We need to create a workforce fit for the future

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Pharmacy First is entering a new phase. From autumn 2026, prescribing will begin within national community pharmacy services, initially through a small number of participating pharmacies. The existing seven clinical pathways will be joined by five prescribing pathways covering acute otitis externa, seasonal allergic rhinitis in children, mild to moderate acne, low-frequency episodic migraine and mild skin and soft tissue infections and scabies.

The opportunity is substantial. NHS England reports that Pharmacy First has delivered 14 million consultations since its launch in February 2024, and estimates that the five new conditions could eventually generate two to three million community pharmacy consultations each year.

But growth on that scale will test whether the service is genuinely simple for patients and workable for pharmacy teams. A service can be clinically sound on paper yet still fail if people cannot tell what it covers, whether they are eligible, where it is available or what will happen when they walk through the door.

Navigation is a team job

The solution is not simply a communications campaign. It starts with the workforce. Every member of the pharmacy team should understand the pathways well enough to give a clear, consistent explanation, gather the right initial information, recognise when escalation is needed and make a confident handover.

That is not about asking people to work beyond their competence. It is about making navigation a shared team responsibility rather than leaving every query with the pharmacist.

Freeing pharmacists to prescribe

Prescribing also changes the shape of the pharmacist’s role. If pharmacists remain tied to avoidable operational bottlenecks, a prescribing qualification will not create clinical capacity by itself.

Pharmacy technicians and support staff need structured development to take on appropriate responsibilities in dispensing, medicines optimisation, service administration and workflow coordination, releasing pharmacists for assessment, decision-making and prescribing.

The planned move from Level 3 to Level 4 provides a stronger foundation, but Pharmacy First will also require development beyond initial registration. The proposed UK-wide pathway from the Association of Pharmacy Technicians UK (APTUK) maps progression from Foundation Practice at Level 4 to Enhanced Practice at Level 6 across clinical, leadership, research and education capabilities.

That clarity matters: pharmacy technicians need to see how learning leads to greater responsibility, while employers need confidence that new roles sit within a consistent, transferable and properly supported professional pathway.

Training in the working day

Training must therefore be practical and built into normal operations. Short case-based scenarios, simulated triage conversations, team briefings when pathways change and structured reflection on referrals or near misses can all improve confidence without treating development as something separate from the working day.

These approaches are common in experiential learning in apprenticeships. Flexible learning matters, but so do protected time and accessible supervision.

Systems and sustainability

Digital design is part of workforce design too. Teams need systems that make eligibility, clinical records, referrals and claims straightforward. Patients need consistent language across NHS channels, GP practices and pharmacies. When information differs between entry points, pharmacy staff carry the burden of explaining the mismatch and patients lose confidence.

Finally, the model must be sustainable. Community Pharmacy England has warned that prescribing brings additional workload, governance and infrastructure requirements, and that sufficient investment will be essential.

NHS England is supporting system readiness and governance, but each pharmacy will still need the people, time, space and processes to deliver safely. Success should be judged not only by consultation volumes but by completed pathways, avoidable referrals, patient understanding, team confidence and the administrative time required to provide the service.

Three tests

As Pharmacy First expands, every change should pass three tests: is it easy to find, easy to understand and sustainable to provide? If we want the service to fulfil its promise, building a confident, adaptable whole-pharmacy team cannot be an afterthought. It is the foundation.

Emma Seton is chief executive of Buttercups Training