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A Swindon pharmacy has failed in its appeal against an NHS England decision to recover a £606.77 ‘overpayment’ with regard to Pharmacy First consultations.

Ashington Way Pharmacy was informed by the NHS Business Services Authority (NHSBSA) of its clawback plans in July this year after a post-payment verification (PPV) exercise indicated it had claimed for 38 clinical pathways consultations between January 2024 and June 2025 that did not meet the gateway criteria.

The PPV exercise looked at claims for consultations in which the submitted age or gender information did not meet the relevant gateway points.

In an appeal lodged in August, the pharmacy stated it did not agree it had been overpaid as all Pharmacy First consultations “were carried out on referrals from GPs” but acknowledged that it “may have ticked clinical pathway instead of minor illness,” and offered to share emails from the local GP surgery as evidence.

The contractor stated: “My appeal is that the error was purely an administrative one as I ticked the incorrect box on PharmOutcomes and the payment should still be the same and so payment should still go ahead.”

However, a previous investigation by the NHSBSA’s provider assurance team had found that in some of these instances there was no record of a GP referral as patients had self-referred, and that some consultations had resulted in a prescription medicine being supplied “which is not an outcome for a minor illness consultation”.

The pharmacist informed the NHSBSA that he has independent prescribing annotation.

Considering the appeal, NHS Resolution found that the pharmacy had failed to provide evidence to support its case.

NHSR’s head of appeals stated: “I do not consider that equality of the consultation fees establishes entitlement to payment. Payment depends upon the service having been provided in accordance with the requirements applicable to the element of Pharmacy First under which the claim is made.

“The distinction between Clinical Pathway and Minor Illness consultations is material because the eligibility, referral, permitted outcomes and record-keeping requirements are not the same.

“A Minor Illness consultation requires an appropriate secure electronic referral.”

They added: “The appellant’s status as an independent prescriber does not alter the requirements of the specification or convert a separate prescribing activity into an eligible Pharmacy First Minor Illness consultation.

“I dismiss the appeal and confirm the decision of NHS England to recover the overpayment of £606.77.”

Ashington Way Pharmacy has been approached for comment.

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