The territory AMA has come out guns blazing but the RACGP has taken a more diplomatic approach.
With the Northern Territory government allegedly under increasing pressure to deliver promised pharmacy scope of practice reforms, the two biggest primary care advocacy organisations have taken different tacts.
Where the AMA NT has put out a fiery press release calling on the chief minister to abandon the idea completely, the RACGP’s NT chair has called for a measured, evidence-based approach to health accessibility issues in the territory.
Both groups have publicly said that they would prefer to see trials of non-dispensing pharmacists embedded in community general practice.
The Northern Territory is one of the only jurisdictions left which has not introduced a broad pharmacist-led prescribing trial.
In mid-2024, then-opposition leader Lia Finocchiaro pledged to fund an extended scope of practice program allowing trained pharmacists to offer health services for 21 separate conditions.
The Medical Republic understands that the range of conditions would be similar, if not identical, to those offered in Queensland’s expanded scope of practice trial. These include asthma, wound management, shingles and hypertension management.
“This will be a game changer for patients,” Ms Finocchiaro said at the time.
“It will save them time and money.
“This means more convenient access to world class medical treatment and avoids having to make an appointment to see the doctor or visit an emergency department.”
Pharmacists in the territory are required to do up to 12 months of training and can access a training subsidy of $8500 upon completion.
The actual prescribing program, though, is yet to materialise.
According to the RACGP, various advocacy bodies have recently been called on to contribute to an expert advisory group for the program.
“Bringing pharmacists and doctors together around the same table is the right approach,” RACGP NT chair Dr Sam Heard said.
“An [expert advisory group] will address genuine gaps in access to healthcare and medicines that can be safely diagnosed in a retail pharmacy setting to be identified and addressed using good data, strong governance and collaboration.”
He said he welcomed the territory government’s “measured and pragmatic approach” and that the college looked forward to working constructively with other stakeholders.
That is not to say that the RACGP is supportive of pharmacist-led prescribing, either in the Northern Territory or anywhere else.
“Any proposal to expand access to medicines normally reserved for longer-term or chronic use must be carefully assessed to ensure it is necessary, safe and supported by appropriate clinical governance,” Dr Heard said.
“I am particularly concerned with allowing broader access to a range of antibiotics. International evidence shows how quickly antimicrobial resistance can propagate.
“The NT leads the nation in development of antibiotic resistance – it is a real concern here in the territory, and we absolutely must avoid liberal access to antibiotics in a retail setting.”
Although he acknowledged that it was outside the remit of this particular piece of work, Dr Heard said there was merit in exploring models where pharmacists were embedded in general practices.
AMA NT president Dr John Zorbas was direct in his criticism, making reference to the Pharmacy Guild of Australia’s prominent role in pushing pharmacist-led prescribing.
“Let us be clear about what is being proposed: this is an initiative pushed by an industrial organisation representing retail pharmacy owners, not a clinical body representing pharmacists,” Dr Zorbas said.
“Healthcare decisions must be driven by clinical need, not retail foot traffic.
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“Removing the critical separation between the person diagnosing a condition and the business profiting from selling the medication creates an unacceptable financial conflict of interest.”
According to the AMA NT, pharmacist-led prescribing in the territory would risk introducing diagnostic blind spots, fragmented care, additional pressure on hospitals and potential conflicts of interest.
“Bypassing GPs will only fragment much needed ongoing care,” Dr Zorbas said, who is a critical care physician by training.
“Furthermore, unregulated prescribing in retail settings significantly increases the risk of over-prescribing antibiotics, accelerating antimicrobial resistance and ultimately putting immense downstream pressure on our public hospitals.”
The AMA NT said it supports collaborative models of care, such as nurse practitioner prescribing.
“We call on the NT chief minister and cabinet to listen to their clinical workforce, rather than retail lobbyists, and reject this unsafe trial in favour of genuine, team-based primary care,” Dr Zorbas said.
“The best care for Territorians comes from investments in clinicians on the frontline of the territory, not retail lobby groups based outside of the NT.”
