The quiet NHS trial that could let pharmacists prescribe routine antibiotics – and what GPs really think

The woman at the counter knows exactly what she needs. “It’s another water infection,” she tells the pharmacist, shifting her weight from one foot to the other. She’s had them before, she’s sure of the symptoms, and the next GP appointment is ten days away.

Instead of sending her back to reception to beg for a same-day slot, the pharmacist takes her into a small consultation room at the back. Blood pressure, questions about fever and pain, quick checks for any “red flag” signs – all done in ten minutes. She leaves with a box of antibiotics and a warning: “If this gets worse, you must still call your GP or 111.”

Across the country, similar conversations are happening in quietly selected sites. No big posters, no political fanfare, just a low-key NHS trial that could normalise something once firmly in the GP’s domain: pharmacists prescribing routine antibiotics.

Not every doctor is reassured. Many are cautiously supportive. Some are worried. Almost all agree on one thing: how this is done matters far more than whether it happens at all.

Why pharmacists are being asked to step in

The backdrop is familiar. GP surgeries struggling with demand, patients frustrated by phone queues, and winter illness seasons that never seem to end. For years, policymakers have looked to community pharmacies as “the front door of the NHS” that isn’t being fully used.

Two big trends now converge:

• Access pressure: Millions of appointments each year are for common infections such as uncomplicated urinary tract infections (UTIs) or sore throats.
• Pharmacy reform: From 2026, all newly qualified pharmacists in Great Britain will train as independent prescribers, with far more clinical responsibility built in.

The new trial sits on top of the existing Pharmacy First schemes in England and similar services in Scotland and Wales, which already allow pharmacists to supply some antibiotics under tight protocols. The difference here is subtle but important: instead of following a fixed “if X then Y” recipe, pharmacists in pilot areas are being given more discretion to assess, decide and prescribe.

Behind the scenes, the NHS wants to know whether this shift:

• Cuts waiting times and GP workload.
• Improves patient experience.
• Keeps antibiotic use safe and appropriate.

Antibiotic resistance remains the loud warning siren in the background. Every extra prescription written – in a surgery or in a chemist – feeds into that risk.

What antibiotics are actually on the table

This isn’t a free‑for‑all. The trial focuses on routine, low‑risk infections where guidelines are well established and red-flag symptoms are clear. Depending on the area, these can include:

• Uncomplicated UTIs in non‑pregnant women.
• Mild skin infections such as impetigo or infected insect bites.
• Some ear and sinus infections without systemic symptoms.
• Certain sore throats where strep tests or clear clinical criteria are used.

Strong or complex antibiotics are not being handed over on a whim. Doses and courses follow the same national guidelines GPs use, and many sites require pharmacists to document why they chose a particular drug.

In practice, much of this still looks like the current “patient group direction” (PGD) model, where a detailed protocol governs who can receive what. The trial edges towards full independent prescribing by:

• Giving pharmacists more room to judge borderline cases.
• Letting them choose between more than one antibiotic option.
• In some places, linking decisions to simple point‑of‑care tests.

One pharmacist involved in an early pilot put it bluntly: “We’re not vending machines. The job is to say ‘no’ when it’s safer to wait, as well as ‘yes’ when someone clearly needs treating.”

How the trial works for a patient

Most patients first hear about the service from a GP receptionist, practice website or pharmacy window notice. The journey is designed to be simple.

1. Initial contact
   You call or walk into a participating pharmacy describing your symptoms. Some areas also allow referrals from NHS 111 or GP practices.

2. Clinical assessment
   A pharmacist takes you into a private room, not the shop floor. They run through a structured questionnaire, check medicines you already take and may examine you if needed.

3. Decision point

   • If your symptoms fit the criteria and no warning signs appear, the pharmacist can prescribe or supply an antibiotic there and then.
     
   • If anything doesn’t add up – severe pain, high fever, pregnancy, existing kidney problems – they refer you back to your GP, an urgent care centre or A&E.

4. Follow‑up and records
   The supply is recorded on your Summary Care Record where possible, and information is sent to your GP practice so your regular team knows what has been given.

