RACGP slams sweeping pharmacy scope expansion

The New South Wales Government is moving quickly to significantly increase the scope of its pharmacists by allowing them to treat an expanded list for potentially complicated conditions.
 
The unexpected announcement came via a speech from NSW Health Minister Ryan Park on Thursday at a Pharmacy Guild conference, and has drawn swift and fierce criticism from GPs.
 
The change will add ear infections, wound management, nausea, gastro-oesophageal reflux disease, acne, and muscle and joint pain to pharmacy scope of practice.
 
RACGP NSW&ACT Chair Dr Rebekah Hoffman has called the shock move ‘reckless’ and ‘dangerous’.
 
‘There are significant risks of serious and even life-threatening illnesses being missed with the conditions the NSW Government wants to allow pharmacists to treat,’ she told newsGP.
 
‘This is politically driven policy, and it has potentially devastating consequences for people across New South Wales due to the risks of incorrect treatment and serious illnesses being missed.’
 
Dr Hoffman says it has the potential to significantly impact GPs and their ability to assess patients appropriately, as well as impacting the work being done on antimicrobial stewardship.
 
‘It makes it more difficult to be able to actually treat and understand our patients when they’re accessing care elsewhere, and often inappropriately accessing care elsewhere,’ she said.

‘Plus, there is a real risk that when patients are going into a pharmacist, they walk out with an antibiotic even if it’s not indicated and we’ve tried really hard as GPs to educate the population that they don’t necessarily need antibiotics for every UTI and every ear infection.’
 
Minister Park told newsGP that by ‘empowering pharmacists to undertake consultations on more conditions, we can relieve the pressure on GPs and end the wait times’.
 
‘We know it is becoming more difficult to access a GP than ever before, with people often waiting days or even weeks before they can find an appointment,’ he said.
 
He also gave new insights to the proposal, saying that ‘subject to appropriate training and ongoing work in implementation work, the expanded service delivery could commence as soon as 2026’.
 
‘NSW Health has also agreed to authorise individual pharmacists who have successfully completed the Queensland pilot training to deliver selected services in NSW from January 2025 onwards,’ Minister Park said.
 
He said NSW Health is consulting with universities on the development of suitable training.
 
UTI pharmacy prescribing for NSW was made permanent in May this year, before the trial program’s comprehensive review was complete.
 
None of the conditions included in the latest announcement have been trialled in pharmacies in NSW previously.
 
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’.
 
Still the concept is gaining momentum in Australia, with the QLD Government kicking off its own pilot in April and the NT Government entering into public consultation in July.
 
Dr Hoffman says she doesn’t understand why the Government would make such a move when it is still waiting on the results of the NSW UTI pharmacy prescribing pilot.
 
‘The UTI trial has now finished, but we haven’t yet interpreted the data, and we don’t yet have evidence that this trial was a success, that it actually met the outcomes,’ she said.
 
‘They’ve not only expanded the UTI trial, but now they’ve introduced all of these additional new components without actually even understanding whether it’s safe and appropriate to begin with.
 
‘I really think it’s unsafe and it just doesn’t make sense.’
 
Minister Park did not respond to questions about why this decision was made prior to evidence being published from the UTI pilot.
 
But Dr Hoffman says ‘the NSW Government is kidding itself’ if it thinks this will do anything to reduce pressure on the state’s healthcare system.
 
‘If anything, it will have the opposite effect,’ she said.
 
‘We know from the UK that letting non-medically trained health professionals do the work of GPs results in much higher rates of incorrect treatment, delayed diagnosis and serious illnesses being missed.
 
‘It costs governments and patients much more because people often need to go back to the doctor and can end up in hospital when they don’t get the right treatment.’
 
Despite being blindsided by Mr Park’s speech and lack of consultation, Dr Hoffman says she is hoping that all parties can ‘take a step back, take a breath, and actually decide whether or not this is appropriate’.
 
‘It’s really important that we embed communication back to the GPs at the heart of this, and that we make sure that only the safest options, only the safest expansions, actually take place,’ she said.
 
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