NSW and SA further expand pharmacy prescribing

Announcements from both South Australia and New South Wales this week around significantly expanding pharmacy scope of practice has furthered fears from GPs that governments are playing politics with healthcare at the risk of patient misdiagnosis.
 
On Thursday, the NSW Government announced the trial program of pharmacy prescribing for oral contraceptives will be made permanent as of 28 September and will also be expanded for women aged 18–49 years old.
 
It is a model that has been rolling out around the country, with the Queensland Government kicking off its own pilot in April and the Northern Territory Government entering into public consultation in July.
 
The SA Government will also make sweeping changes to its pharmacy prescribing options, announcing plans to allow for the treatment of shingles, psoriasis, dermatitis, school sores, acne, ear infections, wound management, nausea and vomiting, gastro-oesophageal reflux, musculoskeletal pain and rhinitis.
 
This is expected to start in early 2026, following the development of courses in condition-specific training and clinical assessment training.
 
There have been several concerns raised over the effectiveness of pharmacy prescribing programs, with a review of clinical protocols earlier this year finding the majority of them were ‘low-quality’.
 
For NSW, this latest move builds on its existing pharmacy trials, which has seen urinary tract infection (UTI) management fall into pharmacy scope of practice as of June 2024.
 
The program has been heralded as a success by the State Government, with more than 3300 NSW pharmacists providing more than 18,000 consultations to women aged 18–65 with UTI symptoms.
 
But the full evaluation of the three phases of the trial has not been completed and will not be provided to NSW Health until 2025.
 
RACGP NSW&ACT Chair Dr Rebekah Hoffman says the continual expansion of pharmacy scope of practice in the state before the evidence is in, is concerning.
 
‘They’ve moved from a trial phase to business as usual without a complete evaluation of whether or not there were any problems or any significant outcomes from the study,’ she said.

Dr Hoffman told newsGP that in making the NSW pharmacy contraceptive trial permanent, patients could be missing out on important check-ups.
 
‘Good general practice is longitudinal care, and obtaining a script for an oral contraceptive pill is always so much more than just a script,’ she said.
 
‘It involves taking a sexual history, doing opportunistic screenings for things that are really important to do within general practice.
 
‘Many women actually do better on medications other than the oral contraceptive pill, and having conversations around long-acting, reversible contraception is really where the evidence is, and if they’re not having that opportunity to have those conversations with GPs, then we’re worried that that won’t happen.’
 
RACGP SA Chair Dr Siân Goodson labelled the move in her own state ‘reckless’ and warned the SA Government of potentially catastrophic consequences.
 
‘It’s hard to see how this won’t lead to patients with serious conditions delaying medical treatment because they’ve been given a medication by a pharmacist that may treat the symptoms, not the disease,’ she said.
 
‘What looks like an “uncomplicated” ear infection could lead to a hearing loss or could even be cancer.
 
‘Even someone who has finished medical school, but not trained as a GP or other specialist doctor, does not claim to be ready to make such big calls without supervision, yet the SA Government wants pharmacists to make these kinds of decisions off the back of a short online course.’
 
Both Dr Hoffman and Dr Goodson agree that these scope of practice expansions across the states are more to do with political pressure and lobbying than evidence-based models of care.
 
‘It’s been a big push by pharmacy to move into this space,’ Dr Hoffman said.
 
Dr Goodson described it as ‘a political move by a South Australian Government under pressure to address issues in its hospital system’.
 
‘No one should be surprised if it backfires,’ she said.
 
‘This decision was based on politics and lobbying, not evidence.
 
‘There is no substitute for the care you get from a GP who knows you and your medical history.’
 
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