Some areas layer on extra safeguards, such as:

• Checklists that mirror GP decision trees.
• Strep A swabs or C‑reactive protein (CRP) tests for certain throat or chest complaints.
• Automatic pop‑ups in pharmacy software if a patient recently had similar antibiotics.

The consultation itself is funded by the NHS, so patients in England pay only the usual prescription charge unless they qualify for exemptions.

What GPs really think

Ask ten GPs what they make of pharmacist antibiotic prescribing and you will hear a spectrum.

There is real relief from some. Minor infections can clog up same‑day appointments that could otherwise go to frail older patients or people with worrying new symptoms. Handing straightforward cases across to well‑trained pharmacists sounds logical – particularly in areas where the nearest surgery is overwhelmed or miles away.

There is also unease.

Common themes GPs raise include:

• Antibiotic stewardship
  “Every time you make antibiotics easier to get, you risk more being given when they’re not strictly needed,” as one GP partner told a professional forum. Doctors worry that commercial pressures in community pharmacy – targets, retail environment, customer expectations – could make it harder to say no.

• Fragmented care and safety
  If a patient bounces between pharmacy, GP and online providers, no one may have the full picture. Repeated short courses of antibiotics, missed test results or slowly worsening symptoms can all slip through if records don’t join up properly.

• Workload shifting, not shrinking
  GPs fear that borderline or complicated cases may still land back in their in‑tray, but now with an extra layer of consultation to unpick. If a pharmacy visit doesn’t fully resolve things, a “quick” scheme can turn into two appointments instead of one.

• Indemnity and blurred responsibility
  Who is accountable if something is missed? GPs are keen that pharmacists prescribing antibiotics carry clear clinical responsibility, backed by proper training, insurance and governance.

Yet many doctors are also quick to point out the upside when schemes are carefully designed:

“If it’s done with strict protocols, shared records and time for pharmacists to think, it could be brilliant,” one GP wrote in an email circular. “My worry is when it’s done on the cheap and rushed.”

What sits behind GP reactions

GP response	What often lies beneath
“This can really help”	Belief in team‑based care, good local relationships with pharmacies, clear referral routes.
“I’m wary but open‑minded”	Support for innovation, but only with strong data on safety and antibiotic use.
“This is risky”	Past experiences of over‑treatment elsewhere, poor IT links, fear of being left to pick up complications.

Are pharmacists ready for this responsibility?

Modern pharmacists already do far more than count tablets. Their training now includes:

• A five‑year integrated Master’s degree with strong clinical content.
• A foundation year in practice, similar in spirit to medical foundation training.
• Independent prescribing courses for those expanding into clinical roles.

In Scotland and Wales, pharmacist prescribers have long managed conditions such as minor infections, asthma and blood‑pressure checks in structured clinics. The English pilots are catching up with that reality.

Still, readiness is uneven. Not every community pharmacy has:

• Enough consultation space for private assessments.
• Adequate staffing to spend 15–20 minutes per patient without backing up the queue.
• A pharmacist with independent prescribing qualifications on duty at all times.

And, just as in general practice, burnout and workload are very real.

“We’re excited to use our clinical skills more,” one community pharmacist told a local meeting, “but we can’t do this safely on top of everything else with no extra hands.”

What this could mean for patients

For many patients, the appeal is obvious: quicker help, closer to home. If you have had a UTI before, recognise the tell‑tale sting and can’t get a GP call for days, being seen in a high‑street pharmacy the same afternoon feels like common sense.

People who stand to benefit most include:

• Those in areas with severe GP shortages.
• People who work irregular hours and struggle to attend surgery slots.
• Patients who find phone triage difficult, such as those with hearing problems or language barriers.

But convenience is only an advantage if treatment is right.

Pharmacists in these schemes are trained to say no when necessary. You may still be sent back to your GP or to urgent care if:

• Your symptoms don’t quite fit a “routine” pattern.
• You have underlying conditions that change the risk calculation.
• You are pregnant, very young, very old, or recently had the same infection.

