NT pharmacy prescribing expansion ‘deeply concerning’

The RACGP has spoken about out against a Northern Territory decision to expand its pharmacy prescribing program, saying the risk it poses to patient safety, and to pharmacists, is ‘not good enough’.
 
On Tuesday, NT Health Minister Steve Edgington announced that trained pharmacists can now diagnose and treat 21 conditions, without patients ever having to see a GP.
 
It adds a range of conditions including asthma, management for overweight and obesity and oral contraceptive initiation and resupply to the NT Government’s earlier introduction of pharmacy-based treatment for urinary tract infection (UTI). 
 
Minister Edgington said the initiative, which was originally flagged as an election commitment in 2024, will ease pressure on primary care services and hospitals.
 
‘Allowing pharmacists to treat common conditions is a practical step that means Territorians can get fast, convenient care for everyday conditions at their local chemist and frees up GPs for more complex care,’ he said.
 
The NT Government will spend $1 million to train pharmacists, with the first cohort receiving qualifications through James Cook University.
 
The new services will be ‘progressively’ put in place across 43 community pharmacies, with several poised to begin immediately.
 
But RACGP President Dr Michael Wright said that with evaluations across jurisdictions yet to emerge, prescribing changes are being rolled out before decisionmakers have a clear and consistent picture of how they are working in practice.

Dr Wright added that faster access to care should not come at the cost of fragmentation, particularly for chronic conditions, with patient safety relying on continuity and follow-up.

‘These rapid and political announcements look like a way to subvert the important work that would allow some of this to happen safely,’ he told newsGP.
 
‘It’s going to increase risk for patients; it’s going to increase risk for pharmacists too.
 
‘Ultimately patients are going to bear the costs for this, whether it’s financial or in health outcomes, and that’s just not good enough.’
 
RACGP NT Chair Dr Sam Heard described the news as ‘deeply concerning on a number of levels’.
 
He said the college has worked collaboratively as part of an expert advisory committee (EAC) established by NT Health in April, charged with developing a code of conduct and treatment guidelines that pharmacists can use to support clinically safe and appropriate care in the unique NT setting. 
 
‘The Minister’s announcement today shows that due process has not been allowed to occur. The advice of the EAC has been ignored,’ Dr Heard said.
 
‘Pharmacists have been handed the right to prescribe before any of the usual patient safety guardrails have been established. It’s pretty wild. 
 
‘Pharmacists will be flying blind without any NT-specific clinical guidelines or code of practice.’
 
He said the change also allows over-the-counter access to antibiotics at a time when the NT is seeing the highest antibiotic resistance rates nationally and a resurgence of diseases like diphtheria and syphilis.
 
‘This is a third-world scenario, open access to antibiotics is recognised as a significant factor in developing antibiotic resistance and will mean that we are more frequently dealing with infections that are difficult to treat or life threatening,’ Dr Heard said.
 
‘There is no such thing as a simple skin sore in the NT where rheumatic heart disease and kidney failure are very real and life-changing consequences that we see every day.’
 
Tuesday’s announcement means that, once trained, pharmacists in the NT will be allowed to assess, diagnose, and manage:
 

• acute exacerbations of mild plaque psoriasis
• acute minor wound management
• acute nausea and vomiting
• allergic and nonallergic rhinitis
• asthma
• ear infections – treatment and/or management of associated pain
• gastro-oesophageal reflux and gastro-oesophageal reflux disease
• herpes zoster – treatment and/or management of associated pain
• hormonal contraceptive initiation
• impetigo
• management for overweight and obesity
• mild to moderate acne
• mild to moderate atopic dermatitis
• mild, acute, musculoskeletal pain
• oral contraceptive resupply
• oral health risk assessment and fluoride application
• quit smoking 
• travel health
• cardiovascular disease risk reduction
• chronic obstructive pulmonary disease
• UTI.

NT pharmacy prescribing prescribing scope of practice