Pharmacy First cap FAQs

On Monday 31st March 2025, the details of the contractual settlement for 2025/26 were announced, which included a continuation of the Pharmacy First service, including clinical pathways consultations.

As part of this continuation, the capping methodology put in place during the second half of 2024/25 was also carried over into the 2025/26 arrangements. This means that in 2025/26, pharmacies will continue to be assigned to bands depending on their level of delivery in a previous period, and this band placement will determine their volume allocation (“cap”) for the service.

One key difference pharmacy owners should be aware of is that in 2025/26, the caps will be updated monthly. This is unlike 2024/25, where caps were updated quarterly.

Pharmacy owners can refer to the lists published monthly by NHSBSA to see their band placements and caps.

Below are some FAQs covering queries that have been directed to CPE regarding Pharmacy First Clinical Pathways caps.

Why are Pharmacy First Clinical Pathways consultations capped?

The overall budget for pharmacy services in England is limited and strictly controlled by DHSC, NHS England and HM Treasury (HMT). As part of the original introduction of the Pharmacy First service, there was a non-negotiable requirement from HMT that delivery of the service must be capped – they would not permit a ‘blank cheque’ for the service.

As pharmacy owners will know, despite the pharmacy sector receiving the largest uplift across the NHS in 2025/26, the pharmacy service in England remains significantly underfunded. As such, during discussions around the distribution of funding for 2025/26, both CPE and NHS/DHSC officials had to make very difficult decisions around the best way to deploy the limited funding available.

More of the limited funding available could have been allocated to fund more clinical pathways consultations in 2025/26, but this would have been at the expense of other funding streams, such as the increase to the Single Activity Fee. Ultimately, CPE and the Government’s agreed allocation means that the overall total volume of Pharmacy First clinical pathways consultations in 2025/26 can still grow substantially compared to the volume that was delivered in 2024/25. However, it is unlikely that the cap levels for the highest delivering pharmacies will reach the same heights that they did in 2024/25.

Note; caps are currently only in place for the Clinical Pathways element of Pharmacy First (i.e. the cap does not apply to Minor Illness or Urgent Medicine Supply). As part of the settlement for 2024/25 and 2025/26, it was agreed that CPE, DHSC and NHS England will together consider the potential for caps on other clinical services. This is in order to avoid ‘over commissioning’ by Government for services which they cannot afford to pay for under the limited Pharmacy budget, and thereby to avoid draining the contract sum which could impact other payments to pharmacies (such as dispensing fees).

This process may result in adjustment to caps for existing services or the implementation of new caps for services which are not currently capped; pharmacy owners would be notified of any changes in due course.

Why are caps for Pharmacy First Clinical Pathways lower in April and May 2025 than they were at the end of 2024/25?

Caps on the number of consultations that can be delivered per month are based on actual delivery of Pharmacy First (clinical pathways). The mechanism for setting caps for Pharmacy First takes into account ‘underspend’, i.e. where caps are not met from earlier in the year, and it rolls this into allowances for later months. This mechanism meant that as the 2024/25 year progressed, more and more under delivered volume was rolled into caps, and these grew significantly.

However, as the under delivered volume for 2024/25 cannot roll into 2025/26 (HM Treasury rules do not allow transfer of unspent money from one financial year to the next), there is effectively a ‘reset’ of the system. The caps set from April 2025 are based on a target volume for 2025/26, but do not allow any under delivered allocations from 2024/25 to roll over.

As we progress through 2025/26, any under delivered volume will again be rolled over and used to increase allocations later in the year; depending on consultation numbers we may therefore again see the caps become higher later in the year.

How do I find out what my cap is?

Details of cap levels for individual pharmacies are published by the NHSBSA on its website before the start of the applicable month.

The list published by NHSBSA indicates the band assignment and monthly cap for each pharmacy, by ODS code.

If a pharmacy’s ODS code is not included in the list, the pharmacy is automatically considered to be in Band 1 (the lowest band).

How do I increase my cap?

A Pharmacy’s placement within a band is based on their previous delivery of the service. For example, placements for May 2025 were based on pharmacy activity between Dec 2024 to Feb 2025.

Note; this means volume delivered in a specific month (e.g. Feb-25) is taken into account for band placements 3 months later (May-25).

The table below shows the activity required to be placed in the various bands for May 2025:

For bands 1-5, the cap allowed in May 2025 is at least double the average volume delivered in the reference period – meaning these pharmacies would have potential to deliver more than they have historically done and then move up the placements in future months.

Band placements and cap levels will be updated monthly and published on the NHSBSA website.

If a Pharmacy First clinical pathway consultation is provided over a pharmacy’s monthly cap, I won’t be paid a fee for the consultation, but will I be paid for any medicines supplied?

NHSBSA have confirmed that medicines will still be reimbursed for consultations which are over the cap.