Pharmacy scope shows no sign of shrinking

Scope of practice trials in Queensland and WA have recently expanded to include more conditions, despite opposition from doctors.

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In what it is touted as a win for accessibility, the WA government has announced it will be expanding pharmacist prescribing scope for a broad range of acute conditions over the next two years.  

The news comes just as Queensland kicks off the oral contraceptive pill component of its controversial pharmacy scope trial, and a mere two months out from the scope of practice review final report deadline.  

At this stage, the WA plan is just a commitment from the current Labor government to allow pharmacists to “deliver advanced care” by 2027. 

No full list of conditions has been released, but it’s understood to include prescribing for shingles, acne, dermatitis, musculoskeletal pain, inflammation, nausea, vomiting and wound care.  

Health minister Amber-Jade Sanderson said the move was “practical and commonsense policy” that would expand accessibility.  

“Ultimately, this approach will enhance primary care, freeing up time for GPs to support more complex patients in need of more urgent care,” she said. 

“We remain committed to creating a more responsive healthcare system, capable of meeting the evolving needs of our population.” 

RACGP WA chair Dr Ramya Raman said she was concerned that the expansion would lead to incorrect treatment, delayed diagnosis and complications similar to what is being seen in the UK with the rollout of physician associates.  

“What the Cook Government clearly doesn’t get is that patients come with symptoms, not a diagnosis,” she said.  

“Anyone who puts their symptoms into Google will see it throws up countless possible causes.  

“Diagnosis is complex and requires years of training – specialist GPs train for over 10 years to understand the difference between a minor ailment and something more sinister.” 

Of particular concern to Dr Raman was that the government was citing the existing UTI prescribing pilot as a success to justify the further expansion of pharmacist prescribing rights, despite the fact that it has not been independently evaluated.  

“This move will also likely contravene national regulations for medicines, which exist to keep patients safe,” she said.  

“The TGA determines the rules for medicines to protect the health of Australians and has transparent processes in place for safety.” 

But the TGA’s powers only extend so far; each state and territory administers its own poisons act, which effectively determines who is authorised to prescribe what.  

It’s why pharmacists in WA, NSW, Victoria, SA, Tasmania and the ACT have been able to prescribe the oral contraceptive pill to women over the last 18 months, despite a TGA decision from as recently as 2021 to reject applications to down-schedule the drugs.  

At the time, the agency said the adverse effects of oral contraceptives warranted management by a medical practitioner. 

Queensland is the latest to allow the practice, as part of a separate trial running concurrently to its larger scope of practice trial.  

The hormonal contraceptive prescribing pilot kicked off last week at 28 pharmacies across the state.  

Most of these – 25, to be exact – are located in far north Queensland between Mackay and Port Douglas.  

While an evaluation for the Queensland pilot is planned, RACGP state chair Dr Cathryn Hester said she was concerned about its clinical thoroughness.  

“The evaluation for the pilot reads like market research … questions put to patients as part of the evaluation were the same as you might review a pizza delivery service – was it easy to book? Was it convenient? What did you think about the cost?” she said.  

“There are appropriate ways to evaluate health services, and this isn’t it.”