‘Reckless Gamble’: General Practitioners Hit Out at NSW Pharmacist Prescribing Expansion

Sydney — The Royal Australian College of General Practitioners (RACGP) has branded New South Wales’ decision to expand pharmacist prescribing to more complex health conditions a “reckless gamble”, accusing the government of prioritising politics over patient safety.

The comments follow the New South Wales (NSW) Government’s recent announcement of a new trial allowing eligible pharmacist prescribers to treat a wider range of conditions, including ear infections, wounds, hypertension and chronic obstructive pulmonary disease (COPD), ailments which 
RACGP said General Practitioners (GPs) spend more than ten years training to diagnose and manage; resulting in GPs questioning whether political influence was playing a role in the expansion of pharmacists’ commercial role.

RACGP NSW&ACT Chair, Dr. Rebekah Hoffman, stressed that although improving access to healthcare was important, it should not come at the expense of patient safety.

“Patients deserve convenience and safety, diagnosis, follow-up and continuity aren’t optional extras.

“The safeguards built into general practice exist for a reason, to catch red flags, prevent misdiagnosis, use antibiotics appropriately and make sure patients get the follow-up care they need.

“The NSW Government is expanding pharmacy prescribing into more complex care when the evidence for the existing model remains weak, health policy should follow the evidence, not the money,” she said.

Dr. Hoffman acknowledged pharmacists as valued health professionals but warned that expanding their prescribing role could compromise patient safety.

“Pharmacists are highly valued health professionals and we want to ensure healthcare changes are based on evidence that patients will be safer and better off, because donations don’t equal data.

“Access matters, but access to care that hasn’t been proven safe and effective is not progress,” she added.

Dr. Hoffman also questioned whether the existing pharmacist prescribing model had produced enough evidence to justify expanding it into more complex areas of care, and therefore, she called for patient outcomes to be independently measured before the prescribing model was expanded further.

RACGP also raised concerns about the political influence of the Pharmacy Guild, with Dr. Hoffman pointing to its lobbying and political donations.

According to the RACGP, citing the Grattan Institute, the Pharmacy Guild gave AU$2.5 million to political parties over the past five years and spent AU$16.3 million on public campaigns.

The RACGP also referred to comments by NSW Premier, Chris Minns, who said: “I really love this relationship between myself, my government and the Guild.”

Dr. Hoffman said the level of political influence surrounding the policy raised questions about the evidence supporting the expansion.

“The evidence is weak, but the political influence behind this policy is enormous and on public display,” she said.

“The Pharmacy Guild has every right to lobby governments and make political donations.

“But when one of Australia’s biggest political donors keeps securing policies that expand the commercial role of its members, the public has every right to ask what is driving those decisions.

Meanwhile, other Doctors' associations also raised safety concerns around the move, as  Australian Medical Association (AMA) also opposed the expansion, warning that seemingly simple symptoms can sometimes indicate serious underlying illnesses.

AMA NSW President, Dr. Fred Betros, told The Medical Republic that the expansion could further fragment patient care by moving services away from the relationship between patients and their GPs.

Said to have trained in both pharmacy and medicine and previously worked in community pharmacy, Dr. Betros said his background gave him an understanding of what both professions do well.

He said pharmacists were highly skilled in medication management and that he had many pharmacist colleagues whom he “implicitly trust[ed]”, but warned that expanding prescribing responsibilities could lead to serious conditions being overlooked.

“If you’re not trained in it, you’re going to miss it. 

"We train as doctors for years and we prescribe within a collaborative model under the supervision of senior doctors,” he said.

Dr. Betros said conditions such as ear infections, acute vomiting, high blood pressure and COPD were not simply extensions of dispensing and could mask more serious illnesses.

“A wound that will not heal can be the first sign of diabetes or vascular disease,” Dr. Betros said.

“Vomiting is not a diagnosis. It is a symptom, and it sits in front of appendicitis, bowel obstruction, diabetic ketoacidosis, meningitis, ectopic pregnancy and heart attack. An anti-emetic treats none of those," he said.

He warned that the changes could contribute to delays in diagnosis and, in some cases, lead to serious illnesses being misdiagnosed or mistreate.

Also, Rural Doctors Association Australia (RDAA) NSW President Dr. Rachel Christmas, raised concerns about pharmacists managing chronic conditions, particularly in rural and remote communities.

“Very rarely do chronic conditions exist in isolation. Patients may not understand their own complexities either,” she said.

Dr. Christmas questioned whether pharmacists working only two or three days a week in small country towns would have sufficient time and access to accredited training to take on expanded prescribing responsibilities.

She also highlighted the greater health burden faced by rural and remote communities, which experience higher rates of disability and disease and up to 2.5 times more avoidable deaths than major-city residents, according to a 2025 National Rural Health Alliance snapshot report.

Dr. Christmas called on the government to redirect funding towards general practices and nurse immunisers to strengthen preventive healthcare.

However, the NSW Government defended the expansion, saying the trial would improve access to healthcare closer to where people live and free up GP appointments for patients with more complex health needs.

The Government emphasised that regular GP visits remained important, particularly for children, while children requiring catch-up vaccinations or those with complex medical conditions would not be eligible for pharmacist-led vaccination.

It also said more than 250 pharmacists undertaking accredited prescribing training would be able to provide treatment for additional common conditions under the expanded trial.

The NSW Government said appropriate safeguards would be put in place as the trial expanded.