Doctors Push Back on Pharmacist Prescribing Plan, Citing Patient Risks

A national peak body for doctors has opposed a proposed plan to allow pharmacists to prescribe a wide range of medicines, including strictly controlled Schedule 8 drugs such as addictive opioids, stimulants and tranquillisers, citing cases of patients whose conditions worsened due to inadequate diagnosis and care.The Royal Australian College of General Practitioners (RACGP) says the issue is not whether pharmacists can work safely within well-defined protocols, but whether the Pharmacy Board’s proposal includes the safeguards required to manage diagnostic uncertainty and lack of coordination between prescribers.In its submission (pdf) to the Pharmacy Board of Australia, the RACGP said pharmacists lacked the knowledge needed for safe prescribing and were not equipped to provide ongoing preventive care or manage chronic diseases.Cases of Diseases Going UndiagnosedThe college cited several scenarios illustrating how it claimed patient care would suffer under the Pharmacy Board’s plan, including two serious cases involving undiagnosed cancer.In the first, a 49-year-old patient suddenly developed gastroesophageal reflux symptoms. They were given a prescription medication for that issue, along with over-the-counter remedies.The patient continued to self-manage symptoms over several months, including repeat purchases of treatment. He later presented to a GP with progressive discomfort when swallowing and unintentional weight loss and was subsequently diagnosed with oesophageal cancer.In the second example, a patient visited a community pharmacy with what appeared to be a simple urinary tract infection and was given antibiotics. The patient later went to their GP for review, where an underlying serious condition—renal cell carcinoma—was identified.The fragmented nature of care across multiple first-line providers also risks more subtle signals being recognised, the college said, pointing to the case of a 30-year-old woman who went to a pharmacy with discomfort when passing urine and increased urinary frequency, and was given antibiotics.“Over the following two months, she presents to multiple pharmacies with recurrent symptoms,” the submission said.“At each visit her symptoms met protocol criteria, and treatment is supplied in accordance with guidelines. Each encounter occurs as a discrete, time-limited interaction without continuity, shared records, or structured follow-up.“She later presents to a GP after relocation and is identified as experiencing family and domestic violence with urogenital symptoms associated with physical and sexual harm.”In each case there is no mechanism for the original prescribing pharmacist to be made aware of the subsequent diagnosis or outcome, the college noted.That meant there was no way for pharmacists to learn from any error, “limiting both individual and system-level capacity to detect and correct diagnostic errors over time.”“Harm can arise even when protocols are adhered to, because protocols cannot fully resolve diagnostic uncertainty, nor substitute for continuity, reassessment and accountability over time,” the submission concluded.Prescribing Goes Beyond Issuing Medicines: RACCP Resident“Prescribing is not simply about issuing a medicine. It is the end point of a diagnostic process, and safe prescribing depends on continuity of care, follow-up, access to a patient’s clinical history, and clear accountability for outcomes,” said RACGP President Dr. Michael Wright.“Equally important is the ability to recognise, reassess, and manage diagnostic uncertainty over time, as symptoms evolve and new information emerges.“A patient may receive treatment that appears appropriate at the time, only for a more serious underlying condition to emerge weeks or months later. Without continuity, shared records and structured reassessment, those risks can go undetected,” he said.Wright said it was critical that the Pharmacy Board provide independent, fearless advice to governments and regulators, and ensure robust safety measures are embedded in any prescribing model.The college said pharmacists should not be allowed to prescribe Schedule 8 drugs under any circumstances and that it did not support allowing pharmacists to prescribe based solely on completing an approved training program.It said they should also have minimum clinical experience after registration, clear rules governing where and under whose oversight they can practise, and a proven ability to manage uncertain diagnoses in different clinical situations.In Australia, pharmacists have gained limited prescribing powers in some states in recent years, with Victoria introducing a pilot in 2023 and Queensland following with a broader prescribing trial in 2024.Other countries, including the United Kingdom, the United States, Canada, Poland, Switzerland and Denmark, allow pharmacists to prescribe medicines, commonly for contraception, smoking cessation and urinary tract infections.The Epoch Times has approached the Pharmaceutical Society of Australia for comment.