NHS Pharmacy First Service: clinical pathways, patient group directions and protocol

The documents in this article are the current clinical pathways, patient group directions (PGDs), protocols, and master PGD/protocol authorisation sheet for the NHS Pharmacy First Service. These will remain in place until 11:59pm on Tuesday 30 September 2025.

NHS England will publish updated clinical pathways, PGDs, protocol, and master PGD/protocol authorisation sheet on Monday 22 September 2025. These updated documents will come into effect from Wednesday 1 October 2025.

1a. Supply of nitrofurantoin capsules/tablets for the treatment of Urinary Tract Infection.

2a. Supply of aciclovir tablets/dispersible tablets for the treatment of shingles (herpes zoster) infection.

2b. Supply of valaciclovir tablets for the treatment of shingles (herpes zoster) infection.

3a. Protocol for the supply of topical hydrogen peroxide 1% cream (e.g. Crystacide® 1% cream) for the treatment of localised non-bullous impetigo. 

3b. Supply of fusidic acid 20mg/g (2%) cream for the treatment of localised non-bullous impetigo. 

3c. Supply of flucloxacillin capsules/oral solution/oral suspension for the treatment of widespread non-bullous impetigo.

3d. Supply of clarithromycin tablets/oral suspension/oral solution for the treatment of widespread non-bullous impetigo. 

3e. Supply of erythromycin tablets/oral suspension/oral solution for the treatment of widespread non-bullous impetigo in pregnant individuals (aged 16 years and over) 

4a. Supply of flucloxacillin capsules/oral solution/oral suspension for the treatment of infected insect bite(s) and sting(s).

4b. Supply of clarithromycin tablets/oral suspension/oral solution for the treatment of infected insect bite(s) and sting(s). 

4c. Supply of erythromycin tablets/oral suspension/oral solution for the treatment of infected insect bite(s) and sting(s) in pregnant individuals (aged 16 years and over). 

5a. Supply of phenoxymethylpenicillin (penicillin V) tablets/oral solution/oral suspension for the treatment of acute sore throat due to suspected streptococcal infection. 

5b. Supply of clarithromycin tablets/oral suspension/oral solution for the treatment of acute sore throat due to suspected streptococcal infection. 

5c. Supply of erythromycin tablets/oral suspension/oral solution for the treatment of acute sore throat due to suspected streptococcal infection in pregnant individuals (aged 16 years 
and over)

6a. Supply of fluticasone furoate 27.5 micrograms/ dose nasal spray (e.g. Avamys® nasal spray suspension) for the treatment of acute sinusitis (rhinosinusitis).

6b. Supply of mometasone furoate monohydrate 50 micrograms/dose nasal spray for the treatment of acute sinusitis (rhinosinusitis)

6c. Supply of phenoxymethylpenicillin (penicillin V) tablets/oral solution/oral suspension for the treatment of acute bacterial sinusitis (rhinosinusitis)

6d. Supply of clarithromycin tablets/oral suspension/oral solution for the treatment of acute bacterial sinusitis (rhinosinusitis).

6e. Supply of clarithromycin tablets/oral suspension/oral solution for the treatment of acute bacterial sinusitis (rhinosinusitis).

6f. Supply of doxycycline capsules/dispersible tablets for the treatment of acute bacterial sinusitis (rhinosinusitis).

7a. Supply of Otigo® (phenazone 40mg/lidocaine hydrochloride 10mg/g) ear drops, solution for the symptomatic relief of pain due to acute otitis media.

7b. Supply of amoxicillin capsules/oral suspension/oral solution for the treatment of acute otitis media.

7c. Supply of clarithromycin tablets/oral suspension/oral solution for the treatment of acute otitis media.

7d. Supply of erythromycin tablets/oral suspension/oral solution for the treatment of acute otitis media.