For patients, that can be frustrating. Yet in infection medicine, the difference between “mild” and “worrying” is sometimes only clear after a good, unhurried history and examination – not just a description at the counter.

How to use pharmacy antibiotic services wisely

• Treat them as another part of the NHS team, not a shortcut that guarantees tablets.
• Bring a list (or photos) of all medicines you already take.
• Be honest about alcohol, sexual history and any recent travel – it can change what’s safe.
• Ask what to watch for if you don’t improve, and when you should seek further help.
• Complete the course as prescribed, unless your clinician advises otherwise.

The antibiotic resistance question that refuses to go away

Antibiotic resistance is often talked about in distant terms – “a global threat”, “a problem for 2050”. In reality it looks like something much more personal: a urine sample that no longer responds to the usual treatment, a chest infection that needs intravenous drugs instead of tablets.

Every new scheme is judged against one big question: will this lead to more antibiotics being used overall, or just move where they are prescribed?

If pharmacist‑led care:

• Replaces many GP appointments for the same conditions, sticking closely to guidelines, the overall impact on resistance may be neutral or even positive, thanks to more timely treatment and fewer complications.
• Adds extra opportunities to obtain antibiotics, especially for viral illnesses where they do not help, resistance will worsen.

That’s why the trial is being closely watched. Data on:

• How many antibiotics are prescribed.
• For which conditions.
• How often patients are later admitted to hospital.

will feed into decisions about whether to expand or rein in the model.

Both GPs and pharmacists are tied into UK antimicrobial stewardship programmes. The success of this trial will rest on how seriously those commitments are taken when face‑to‑face with a patient who “just wants something to clear it up”.

What happens next

The current pilots will be evaluated over the next few years by NHS England and local integrated care systems. The questions they want answered include:

• Are patients satisfied with pharmacy‑led infection care?
• Has GP same‑day demand dropped – and for which groups?
• Are there any signals of increased complications or hospital admissions?
• Have overall antibiotic prescribing rates changed?

If the results look safe, expect a phased national roll‑out, tied in with the new generation of independent prescribing pharmacists. If not, schemes may be scaled back to more limited PGD‑style services.

Patients, meanwhile, are likely to see more signs in pharmacy windows and more receptionists asking, “Would you be happy to see a pharmacist about this instead?”

For now, the trial remains quiet by design: small, controlled, carefully watched. Its outcome will shape not only who writes your next antibiotic prescription, but also how the NHS balances access, safety and resistance in the decade ahead.

How to protect yourself – and antibiotics – whatever happens

• Don’t save or share leftover antibiotics; they’re prescribed for specific people and infections.
• Challenge your own expectations: sometimes the safest answer really is rest, fluids and time.
• If you are given antibiotics, ask what infection they are for and how you’ll know they’ve worked.
• Whether you see a GP, nurse or pharmacist, stick to one prescriber for the same illness where possible, so someone has the full picture.

FAQ:

• Can I just walk into any pharmacy and get antibiotics now? No. Only pharmacies signed up to specific NHS schemes can supply antibiotics for certain conditions, and even then only after a proper assessment. You may still be referred back to your GP or to urgent care.
• Is it safe for pharmacists to prescribe antibiotics? When they are properly trained, have access to your records and use clear protocols, evidence from other parts of the UK suggests it can be safe and effective. The current trial exists to confirm that in real English settings.
• Will this make it harder to see my GP? The intention is the opposite: by moving straightforward infections to pharmacies, GPs should have more time for complex and urgent cases. How well that works will depend on local staffing and how widely the schemes are adopted.
• Could pharmacists over‑prescribe because they work in shops? Commercial pressure is a concern many GPs raise, but pharmacists are regulated health professionals bound by the same ethical duty to put patient safety first. Safeguards such as prescribing audits and shared records aim to keep practice in line with national guidelines.
• What should I do if I don’t get better after antibiotics from a pharmacy? Follow the safety‑net advice you were given at the consultation. If symptoms are not improving, or if you develop new or worrying features, contact your GP, NHS 111 or urgent care as directed – and tell them exactly what you have already taken and when.