BACKGROUND: Acute sore throat is managed in community pharmacies in England and Wales under different clinical pathways: Acute Sore Throat Pharmacy First (ASTPF) and Sore Throat Test and Treat (STTT), respectively. ASTPF launched in 2024 and allows antibiotic supply with FeverPAIN scores 4 and 5. STTT launched in 2018 and allows antibiotic supply with FeverPAIN ≥2 or Centor ≥3, if point-of-care testing confirms presence of group A Streptococcus (GAS). OBJECTIVES: To compare antibiotic supply rates of ASTPF and STTT, between 1 February 2024 and 30 July 2024, covering the first 6 months of ASTPF. METHODS: A descriptive study using anonymized individual-level data from electronic pharmacy records of STTT and anonymized population-level aggregate data from electronic records of ASTPF consultations meeting the gateway criteria for reimbursement. RESULTS: During the study period, 317 864 ASTPF and 27 684 STTT consultations were recorded across participating pharmacies, representing 551.0 and 874.9 consultations per 100 000 population in England (57 690 300) and Wales (3 164 400), respectively. The antibiotic supply rate was 72.7% (95% CI: 72.5% to 72.8%) for ASTPF and 29.9% (95% CI: 29.4% to 30.5%) for STTT. CONCLUSIONS: In this natural experiment in two similar healthcare systems with pharmacy-led sore throat services, we found different rates of antibiotic supply. Differences could be attributable to service implementation, pharmacists' initial training, engagement with GPs, pathway differences (e.g. gateway criteria and use of point-of-care tests), symptom severity, or most likely a combination of multiple factors. This early analysis suggests adapting the ASTPF pathway, to include point-of-care testing, could lead to reductions in unnecessary antibiotic supply.