration, indemnity, scope-of-practice declarations and authorisations kept for at least five years and available to commissioners on request. |
| Locums | The same checks apply to permanent and locum staff; employers should seek assurance that employment checks have been completed. |
The ICB letter of the same date sets the commissioning timetable. ICBs were to have a process for identifying, approving and onboarding pharmacies by August 2026. Once the legal Directions are published in the autumn, they must onboard all eligible pharmacies that express an interest. By 31 March 2027, at least 95 per cent of onboarded pharmacies must be delivering prescriber-led consultations, and all of them must show prescribing activity through ePACT. Each ICB, or ICB cluster, gets £51,000 for 2026/27 to run this. Your local ICB is therefore the gatekeeper, and its process is the first thing to ask about.
Do you need a prescriber every day, and can locums do it?
No daily requirement has been published, and locums are not excluded. The service is an extension of Pharmacy First, so on days without a prescriber the PGD-based pathways run as normal. What NHS England wants to see is activity: prescribing recorded through ePACT and prescriber-led consultations happening at 95 per cent of onboarded pharmacies by 31 March 2027. A pharmacy with a prescriber two days a week can show that.
The awkward part is the prescribing-only pathways. A patient with suspected bacterial conjunctivitis who arrives on a non-prescriber day cannot be treated under the new pathway. You will need a script for the team: book the patient for the prescriber's next session, or refer on. That is a service-design question, and the specification should address it. It had not been published by late August 2026.
On locums, the framework is explicit that its checks apply to "both permanent and locum staff". The pharmacy signs up; the prescriber must hold the annotation, the indemnity and a scope-of-practice declaration, and must be set up on your EPS system. Nothing published prevents a locum prescriber from delivering the service on that basis. The Terms of Service changes are the document to watch. There is also a pipeline to consider. NHS England's Pharmacist Enhanced Practice Pathway pilot was announced on 5 August 2026. It offers 1,200 funded places for newly qualified prescribers. Applications open on 1 September 2026 for those who have a workplace educational supervisor. A pharmacy that can provide that supervisor has a route to a supported, affordable prescriber.
Can you opt out later?
Almost certainly, but the terms have not been published. Advanced services in the contract can be stopped by giving notice, and nothing in the announcement suggests prescribing will be locked in. If you withdraw, the £525 stops. Whether the £500 set-up payment is recoverable is not stated. The bigger risk is reputational: ICBs are measured on the share of onboarded pharmacies that actually prescribe, so a pharmacy that signs up and never delivers will be noticed.
The sensible approach is to treat the first year as a trial with a review date. Set the consultation volume you need to see by, say, March 2027, and decide then. For the ICB, that is also when the 95 per cent target bites.
How do you decide?
Work through the checklist below with your last twelve months of Pharmacy First data in front of you. If you cannot answer the first three questions with a yes, the service is not for you this year.
- Do you have a pharmacist with an IP annotation who will be on the premises on a regular pattern from the autumn?
- Did you deliver 20 or more clinical pathway consultations in most months of the last year, or can you see a route to it?
- Can your clinical IT system create EPS prescriptions, and has the supplier given you a date for NHS assurance?
- Does your indemnity policy, or the prescriber's, explicitly cover NHS prescribing in community pharmacy?
- Who is the named clinical supervisor, and have you costed one session a month plus an annual appraisal?
- How many patients did you refer on last month who a prescriber could have treated, in the existing pathways or the five candidate ones?
- Has your ICB published its onboarding process, and have you registered an interest?
If you already have a prescriber and a busy Pharmacy First service, sign up. The £525 is margin, the new pathways are extra fees, and the governance is mostly what you should be doing anyway. If you have neither, do not recruit a prescriber for £6,300 a year of NHS money. Grow the PGD service, consider a newly qualified prescriber on the funded pilot pathway, and revisit the decision when the specification, the pathways and the withdrawal terms are public.
Key takeaways
- The NHS pays £500 once and £525 a month, worth £6,800 in the first year, plus the same £17, £25 and £20 consultation fees as the PGD services.
- The £525 equals 31 consultations at £17; it does not fund a prescriber's hours, supervision, indemnity or IT.
- Extra income comes from the prescribing-only pathways, patients outside PGD criteria, the higher cap band and reaching the £1,000 threshold, not from consultations you already do.
- Pharmacies with an employed prescriber and 30 or more clinical pathway consultations a month gain most; single-pharmacist pharmacies with low volume gain least.
- Only 12.6 per cent of IPA members surveyed in June 2026 intend to deliver the service; 57.5 per cent do not.
- NHS England's framework of 31 July 2026 expects named supervision, an annual prescribing appraisal, indemnity, scope declarations and five-year records, for locums as well as employees.
- ICBs must have 95 per cent of onboarded pharmacies prescribing by 31 March 2027; the specification, Directions and withdrawal terms are still to come.
Sources and further reading
- Community Pharmacy Contractual Framework: financial year 2026 to 2027 (DHSC, 29 May 2026)
- Prescribing within the CPCF (Community Pharmacy England)
- Pharmacy First service (Community Pharmacy England)
- Professional assurance framework for delivering NHS community pharmacy clinical services (NHS England, 31 July 2026)
- Preparing for prescribing in national community pharmacy services: letter to ICBs (NHS England, 31 July 2026)
- Six in 10 pharmacies do not plan to deliver new prescribing services (The Pharmacist, 18 June 2026)
- Independent Prescribing in Community Pharmacy Pathfinder Programme: transition and future direction (NHS England, 30 October 2025)
FAQs
Know your Pharmacy First numbers before you sign.
The business case turns on how many consultations you deliver each month, how many you lose to PGD exclusions, and how quickly claims go in. Dataforge PMR puts service volumes, consultation records and claim status on one screen so the decision rests on your own figures.
See Dataforge PMR