NSW Government announces contraceptive pharmacy prescribing

The RACGP has hit back at moves by the New South Wales Government to allow pharmacists to prescribe contraceptives to women over the age of 18 without seeing a GP.

Under a $4.5 million state investment, women will be able to ‘access the pill quickly through their eligible local pharmacy, without needing to book a GP appointment’. 

Pharmacists will upskill up via a graduate certificate from James Cook University enabling them to prescribe contraception for women at lower risk of complications, and after participation in a NSW ‘induction to reproductive health course’. 

Under the changes announced on Wednesday, participating pharmacists will also be able to resupply further contraceptive options, including 'additional oral contraceptive pills, the medroxyprogesterone acetate injection, and the combined hormonal contraceptive ring'. 

The state will pick up the cost of the 5000 consultations with a trained pharmacist, and once exhausted, it is expected to cost between $20 and $60 per consult.

The Government anticipates up to 60 pharmacists will be ready to start, with more coming on board as training is completed. 

The NSW expansion follows an oral contraceptive pill resupply clinical trial which began in September 2023. There are currently 773 pharmacies registered with Healthdirect to provide this resupply service.

NSW Premier Chris Minns said this is ‘basic healthcare for millions of Australian women’. 

‘Just because something’s always been done a certain way, it doesn’t mean it’s the best way to keep doing it –it’s not working for busy women to access a doctor to get a script,’ he said. 

‘Being able to go to your local pharmacy and sort it out quickly just makes sense.’ 

However, RACGP Vice President Dr Ramya Raman says ‘sorting it out quickly’ isn’t the best approach for women. 

‘As a practising GP and a woman myself, the fact that my healthcare is being deemed to be something that can be sorted out very quickly is just disrespectful – it’s not about trying to sort things out quickly,’ she told newsGP. 

Dr Raman said several other states have been involved in re-supply of the pill via pharmacists, and not initiation, ‘because the initiation component of it is a clinical encounter that involves appropriate history taking, including making sure that safe prescribing is occurring.’ 

These were comprehensive consultations which explored the contraceptive options available to women, as well as preventive health measures such as breast screening and cervical cancer checks, she said.

RACGP President Dr Michael Wright described the move by the NSW Government as ‘really troubling’.

‘It’s really concerning to see another state’s policy being led by lobbyists rather than being based around evidence,’ he told newsGP.

He referenced a previous decision by the Therapeutic Goods Administration (TGA) rejecting an application to down-schedule oral contraceptives, which would have allowed them to be accessed over the counter at pharmacies.

‘This sends a very troubling message to women, that the expert advice from the TGA can be ignored,’ he said.

‘Health policy needs to be guided by the evidence.’

Dr Raman is also concerned by the dominant message of access given to the public. 

‘Access is important, and I understand the reasons for that, but the safety component is what is being missed, specifically relating to patient safety system design,’ she said.

There were also broader system issues, Dr Raman said, such as how pharmacist prescribing decisions will be relayed back to a patient’s GP, or hospital if and when needed.  

‘I want to make it clear that this isn’t about the competence of the pharmacist,’ she said.
 
‘The conflict-of-interest issues we have is that in most of healthcare, we separate prescribing and dispensing to reduce bias, and here we are moving towards combining them without actually defining appropriate safeguards,’ she said. 

The NSW announcement comes just weeks after Federal Health and Ageing Minister Mark Butler announced that from 2027, the Government will commence a pharmacy trial allowing concession card holders to access contraceptives prescribed by qualified pharmacists (under private prescriptions as they are not eligible for PBS funding) along with treatment for uncomplicated urinary tract infections.

While the Federal program is seeking to ensure equity in contraceptive access, the state and federal announcements have sparked discussion about whether the in-depth nature of contraceptive consultations is well understood by policy makers.

Prominent women’s health expert and Head of Monash University’s Department of General Practice, Professor Danielle Mazza, said she holds several concerns about both the State and Federal announcements.

‘I’m not sure there is an appreciation of the reality of what high-quality contraceptive prescribing involves. There are a lot of factors that need to be considered in the shared decision-making process that is related to contraceptive choice and effective use,’ she told newsGP.
 
‘We already have problems in Australia and worldwide with a turning away by women of hormonal contraception and gathering mistrust in the science and evidence that sits behind contraception. 

‘During contraceptive counselling, you need to be challenging the myths and misconceptions and pure falsehoods that are becoming ubiquitous in social media posts and by influencers just trashing young people’s social media feeds.’ 

It’s this counselling aspect of care that Professor Mazza believes could fall short for women 
as governments across the country take steps to make contraception more readily accessible.
 
‘Often women have tried various forms of contraception in the past, and it’s quite a complex process to go through each one of those in turn, and to understand what was happening at the time, what their experiences were, what side effects they might have encountered, and to try and talk all that through,’ she said.

‘You need to have a very thorough understanding of all of that. Then you’ve also got to take into account  women’s quite often complex comorbidity and issues such as endometriosis, heavy menstrual bleeding, polycystic ovarian syndrome and premenstrual dysphoric disorder.  

‘All of these are conditions that we use hormonal contraception to manage and needs to be taken into consideration when we’re discussing contraception with our patients.’ 

And these are not uncommon conditions, Professor Mazza adds. 

‘One in seven women has endometriosis, so we’ve got to be talking to them about that,’ she said. 

‘Then there are issues of violence in women’s lives and the potential for reproductive coercion around their contraceptive choice.
  
‘And there are also issues to do with women’s family histories, particularly around conditions like breast cancer and clotting disorders, which may impact how we advise around various methods.’ 

Professor Mazza also expresses concern over whether pharmacists will have time available to carry out a comprehensive consultation and whether a private consulting room will actually be available, particularly given their growing role in healthcare.
  
According to a March newsGP poll, half of the 1106 respondents said their average contraception consultation takes 20–30 minutes.

‘It’s very hard to do that properly in a short period of time,’ Professor Mazza said.

‘I worry about the capacity of pharmacy to hold 15–30-minute consultations in a private consulting room when they’ve got dispensing duties, staffing issues, and when those consulting rooms are being called upon to do all the other things that government currently wants pharmacy to do.
  
‘It is wrong to think that contraceptive counselling is always a simple, transactional process that is protocol driven. It’s not checklist medicine. It’s actually quite involved to deliver it to a high standard.'

Professor Mazza said she also worries efforts to increase access to long-acting reversible contraception could be watered down if patients reach for more readily available options – something she says ‘hasn’t really been addressed’ by these new initiatives.

‘What’s actually going to happen? There will be a push factor by patients to get something on the spot, so will they be more likely to take up the oral contraceptive rather than opt for a long-acting method that’s more effective from a contraceptive point of view and more cost effective for them?’ she said.
 
‘I have a lot of concerns that have yet to be answered, and I want women to receive high-quality care.’ 

Professor Mazza says her views aren’t based around guarding access, but ensuring quality and safety. 

‘I have a high degree of respect for my pharmacy colleagues. I do a lot of work in the pharmacy space around all kinds of women’s health issues. I am very supportive of resupply, but I’m very concerned that women will lose out if the strong relationship of general practice with contraceptive prescribing is lost,’ she said.

‘We want women to have access to contraception, but we also want women to have access to high quality contraceptive counselling and prescribing.
 
‘And we need to reduce fragmentation. We need to promote continuity of care because these are issues women deal with at all phases of their reproductive lives and their choices may need to change over the course of their lives, according to their needs and medical histories which change as well.’
 
Log in below to join the conversation. 

contraception pharmacy prescribing urinary tract infection women’s health