Reduce A&E waiting times with 'Pharmacy First' and tax incentives
Reform UK · what the evidence says
An independent, source-checked look at Reform UK’s policy “Reduce A&E waiting times with 'Pharmacy First' and tax incentives” — what it would actually do across the things that affect your life. Every claim below quotes the source behind it. How this works.
Public finances & the next generation — Genuinely contested
n/a · low confidence
The policy proposes tax incentives for new pharmacies and extra staff, but no independent costing of those incentives appears in the evidence, so it is impossible to judge whether the fiscal cost is offset by savings elsewhere. Until the tax relief is costed, the net effect on public finances cannot be determined.
The evidence
- The policy offers tax incentives for new pharmacies and those employing more staff, alongside a Pharmacy First campaign. — reformparty.uk (manifesto) — “offer tax incentives for new pharmacies and those employing more staff”
- The government has already invested £645 million over two years to expand community pharmacy services including Pharmacy First. — commonslibrary.parliament.uk (government) — “£645 million investment over two years to expand community pharmacy services, including Pharmacy First”
- The National Pharmacy Association (an advocacy body) estimates potential A&E savings of £215 million per year from redirecting minor-ailment patients to pharmacies. — npa.co.uk (media) — “a potential saving of £215 million per year”
- The tax-incentive element as proposed is distinct from existing schemes and lacks independent costing in available evidence. — taxwatchuk.org (media) — “Existing searches primarily focus on the operational aspects and funding of the current Pharmacy First scheme, or general tax breaks for pharmaceutical companies”
Biggest unknown: The size of the tax-incentive revenue cost — and whether any resulting NHS savings (estimated only by an advocacy body) would offset it — is entirely unquantified in the provided evidence.
Our reading: The policy has two fiscal components: a campaign (low marginal cost) and tax incentives for new pharmacies and additional staff. Tax incentives reduce Exchequer revenue; their magnitude depends entirely on uptake, the structure of the relief, and how many pharmacies qualify. No independent or government costing of these incentives appears in the provided evidence — the one reference to tax relief (E26) concerns an existing, unrelated registration-fee relief of £62 per pharmacist, not a new incentive for pharmacy expansion. On the savings side, the only quantified estimate is £215 million per year from the NPA (E3), an advocacy body representing pharmacies, which must be down-weighted and cannot alone anchor a verdict. The LSHTM/NIHR evaluation (E20) is ongoing and has not reported cost-effectiveness findings. With revenue cost unquantified and savings estimates coming solely from an interested advocacy source, the net fiscal effect — whether trivially small or materially negative — cannot be determined from the evidence. The verdict is therefore too-uncertain.
Healthcare — Mixed picture
minor · moderate confidence
The 'Pharmacy First' approach already exists and is showing real early results — over 6 million consultations in two years — but the tax-incentive element is vague and the existing scheme is already stretched on workforce and funding. Real gains are plausible but limited without deeper investment.
The evidence
- The policy commits to a 'Pharmacy First, GP Second, A&E Last' campaign and tax incentives for new pharmacies and those employing more staff. — reformparty.uk (manifesto) — “offer tax incentives for new pharmacies and those employing more staff”
- The existing NHS Pharmacy First service delivered over 6.2 million consultations in its first two years. — the-pda.org (media) — “the total number of Pharmacy First consultations exceeded 6.2 million”
- NHS England initially estimated the service could save up to 10 million GP appointments annually once fully implemented — this is a forecast, not a measured outcome. — ramseypharmacy.co.uk (media) — “NHS England initially estimated the service could save up to 10 million GP appointments annually once fully implemented”
- Over 95% of pharmacies in England have already signed up for Pharmacy First, making the service widely accessible. — nds.healthwatch.co.uk (media) — “Over 95% of pharmacies in England (approximately 9,200 to 10,900) have signed up for the service, making it widely accessible”
- The number of FTE pharmacists per pharmacy remained static at 1.8 between 2021 and 2024, and pharmacy technicians declined, despite increased service demands. — the-pda.org (media) — “the number of full-time equivalent (FTE) pharmacists per pharmacy remained static (1.8 in 2021 and 2024), and pharmacy technicians declined (0.6 FTE in 2021 to 0.4 FTE in 2024), despite the increased service demands”
- The National Pharmacy Association (an advocacy body) estimates 6 million A&E hours per year are spent on conditions treatable in a pharmacy, representing a potential £215 million saving — this is an advocacy estimate, not a verified baseline. — npa.co.uk (media) — “at least 6 million hours in A&E last year were spent by patients with minor issues treatable in a pharmacy, equating to a potential saving of £215 million per year”
- Key barriers to Pharmacy First's effectiveness include lack of public awareness, inadequate training access, and poor IT interoperability between pharmacies and GP practices. — ijhpm.com (media) — “Key hindrances included a lack of public awareness, inadequate training access, and poor IT interoperability between pharmacies and general practices”
Biggest unknown: Whether tax incentives for new pharmacies and extra staff will be large enough to materially expand pharmacy capacity beyond the already-stretched workforce, or whether they will merely duplicate existing NHS Pharmacy First infrastructure.
Our reading: The 'Pharmacy First' campaign element of this policy overlaps substantially with an already-operational NHS service. The evidence shows real, measurable activity: 6.2 million consultations in two years and wide pharmacy sign-up (95%+). The mechanism — diverting minor conditions from A&E and GPs to pharmacies — is not just theoretically plausible; it is already firing at scale. This gives credible grounds for an improvement signal on A&E waiting times and GP access. However, the direction is 'mixed' rather than cleanly 'improves' for two reasons. First, the workforce constraint is a hard ceiling: pharmacist numbers per pharmacy are static and technician numbers have fallen even as demand rose. Without resolving this, a campaign encouraging more pharmacy use could overload the existing system. Second, the policy's novel element — tax incentives for new pharmacies and additional staff — is stated with no committed budget, no quantified target, and no statutory mechanism. Under the soft-verb rule this element alone would be 'negligible'; the only reason the verdict is not negligible overall is that the Pharmacy First campaign component builds on a demonstrated, active scheme. The NPA's estimate of 6 million avoidable A&E hours is an advocacy projection and cannot be treated as a verified baseline; it illustrates potential headroom but not proven effect. The NHS England projection of 10 million freed GP appointments is similarly a forecast. Known implementation barriers — poor IT interoperability, uneven public awareness, and pharmacy workforce strain — further cap the realistic near-term gain. Net effect: real but modest improvement in A&E pressure via campaign reinforcement of existing activity, offset by genuine risk that workforce and funding constraints cap gains or worsen pharmacy strain. Hence 'mixed/minor'. Confidence is moderate because the Pharmacy First evidence base is reasonably strong, but the additionality of the tax-incentive mechanism remains undemonstrated.