It is time to leave the Machiavellian era of Australian healthcare behind

Community pharmacy groups are lobbying for pharmacy prescribing, a topic that has been on the wish list for a long time. Medical groups are concerned about patient safety and fragmentation and are pushing back. Is this Australian conflict model what we want or is there a better way forward?

Some pharmacists want to be able to write prescriptions as they believe it is in the scope of practice of a pharmacist and more convenient for patients.

Examples from abroad are used as an argument why Australia must follow suit. A ‘collaborative prescribing pilot’ is underway and the pharmacy sector is looking forward to the soon-to-be released results.

Pharmacists expect that their proposal will be cost-saving as people will not need to see the family doctor for prescriptions.


Not surprisingly, medical groups are upset and believe the proposal is not helpful and not in the best interest of patients.

Doctors are concerned that soon the head doesn’t know what the tail is doing or, in other words, that more prescribers will lead to more fragmentation and adverse health outcomes.

Concerns have been raised that warning signs or significant (mental) health conditions will be missed and screening opportunities lost. Some have also argued that pharmacists prescribing and selling medications at the same time creates commercial conflicts of interest.

As a result there will likely be pushback from medical groups. It is to be expected that when the debate heats up some unpleasant words will be said in the media before the Health Minister of the day makes a decision based on evidence, opinion or political expedience.

Then there will be a loser (usually not the Health Minister) and a winner, and the relationship between pharmacists and doctors remains sour at the expense of patient care.

A better way

This series of events has become a familiar scenario in Australian healthcare. What’s missing is of course a joint strategy or a solution that would benefit both parties as well as our patients (a win-win-win solution).

Community pharmacists play an essential role within primary care teams. The pharmacy sector is under pressure and is attempting to implement strategies to remain viable into the future, such as introducing services currently provided by doctors, nurses and others.

An obvious way forward would be for pharmacists and doctors to explore models that are not competitive but complement each other. This is a joint process that requires broad support from both parties.

We desperately need genuine collaborative models of care, such as pharmacists working in general practice, but there may be other models too.

This is of course easier said than done. It is, however, time to leave the Machiavellian era of Australian healthcare behind. Who’s going to take the first step?

The problem with non-medical prescribing

The problem with non medical prescribing

Imagine you’ve hired a well-regarded handyman to do some home-improvements. One day you notice he is working on the electrical wiring in the kid’s entertainment area. “Isn’t that a job for the electrician?” you ask.

“No worries,” is his answer, “I’m qualified to do this as I’ve just finished the course ‘Terminate cables, cords and accessories in hazardous area installations.'”

Are you reassured? If you’re like me, you would be concerned. Very concerned.

It would be different if you knew that the handyman was only allowed to do, let’s say switches and light bulbs, and was supervised by a qualified electrician.

Ofcourse it would be easier if the handyman could do it all. Perhaps a bit quicker too. But I’d still have serious safety concerns.

It’s not much different when it comes to prescribing medicines. This is very complex and can go very wrong.

Non-medical prescribing (prescribing by non-doctors) should only occur, like the AMA says, in a medically led and delegated team environment and only in the context of ‘role delegation’, not ‘task substitution’.

Problems with regards to access should be solved in another way, such as reducing the non-medical workload of doctors including red-tape (like the PBS prescription authority hotline).

To those accusing doctors of protecting their turf: ‘First do no harm’, is still a good principle in medicine. In health politics many decisions are made because ‘they seemed like a good idea at the time’ and sound evidence to support these decisions is, unfortunately, often not available.