Medical leaders issue joint pharmacy scope warning

A wide-ranging group of health leaders has urged policymakers to put patient safety first as they weigh up a Pharmacy Board of Australia proposal to allow pharmacists to prescribe Schedule 8 medications.
 
The plea was delivered on Thursday in an open letter signed by the RACGP, the AMA, the Council of Presidents of Medical Colleges (CPMC), the Australian College of Nurse Practitioners, along with the chief executive of Choice Chemist, Choice Aged Care and the Wellness Partners Foundation.
 
Addressed to Federal and State health ministers, as well as the Australian Health Practitioner Regulation Agency and the national boards, the letter set out ‘shared principles to guide the safe expansion of prescribing and diagnostic authority within Australia’s health system’.
 
‘This is not a statement about professional boundaries or the capability of any profession,’ the signatories wrote.
 
‘We acknowledge the objective of improving access to care across Australia.
 
‘However, we hold significant concerns regarding whether the proposed model, as currently designed, sufficiently ensures patient safety and maintains the high standards required for safe prescribing practice.’
 
The letter comes in the same week consultation closed on a proposal backed by the Pharmacy Board of Australia to expand pharmacist prescribing authority to Schedule 8 medications.
 
The signatories describe prescribing as ‘intrinsically linked to diagnostic capability’, and ‘the culmination of a diagnostic process that often unfolds over time’.
 
‘In this reality, systems of care – not just individual capability – are critical to patient safety,’ they wrote.
 
‘Prescribing safety should be evaluated across the full continuum of care, not just at the point of care.
 
‘This necessitates systems that enable continuity, structured follow-up and clear lines of responsibility for patient outcomes.
 
‘Approaches delivered in fragmented or episodic settings risk limiting ongoing review, constraining opportunities for reassessment and increasing the likelihood of conditions being overlooked or identified too late.’
 
The letter described the principles as ‘particularly relevant in the context of current consultations’, with signatories saying they ‘do not seek to pre-empt their outcomes’.
 
‘Rather, this statement is offered to support those processes by highlighting system-level safeguards that are critical to patient safety over time,’ it says.
 
The letter follows a significant intervention from Australia’s largest medical indemnity provider, Avant, who publicly aired concerns last week, saying around one in every six of its indemnity claims involved medication-related issues.
 
For RACGP President Dr Michael Wright, the open letter is a significant step.
 
‘This is a pretty important sign to see doctors, nurses, pharmacists all coming together to highlight the risks of these proposals,’ he told newsGP.
 
‘We all want health professionals to create a safe health system, not to fragment it and go down the path of a health policy that is not supported by evidence.’
 
He believes the RACGP’s concerns have repeatedly been dismissed.

‘It’s about protecting the safety of patients and our health system,’ Dr Wright said.

‘We just don’t have the evidence what’s proposed is safe, but we are seeing increasing evidence, including what Avant released on the weekend, for the risk related to medication events.

‘That will just get worse if prescribing is expanded without safe integration, without continuity of care and clear accountability.’
 
Meanwhile, CEO of Choice Chemist and Choice Aged Care pharmacist Michael Bonner, told the Sydney Morning Herald he supports the Pharmacy Board proposals in principle but is concerned about his team of aged-care pharmacists working in isolation.
 
‘When pharmacists begin prescribing under an endorsed framework, that prescribing should be GP-connected, team-based, and operating within governance structures accountable to the patient and their care system,’ he said.
 
‘That is what the endorsement framework needs to deliver, in every setting.’
 
Another signatory is CPMC Chair, orthopaedic surgeon and academic Associate Professor Kerin Fielding.
 
‘We owe it to all Australians to ensure all patients are provided appropriate prescribing safeguards with medical oversight that can monitor their care, to follow up if their condition changes, and take responsibility for their ongoing treatment,’ she said.
 
‘Our concern is that the proposed model does not provide the level of oversight, continuity and accountability patients deserve.
 
‘Any expansion of prescribing powers must put patient safety first and ensure there are clear safeguards in place, particularly for higher-risk medicines.’
 
A spokesperson for the Pharmacy Guild said it ‘agrees safety, connected care and accountability are critical’.
 
‘It’s exactly what we’re working towards through the national framework process,’ they told newsGP.
 
‘Enabling specially trained pharmacists to examine, diagnose and treat patients means more people getting the care they need when and where they need it.’
 
They also said evidence shows pharmacist prescribing is safe and effective. 
 
‘GPs and pharmacists, as highly trained health professionals, work together every day to improve the health of our communities,’ they said.
 
‘Prescribing pharmacists operate within strict treatment protocols after they have completed significant additional training.
 
‘There have been zero cases of malpractice or referrals to AHPRA.
 
‘For conditions like shingles, ear infections and UTIs, early diagnosis and treatment reduce significant complications.’
 
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Pharmacy Board of Australia pharmacy prescribing scope of practice