Payment criteria

No consultation fee can be claimed where the pharmacist cannot make any contact with a referred patient. 

For patients with symptoms associated with the seven clinical pathways, a consultation is completed when a clinical pathway outcome is reached. 

• For a referred patient, a consultation fee may always be claimed 
• For patients identified by the pharmacy, a fee is payable only when a gateway point in one of the clinical pathways is crossed and an outcome is reached. 

Claims for payment should be submitted within one month of, and no later than three months from, the claim period for the chargeable activity provided. 

Pharmacy contractors providing the Pharmacy First service will be able to claim: 

• Service fee: £15 per consultation (note: if the patient needs to be referred to another pharmacy to provide the clinical pathways consultation, no payment will be due to the referring pharmacy). Only clinical pathway consultations that cross the gateway point and reach an outcome set out in the pathway will count towards meeting the monthly minimum number of consultations for the monthly fixed payment. 
• Medicine reimbursement (where applicable): price based on the listed Part VIIIA Drug Tariff basic prices. 

• • Discount deduction arrangements apply, including the Discount Not Deducted status 
  • Out of pocket and/or broken bulk cannot be claimed 
  • Price concessions do apply 
  • The zero rate on medicines prescribed on prescriptions has been extended to medicines supplied to patients under the PGDs. 

• Monthly fixed payments: £1,000 monthly can be claimed from February 2024 onwards, subject to meeting the clinical pathways consultation thresholds. 

Provision of the Pharmacy Contraception and Hypertension Case-Finding Services alongside Pharmacy First is due to become a requirement to receive the monthly £1,000 Pharmacy First payment by March 31, 2025. 

An initial fixed payment of £2,000 could be claimed from December 1, 2023 up to the launch of the service. The pharmacy must provide five clinical pathway consultations by March 31, 2024, otherwise the payment will be recovered. 

From April 2024, an initial cap of 3,000 consultations per month per pharmacy will be in place – a temporary measure and agreed in order not to hinder the uptake of the service in its early months. It should not be seen as a ‘target’. 

From October 1, 2024 new caps will be introduced based on actual provision of clinical pathway consultations, designed to deliver 3 million consultations per quarter with any unused activity rolling forward to subsequent quarters of that financial year.