British Prime Minister Andy Burnham announced last month an expansion of the National Health Service Pharmacy First scheme, adding migraines, acne, scabies, ear infections and allergic rhinitis to the list of conditions qualified pharmacists can treat without a general practitioner referral. While this could partially relieve wait times at GP offices and emergency rooms, it’s sidestepping the larger chronic problem, going back at least 15 years, of a severely budget-constrained NHS system. Think tanks like the King’s Fund have said that increased budgets announced by the Labour Government two years ago weren’t sufficient to make up for years of neglect in which spending grew at less than 3% in real terms between 2010 and 2024.

Burnham has a plan to make community pharmacies the “front door” of the NHS, positioning them as the main point of contact for patients seeking care for minor ailments. Pharmacy First was originally launched in 2024 and covered seven common conditions, such as sore throats, earaches and urinary tract infections. The expansion of five conditions launches this month in participating pharmacies, building on the apparent success of the initial program and £340 million in recent investments. Pharmacies essentially replace GPs for certain relatively simple conditions to diagnose and treat. As such, this could ease pressure on doctors and emergency departments.

Pharmacists in Britain already serve several roles that their counterparts in the United States don’t, including a larger say regarding dispensing of and advice on behind-the-counter drugs which patients can access without a prescription, ranging from statins to combat high cholesterol to erectile dysfunction medicines. Pharmacy First adds to pharmacists’ tasks. It’s unclear, however, whether what pharmacists get in return is considered proper remuneration . And some say that the initiative is risky due to pharmacists’ limited training for distinguishing serious from non-serious issues. But supporters emphasize the convenience for simple cases and freed-up GP time. This is because the NHS community pharmacy arrangement provides immediate care close to home, preventing emergency room visits or phone inquiries and lines at local GP clinics. Accordingly, it transforms community pharmacies into triage hubs.

Scotland already has a program called NHS Pharmacy First Scotland , which appears to have served as a blueprint. Scotland’s Pharmacy First has been treating a much broader range of around 30 ailments since 2020. The Scottish government pays pharmacies directly for providing patient care and clinical consultations. Whether the amounts reimbursed to pharmacists are considered sufficient is subject to debate.

Approximately a third of Scotland’s population uses Pharmacy First every year. Under Pharmacy First Plus , the Scottish government expanded the program to include diagnosis and management of more complex conditions at the pharmacy, such as eye infections.

The question, however, is whether these are band-aids being applied to healthcare systems that are chronically underfunded across a wide array of medical services and technologies. This even includes budget shortfalls for items deemed cost-effective by the National Institute for Clinical Health Care Excellence that covers England and Wales or the Scottish Medicines Consortium.

Shifting clinical burdens to community pharmacies cannot solve the fundamental crisis of systemic underfunding in both the Scottish and English NHS systems.

Arguably, from its founding in the late 1940s, the NHS served the British people well until the money fell short, at least in certain areas, to appropriately fund a medical services and new technologies. Even on a comparatively modest budget, the NHS still does admirably well for the population as a whole. Yet many experts suggest that it’s a system in need of structural repair and especially more resources.

While Tory governments appear to have made things worse over the years, particularly between 2010 and 2019, when in power Labour hasn’t exactly been a big spender on the NHS. Burnham’s government is playing catch-up now. But historically, whatever boosts in spending Labour have introduced when they’ve assumed office, the system remains chronically underfunded in a number of key areas..