President’s Message: a wake-up call the NSW Government cannot ignore

September should be a wake-up call for the NSW Government.

This month laid bare two failures the NSW Government can no longer explain away: a hospital system under sustained pressure and a decision to expand pharmacy prescribing as a substitute for comprehensive medical care. The warning lights are no longer flickering. They are flashing across the entire health system.

There are now 169 days until the NSW election on March 13, 2027. Every party must explain whether it is prepared to confront these problems or continue managing one crisis at a time while patients pay the price.

The latest Bureau of Health Information Healthcare Quarterly results confirmed the scale of the pressure. More than one in 10 patients spent longer than 12 hours in an emergency department, while fewer than one in three admitted or transferred patients left within six hours. Our emergency departments remain the barometer of the health system, and the reading is unmistakable.

AMA (NSW) took that warning to the NSW Parliament and the public this month. Vice president Dr Theresa Ly, CEO Dominique Egan and I met with Health Minister Ryan Park and opposition health spokeswoman Sarah Mitchell. We put the evidence, the concerns of doctors and practical solutions before them.

No one can now say they were not warned.

The most concerning response this month was the NSW Government’s decision to further expand pharmacists’ scope of practice.

I have degrees in medicine and pharmacy. I worked in community pharmacy throughout my medical training and know the skill and value pharmacists bring to healthcare. My concern comes from that experience and from seeing, every week, how similar symptoms can conceal very different and sometimes life-threatening conditions.

Pharmacists are highly trained experts in medicines, drug interactions and safe dispensing. Their role is indispensable, and doctors rely on their expertise every day. But expertise in medicines is not the same as the years of clinical training needed to assess symptoms, conduct a physical examination, form a differential diagnosis and decide what must not be missed.

The expansion reaches into presentations including acute vomiting, ear infections, wounds, high blood pressure and exacerbations of chronic obstructive pulmonary disease. These are not simple transactions. Each may be the first sign of a condition requiring urgent investigation or hospital care.

A symptom is not a diagnosis. Vomiting may be caused by gastroenteritis, but it can also indicate appendicitis, bowel obstruction, diabetic ketoacidosis, meningitis, ectopic pregnancy or a heart attack. Treating the symptom without identifying its cause can delay urgent care and expose patients to serious harm.

The NSW Government’s own urinary tract infection trial should have triggered caution, not expansion. More than nine in 10 episodes resulted in antibiotics being supplied, while only 7.3 per cent of patients were referred to a GP or emergency department. Those figures do not show that patients received the right diagnosis or that more complex causes were identified.

Australia already has the highest total volume of antibiotics prescribed for systemic use among OECD countries. At a time when antimicrobial resistance is a growing threat, the answer cannot be to create more pathways to antibiotics without stronger diagnosis, testing and follow-up.

The question for the Premier and Minister Park is simple: are patients receiving faster access to proper diagnosis, or merely faster access to a prescription? Convenience matters, but it cannot come at the expense of diagnosis, continuity and patient safety.

This is not a turf war, and it is not an attack on pharmacists. Safe extended roles operate within collaborative teams with clear referral pathways and medical oversight. What has been announced is substitution, not collaboration. It fragments care, weakens continuity and leaves patients responsible for navigating between disconnected providers.

The Premier has spoken with the Pharmacy Guild and publicly dismissed resistance as opposition to change. He must now engage directly with the medical profession and produce evidence that this model is safe. Patient safety concerns cannot be waved away as protection of the status quo.

If the NSW Government genuinely wants to improve access and reduce pressure on hospitals, it should strengthen general practice, expand doctor-led public outpatient and rapid access clinics, and ensure patients can receive diagnosis, treatment and follow-up through one connected system. Changing who can prescribe does not fix why patients cannot access comprehensive medical care.

That is why the NSW Preventative Health Summit, in Parramatta on 7 and 9 October, matters. The health system cannot prescribe its way out of chronic disease or hospital pressure. The summit is the NSW Government’s next opportunity to show that it understands the scale of the problem. I welcome it, and I will be there on behalf of AMA (NSW) with Dominique Egan.

I know many of our members are also attending because we all know that proper investment in preventative health is the key to a sustainable health system.

But we cannot have another talkfest. Doctors have watched governments convene experts, publish reports and move on while preventable disease continues to fill hospital beds. Minister Park must bring political courage to the summit. It must end with a dated plan, dedicated funding and clear accountability for delivery.

The evidence is overwhelming. Chronic conditions account for about 70 per cent of the disease burden in NSW, while 36 per cent of that burden is linked to modifiable risk factors. Almost three in five NSW adults are living with overweight or obesity. Daily vaping among adults rose from 1.2 per cent in 2020 to 6.9 per cent.

Failing to invest in prevention does not save money. It merely shifts a much larger bill into our hospitals.

AMA (NSW) will take three clear priorities to the summit.

First, NSW needs a quarantined Prevention Fund of around $55 million a year for at least four years. Funding should support locally tailored programs delivered in partnership with general practice, Aboriginal Community Controlled Health Organisations, local government and community groups, with successful initiatives expanded across NSW.

Second, the NSW Government should support a national levy on sugar-sweetened beverages, with revenue directed towards preventative health initiatives.

Finally, the Government must implement the preventative health recommendations of the Special Commission of Inquiry into Healthcare Funding and publicly report on its progress.

These are practical measures backed by evidence. What is needed now is the resolve to act.

With 169 days until polling day, the NSW Government has been put on notice. So have the Opposition and crossbench. Every party must explain how it will reduce preventable disease, protect access to comprehensive medical care and restore confidence in our public hospitals.

September was the warning. October must be the month the NSW Government proves it has listened.