Peak bodies want an urgent freeze, telling the NSW premier there’s a lack of evidence for benefits to the program.
Five peak medical organisations are calling on the New South Wales premier to freeze further pharmacy prescribing expansions for managing chronic conditions, citing a lack of evidence.
Any further expansion of pharmacist prescribing for chronic and complex conditions risks undermining patient safety and potential conflicts of interest, the organisations say.
The consortium behind an open letter to NSW premier Chris Minns comprised the AMA, the RACGP, the Royal Australasian College of Physicians, the Royal Australasian College of Surgeons, and the Australian Salaried Medical Officers Federation.
In September, the state government announced a new trial allowing eligible pharmacists to manage chronic conditions, including high blood pressure and chronic obstructive pulmonary disease.
The organisations called on the government to pause any further expansion of prescribing until an independent evaluation of the Queensland pilot was released, with appropriate safeguards and condition-specific evidence in place first.
It also called for an urgent meeting with Mr Minns to voice their concerns, request evidence supporting the proposed expansion of pharmacy prescribing, and discuss a path forward that placed patient safety and evidence “at the centre of reform”.
RACGP NSW chair Dr Rebekah Hoffman told Health Services Daily the consortium sent the letter last week but was yet to receive a response.
“We are very happy to have conversations around how to simplify ongoing prescription management and to make sure people are accessing the right scripts for their chronic disease,” she said.
“[But] it’s so much more encompassing than seeing a pharmacist for a prescription. It’s multidisciplinary care.”
If it was a matter of access, Dr Hoffman pointed to the college’s latest Health of the Nation report, which found 99% of patients were able to see a GP when they needed to.
“What we’d really like to do is sit down at a table with [the state government] to co-design… and invite everyone to the table, including our pharmacists, our allied health, and our consumers, to find out what the real problem is and what the real solution should be,” she said.
Since the prescribing expansion was first announced in September, no start date has been announced.
“There’s no money that’s left the government’s hands yet; is this the wisest way to be spending our taxpayers’ money?”
The warning follows medical indemnity insurer Avant calling for a pause on pharmacists’ prescribing powers.
Avant’s analysis of 16,000 closed claims and complaints over the previous five years found that 90% of medication-related claims were prescribing-related. A further third was due to overprescribing.
Avant pointed to the evaluation of Queensland’s UTI pilot, which found approximately half of participating pharmacists found it difficult to charge a consultation fee when they did not supply medication.
AMA NSW president Dr Fred Betros told HSD there was never any broad consultation at the state level about the proposed expansion.
“We haven’t been listened to, which is really concerning,” he said.
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“We’re not against collaborative models. Every Australian should expect equity of access and good healthcare.”
Dr Betros said nurse practitioners, for instance, were “essential” to providing good-quality care – provided they worked “under the oversight of a registered medical practitioner”.
However, he told HSD the concern was that pharmacists lacked sufficient clinical tools to diagnose and make management decisions, noting that even doctors sometimes struggled to reach a diagnosis despite having blood tests and imaging at hand.
By year’s end, 250 NSW pharmacists who completed accredited prescribing training at the University of Newcastle or the University of Technology Sydney are expected to qualify to prescribe for up to 23 common conditions, including nausea and vomiting, reflux, rhinitis, musculoskeletal pain and acne.
From 1 January 2027, they will also be able to administer all vaccines under the National Immunisation Program.
“Vomiting isn’t a diagnosis. It’s a symptom,” Dr Betros said, which could indicate a diabetic concern, appendicitis, bowel obstruction, ectopic pregnancy, or ovarian torsion.
“If you’re just treating the [symptom], you’re not really thinking about what the underlying problem is, [and] you’re potentially missing an opportunity to diagnose someone early that three or four days later can have significant consequences,” he said.
Currently, there is no obligation for a pharmacist to report back to a medical practitioner that they’ve initiated a treatment – something Dr Betros called a “dangerous precedent”.
Dr Betros said patients whose treatment pharmacists initiate or prescriptions they resupply should have an established GP. Pharmacists should also be legally responsible for informing a GP or other medical practitioner of the treatment and advice provided, he said.
“Without that, you’re really fracturing treatment pathways and overall care of a patient,” he said.
Australian Salaried Medical Officers Federation NSW president Dr Nicholas Spooner said members on the “frontline” in hospitals witnessed the consequences of fragmented care firsthand.
“Patients with chronic and complex illness need coordinated care pathways and clear clinical accountability. Any reform must strengthen those systems, not weaken them,” Dr Spooner said.