NHS Pharmacy First (Scotland) Service - Processing Claims
Published: 16th July 2026
Thanks to everyone who sent in feedback and questions on the article we ran last week on the NHS PFS Service. The top question for this week is around the processing of claims for the service.
Here are the details - a flowchart and some scenarios to illustrate claiming.
Standard Pharmacy First Scotland (NHS PFS)
Making Claims for Standard NHS Pharmacy First Scotland (NHS PFS) following a valid consultation as described above
| Scenario | Explanation | Action required |
|---|---|---|
| A patient only needs advice or chooses to purchase an OTC medicine following an eligible consultation. | This is one advice activity, being made under Standard NHS PFS. | Make one claim on Standard NHS PFS - Advice 1/0.1 activity will be credited. |
| A patient has one condition – a headache. After an eligible consultation providing advice, they are supplied with paracetamol to treat their headache. | This is one supply activity, being made under Standard NHS PFS. Advice being given is implied and accounted for when products are supplied. | Supply the medicine on Standard NHS PFS – Treatment. There is no need for a separate claim to be made for the advice provided. 1/0.1 activity will be credited. Medicines on the Approved List will be reimbursed. |
| A patient has one condition - head lice. After consultation with advice, two medicines from the Approved List to treat their single condition, dimeticone 4% lotion and a Nitcomb for head lice are supplied. | This is one condition, being treated under Standard NHS PFS. Advice being given is implied and accounted for when products are supplied. | Supply both medicines on the same Standard NHS PFS – Treatment. There is no need for a separate claim to be made for the advice provided. 1/0.1 activity will be credited. Medicines on the Approved List will be reimbursed. |
| A patient has two conditions – acne and a sore throat. After consultation with advice, Acnecide 5% Gel and Benzydamine 0.15% Oro mucosal Spray Sugar Free, both from the NHS PFS Approved List, are supplied | This is two conditions; both being treated under Standard NHS PFS. Advice being given is implied and accounted for when products are supplied. | All medicines supplied for each individual condition should be supplied on separate Standard NHS PFS – Treatment – in this case Acnecide on one and Benzydamine on the other. This will ensure an activity is allocated for each condition – in this case, two activities (2/0.2) in total. There is no need for a separate claim to be made for the advice provided. Medicines on the Approved List will be reimbursed. |
| The patient has symptoms of a throat infection and is given advice and referred to another healthcare provider out with the community pharmacy (this could include referral to a CPIP Pharmacist in a different community pharmacy). | This is one referral activity, being made under Standard NHS PFS. Advice being given is implied and accounted for when the claim is made. | Make one claim on Standard NHS PFS Referral. There is no need for a separate claim to be made for the advice provided. 1/0.1 activity will be credited. |
| The patient has symptoms of a throat infection and is referred to the pharmacist in the community pharmacy. | This is one condition, with all consultations taking place in the same pharmacy. At this stage nothing is claimed. | Do not make any claim at this stage. Pharmacist will make appropriate claim in line with the outcome of their consultation with the patient. |
PGD Pharmacy First Scotland (NHS PFS)
Can be used by CPIP within inclusion criteria to manage workload
Making Claims for PGD NHS Pharmacy First Scotland (NHS PFS)
| Scenario | Explanation | Action required |
|---|---|---|
| A patient with a UTI only needs advice. | This is one advice activity with a weighting of 1/0.1, being made under NHS PFS UTI PGD. | Make one claim on NHS PFS UTI PGD - Advice 1/0.1 activity will be credited |
| A patient needs one medicine, supplied on PGD – trimethoprim to treat their UTI. | This is one treatment activity on the NHS PFS UTI PGD, with a weighting of 5/0.5. Advice being given is implied and accounted for when the claim is made. |
Supply the trimethoprim on NHS PFS UTI PGD - Treatment. There is no need for a separate claim to be made for the advice provided. 1 activity will be credited with a weighting of 5/0.5. Medicines on the approved list will be reimbursed. |
| A patient needs two medicines: trimethoprim on PGD to treat a UTI and paracetamol for pain relief from the NHS PFS Approved List | This is one condition, being treated under both NHS PFS UTI PGD and Standard NHS PFS. Advice being given is implied and accounted for when the claim is made |
