Pharmacy First Is Adding Five New Conditions This Autumn: What It Means in Gillingham

On 10 September 2026 NHS England announced the biggest change to Pharmacy First since it launched in January 2024. From this autumn, five new conditions are being added to the service, and for the first time the pharmacist will be prescribing in the full sense of the word rather than supplying under a fixed protocol. I am an independent prescriber, I have been reading the detail closely, and there are a few things Gillingham patients should understand before they turn up expecting a migraine prescription on day one.

What are the five new Pharmacy First conditions?

NHS England's announcement lists the new pathways and the patient groups they cover:

• Low-frequency episodic migraine in adults. Migraine that comes in occasional attacks, not chronic daily headache.
• Mild to moderate acne in young people and adults. The persistent spots and blackheads that over-the-counter washes have not shifted.
• Mild skin and soft tissue infections and scabies. Scabies is the intensely itchy mite infestation that spreads through households and care homes, and it is treated with a prescription cream.
• Acute otitis externa in adults. An infection of the outer ear canal, sometimes called swimmer's ear, which causes pain, itching and discharge.
• Seasonal allergic rhinitis in children. Hay fever in children whose symptoms are not controlled by pharmacy medicines.

These sit alongside the existing seven conditions: sore throat, sinusitis, earache in children, impetigo, infected insect bites, shingles and uncomplicated urinary tract infections in women. Our complete guide to Pharmacy First covers those in detail, and nothing about them is changing.

What is different about the new pathways?

The original seven conditions run on patient group directions. That means a pharmacist follows a fixed clinical checklist and, if you meet every criterion, supplies a named medicine at a set dose. It works well for something like a UTI, where the decision is fairly binary. It works less well for migraine or acne, where the right treatment depends on what you have already tried, what else you take, and how you respond.

The five new conditions are prescribing pathways. They can only be delivered by a pharmacist who holds an independent prescribing qualification, and only in a pharmacy that has applied to NHS England to become a prescribing pharmacy. A prescriber can take a fuller history, choose between medicines, adjust doses and follow you up, which is much closer to what a GP does. NHS England estimates up to 3 million consultations a year could move into pharmacies once the pathways are running.

The catch is in that word "only". Not every pharmacy employs a prescriber, and not every pharmacy with one will have signed up straight away. Community Pharmacy England, which negotiates for pharmacy owners, has publicly warned that there is not enough money in the contract to set the new service up on a solid foundation, so for the first few months you will see a patchwork: some pharmacies offering all twelve conditions, most offering the original seven.

Can I get migraine, acne or scabies treatment at Medway Pharmacy?

I am an independent prescriber, and the team here has been delivering Pharmacy First seven days a week since it began. We will confirm on our Pharmacy First page the moment the new pathways are live in Gillingham, and I would rather you check there or ring us than travel in on an assumption. Until then, the original seven conditions are available every day from 7:30am to 10pm, excluding bank holidays, and an outer ear infection in an adult or hay fever in a child can still be assessed by a pharmacist today, with a GP referral if prescription treatment is needed.

Who will and will not qualify

The pathways are deliberately narrow, and understanding the edges will save you a wasted trip.

• Migraine is for adults with occasional attacks. If you have a headache most days, a new type of headache, a headache with weakness or slurred speech, or you are over 50 and this is your first migraine, that is a GP or urgent care problem, not a pharmacy one.
• Acne is for mild to moderate cases. Severe, scarring or cystic acne still needs a GP and often a dermatologist, and some of the strongest acne medicines can never be prescribed in a pharmacy.
• Scabies treatment usually means treating everyone in the household on the same day, whether they itch or not. Be ready for the pharmacist to ask who you live with.
• Otitis externa in adults is the outer ear. Middle ear infections in adults are not included. Earache in children aged 1 to 17 is already covered under the existing pathway, which our Pharmacy First guide explains.
• Hay fever here means children. Adults with hay fever should read our hay fever treatment guide, because most of what adults need is already available over the counter.

A patient who has been waiting for this

A woman in her 30s who works shifts at the hospital has been buying migraine tablets from us for about two years. Paracetamol, then ibuprofen, then the over-the-counter sumatriptan, which helps but not reliably. Every time I have suggested seeing her GP about a proper preventive plan she has given the same answer: she cannot get an appointment that fits around 12-hour shifts, and when she does the attack has passed and she feels she is wasting their time. She is precisely who the migraine pathway is written for. A 20-minute consultation at 8pm with a prescriber who already knows her history, and a follow-up a month later, is the difference between managing and coping. When I told her the announcement had been made she asked for the date. I could not give her one yet. This article is partly for her.

The timing is not accidental either. The pathways arrive as winter starts, which is when GP appointments are hardest to get in Medway and when a pharmacy open until 10pm earns its keep. Outer ear infections are more of a summer problem, but scabies outbreaks in schools and care homes, acne flares and migraine attacks do not keep to a season, and hay fever in children will be waiting for us in March.

How to use the expanded service when it arrives

• Check the pharmacy is a prescribing pharmacy. Ring ahead or look at its website. Turning up at one that only offers the original seven will get you good advice but not a prescription.
• Bring a list of your current medicines, or have the NHS App open. For migraine and acne especially, what you already take changes what can be prescribed.
• Bring the patient. As with earache and ear infections, the pharmacist needs to examine the ear canal or the skin. A description over the phone is not enough.
• Expect follow-up. Prescribing pathways are designed with a review built in, so you may be asked to come back or be contacted in a few weeks.
• Do not stop going to your GP for the serious stuff. The whole point of Pharmacy First is to free GP appointments for people who need them, which some days will be you.

If your condition turns out to be one of the seven existing pathways, or if you would like to talk through whether Pharmacy First is right for you before the new conditions launch, book a consultation online or call us on 01634 575805. We are at 465 Canterbury Street, Gillingham, ME7 5LJ.