Premier, pharmacy prescribing is not healthcare reform

– Opinion by AMA (NSW) president Dr Fred Betros

I have a medical degree and a pharmacy degree, so when I oppose extended scope of practice for pharmacists, it comes from real experience and real concern for patient safety.

I worked in a community pharmacy every weekend for six years with some incredibly talented and dedicated people during my medical school training. I know that pharmacists possess a unique skill set essential to clinical care and no one does it as well as they do.

Pharmacists are trained in pharmacology, pharmaceutical chemistry, toxicology, drug interactions and safe dispensing. They can be a cross check if a doctor gets it wrong with prescribing and they quite rightly can question that, if required.

They also receive baseline knowledge in physiology, biochemistry and pathology, although nowhere near the level of a medical doctor.

But, they have no significant training in clinical medicine regarding complex medical history taking, symptom interpretation, physical examination.

When a patient presents to a doctor with a symptom, a clinical assessment needs to occur, a potential diagnosis determined and a treatment plan developed and actioned. Most of us go through six to eight years of postgraduate training before being allowed to make these decisions as independent practitioners and only after passing our barrier exams for fellowship training.

I see multiple patients a week with abdominal pain and vomiting and many times the initial clinical picture can be similar for viral gastroenteritis, appendicitis, bowel obstruction, ovarian torsion, gallstones, stomach ulceration, diabetic ketoacidosis or pancreatitis. That’s just the common list and does not consider the rarer causes of this common set of symptoms.

If you think a short university bridging course can train a pharmacist for this, you have no real idea on the complexities of medical care in 2026.

I would challenge Premier Chris Minns to explain this to me or provide the evidence, given he has again expanded pharmacists’ scope of practice.

At last week’s Pharmacy Connect 2026 Conference, he stated: “whenever you make a big change, you’re going to get some blowback from voices who supported the status quo, or had an interest in the status quo, or didn’t like the idea of a changing landscape”. He then followed that up to say that “we are not backing down on those changes, indeed, we are proud of those reforms”.

This is a decision that now clearly demonstrates the desperation and failure of both our state and federal governments to provide gold standard care to the people of NSW and wider Australia.

The medical profession has never opposed evidence-based change and I do not accept the evidence he has supplied as objective or meaningful.

Where is the long term follow up data on the patients prescribed antibiotics for their UTI symptoms and where is the diagnosis confirmed with urine culture? How many of those patients were assessed and investigated for a potential undiagnosed cause for their symptoms?

If the reason that patients cannot see a general practitioner for a UTI or ear infection is due to availability, why don’t they attend the Urgent Care Clinics our Health Ministers would have you believe were the answer to all our problems?

These are bulk billed, extended hours clinics located all over NSW. They have not kept the expected numbers of patients from attending our emergency departments and it is delusional to think otherwise. So, the answer is to now move to pharmacy prescribing instead of expanding and properly resourcing the primary care and hospital medical workforces.

Premier Minns may dress this up as reform – but it is an admission that providing patients with a better resourced medical workforce is all too hard for our current leaders.

I openly challenge the reasons for this decision and welcome the opportunity to talk with the Premier. He revealed he has discussed this with the Pharmacy Guild, but he has not engaged with the medical profession and I suspect this is intentional.

I work in clinical situations where we have health professionals with an extended scope of practice such as nurse specialists in areas such as psychiatry and palliative care. These clinicians provide excellent, essential care, but they do so under a collaborative framework and in close consultation with a doctor leading the team. The proposed changes from Premier Minns do not afford a collaborative model of care and are to my mind a complete substitution.

When it is resourced adequately, I know we have one of the best health systems in the world. Unfortunately, our leaders have given up.

With the NSW election next March, I would challenge the people of NSW to ask how our leaders and potential leaders plan to reduce the burden of disease in our society and reverse the abysmal performance of our public hospital system without compromising the quality of that care.