Plans to further expand WA pharmacists’ scope of practice increases the risk of misdiagnoses, fragmented care and undermines doctors’ training, a leading Perth doctor has warned.
The State Government has confirmed pharmacists will be able to diagnose and treat a further 17 conditions including asthma, acne, ear infections, hormonal contraception and obesity management, under its Enhanced Access Community Pharmacy Pilot.
Training will begin next month for the first cohort of pharmacists through accredited Graduate Certificate programs at Western Australian universities.
Health Minister Meredith Hammat said the move will reduce pressure on hospitals and GPs while giving patients safe care options closer to home.
But the move has been criticised by RACGP Vice President and WA Chair Dr Ramya Raman, who said chronic conditions like asthma, respiratory conditions and obesity management do not belong in the retail space. She said this was not a turf war, but about patient safety.
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“First and foremost, I want to say in terms of pharmacists and the work they do, they play a really important role in the community,” she told Medical Forum.
“But the considerations we have to take on board is ensuring quality of care for patients and that the outcomes for patients are not compromised.
“Studies have shown that patients who see the same GP are healthier, they live longer, they’re much more satisfied with their care.”
Dr Raman said similar pharmacy pilots in Queensland had not resulted in less pressure on GPs and that workforce issues within the pharmacy sector would also likely lead to increased pressure if prescribing powers were expanded.
“There is an increased risk of things falling through the cracks and, while the patient may think it is adequate, there is an increased risk of delayed diagnosis,” she added.
“There’s been multiple instances and case studies where a patient has sought treatment in a pharmacy and there’s been a misdiagnosis. Potentially they could be treated for what was suspected to be a urinary tract infection but had a sexually transmitted infection.
“Patients present in vast and various ways and even though it might look like a certain condition we’ve got to look at all the other differentials and, as a GP, I am also trained to know when they need to be referred to a non-GP specialist.”
It comes as the Pharmacy Guild of Australia published its 10-year plan Towards 2035, which aims to make community pharmacists the “first port of call for primary healthcare services through the adoption of full scope of practice”.
It outlines a goal to have 80% of community pharmacists across Australia qualified as prescribing pharmacists by 2035, through pharmacist prescribing training introduced in 2025 and Doctor of Pharmacy courses now available at some universities.
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Under the plan pharmacists would be able to diagnose and treat more than 22 common acute and chronic health conditions.
Guild National President Professor Trent Twomey said the plan was underpinned by the patient-practitioner-practice relationship.
“We know that community pharmacy is the most accessible primary healthcare destination – open earlier, later and longer than other providers,” he said.
“Now is the time to seize the opportunity to do more and expand the services offered in community pharmacies across Australia.”
It builds on recommendations from Professor Mark Cormack’s Unleashing the Potential of our Health Workforce review, released late last year, which called for changes to some prescribing powers among other things to support health practitioners to work to their full scope of practice.
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Dr Raman said the College would prefer to see a multidisciplinary GP-led approach where a patient could access all of their care at a single point.
On whether there is a role for pharmacists prescribing to support patient care and GP time, she said: “The answer is yes, within a general practice and a GP-led team having a pharmacist within the clinical practice, seeing patients and having that continuity and communication is invaluable.
“Pharmacists play a key role within the community and looking after several of our rural and remote communities, but we just have to be careful about the conditions that are on the list.”
In WA an expanded role for community pharmacists was first introduced in August 2024, allowing them to deliver care for a range of conditions including mild to moderate shingles, acne, dermatitis, musculoskeletal pain and inflammation, nausea and vomiting, urinary tract infections and wound management.
The State Government’s new Enhanced Access Community Pharmacy Pilot expands on this. The pilot was developed with the Pharmacy Guild of Western Australia, Pharmaceutical Society of Australia, and universities.
The full list of conditions WA pharmacists will be able to prescribe for under the pilot include:
- Asthma
- Smoking cessation
- Shingles
- Impetigo
- Mild psoriasis
- Mild to moderate acne
- Mild to moderate atopic dermatitis
- Mild, acute musculoskeletal pain
- Allergic and nonallergic rhinitis
- Acute otitis externa
- Acute otitis media
- Acute nausea and vomiting
- Acute minor wound management
- Gastro-oesophageal reflux and Gastro-oesophageal reflux disease
- Hormonal contraception
- Weight loss and management of obesity
- Oral health risk assessment and fluoride application
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