Supply the trimethoprim on NHS PFS UTI PGD - Treatment. There is no need for a separate claim to be made for the advice provided. 1 activity will be credited with a weighting of 5/0.5. Supply the paracetamol on Standard NHS PFS - Treatment. There is no need for a separate claim to be made for the advice provided. 1/0.1 activity will be credited. Medicines on the Approved List will be reimbursed. |
| A patient has one or more of the exclusion criteria for the relevant PGD and can’t be treated in the community pharmacy. | This is one referral activity on NHS PFS UTI PGD, with a weighting of 1/0.1. Advice being given is implied and accounted for when the claim is made. |
Make one claim on NHS PFS UTI PGD – Referral. There is no need for a separate claim to be made for the advice provided. 1/0.1 activity will be credited. |
Community Pharmacist IP (CPIP) Consultation Pharmacy First Scotland (NHS PFS)
Making Claims for CPIP NHS Pharmacy First Scotland (NHS PFS)
| Scenario | Explanation | Action required |
|---|---|---|
| A patient only needs advice following an IP consultation. | This is one advice activity being made under CPIP NHS PFS. | Make one claim on NHS PFS Plus - Advice. 1/0.1 activity will be credited. |
| A patient needs one medicine, supplied on CPIP Rx – penicillin V to treat their throat infection. | This is one condition being treated on the CPIP NHS PFS. Advice being given is implied and accounted for when the claim is made. |
Supply the penicillin V on the CPIP Rx pad. Make one claim on NHS PFS Plus - Treatment. Payment will be made from IP Prescribing Activity Pot Cost of medicine will be reimbursed from CPIP Rx pad. |
| A patient needs two medicines – penicillin V to treat their throat infection supplied on CPIP Rx and paracetamol for related pain relief on the NHS PFS Approved List. | This is one condition, being treated under both CPIP Rx and Standard NHS PFS. Advice being given is implied and accounted for when the claim is made. |
Supply the penicillin V on CPIP Rx pad. Make one claim on NHS PFS Plus – Treatment. Payment will be made from IP Prescribing Activity Pot Supply the paracetamol on the Standard NHS PFS- Treatment. There is no need for a separate claim to be made for the advice provided. 1/0.1 activity will be credited. Cost of medicines will be reimbursed from CPIP Rx pad for penicillin V and Standard NHS PFS - Treatment for paracetamol. |
| A patient needs two medicines – penicillin V to treat their throat infection, and co-codamol 30/500 for related pain relief. Both supplied on CPIP Rx. | This is one condition, being treated on CPIP Rx. | Supply the penicillin V and the co-codamol 30/500 on CPIP Rx. Make one claim on NHS PFS Plus – Treatment. Payment made from IP prescribing activity pot Cost of medicines will be reimbursed from pad. |
| A patient with a sore throat has a consultation with the CPIP who supplies paracetamol. | This is one supply activity, being made under Standard NHS PFS by the CPIP. Advice being given is implied and accounted for when products are supplied. | Supply the medicine on Standard NHS PFS – Treatment. 1/0.1 activity will be credited. Make one claim on NHS PFS Plus – Advice to flag that the consultation was carried out by an IP. 1/0.1 activity will be credited. Medicines on the Approved List will be reimbursed. |
| A patient’s symptoms are out with the current competence of the CPIP and require referral to another healthcare provider out with the community pharmacy. | This is one referral activity, being made under CPIP NHS PFS. | Make one claim on Standard NHS PFS - Referral. There is no need for a separate claim to be made for the advice provided. 1/0.1 activity will be credited. |
If you have any questions, please get in touch at enquiries@cps.scot
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Frequently Asked Questions (FAQs)
No, in most cases. Where a consultation results in a supply, treatment or referral claim, the advice given is implied and accounted for automatically, so a separate advice claim is not required. Advice only needs to be claimed on its own when that is the sole outcome of the consultation.
Each condition assessed during a consultation should be claimed separately. For example, if a patient is treated for two unrelated conditions in the same visit, this results in two separate activity claims, one for each condition, rather than a single combined claim.
The route depends on who delivers the consultation and how the patient is treated. Standard NHS PFS covers general advice, supply and referral. PGD claims apply where a Patient Group Direction is used, such as for UTI treatment, and can be used by a CPIP to manage workload. CPIP claims apply where an Independent Prescriber consultation results in a prescription written on a CPIP Rx pad. The flowchart sets out the full decision pathway for each route.
The top question for this week is around the processing of claims for the service.