Rural and remote patients would bear the brunt of expanded pharmacist-led prescribing, the rural GP college warns.
ACRRM has warned the Pharmacy Board of Australia against expanding pharmacist prescribing, citing fears that it could fragment care and increase clinical risk for rural patients.
The Pharmacy Board’s proposed endorsement aims to introduce a nationally consistent qualification and education standard for pharmacists undertaking pharmacist-led prescribing.
While prescribing is currently limited to schedule 2 and 3 medicines, with schedule 4 medicines allowed to be prescribed in some circumstances, the pharmacy board consultation paper supported authorising pharmacists to prescribe all schedule 2, 3, 4, and 8 medicines.
ACRRM president Dr Rod Martin said prescribing requires broad clinical training, diagnostic expertise, and the capacity to manage complex health conditions over time – skills developed over seven to eight years of medical training.
Many rural generalists prescribe based on a patient’s comprehensive consultation history and known medication tolerances, he told The Medical Republic.
Dr Martin said the proposed pharmacist-led piecemeal model would address individual symptoms in isolation, to patients’ detriment, potentially leading to missed or incorrect diagnoses.
“This fragmentation means [patients are] going to end up with poorer outcomes, and rural and remote outcomes cannot afford to have poorer outcomes,” he said.
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A 2025 National Rural Health Alliance snapshot found rural and remote communities were more likely to have a disability, a higher disease burden, and non-medical painkiller and opioid use – facing up to 2.5 times more avoidable deaths than major city residents.
Dr Martin warned that without collaborative care coordination, pharmacists risk double-prescribing or prescribing inappropriately when a patient’s adverse reaction history is unknown, compromising continuity, inhibiting preventive care, and increasing patient risk.
ACRRM also flagged potential conflicts of interest when pharmacists both prescribe and dispense medicines in the same encounter.
“There must be strong safeguards to ensure prescribing decisions are never influenced by commercial considerations,” Dr Martin said.
The college’s position statement also warned of two growing national concerns – prescription medication dependence and antimicrobial resistance – as risks that expanded pharmacist prescribing could exacerbate.
“Should pharmacists be subjected to these same professional compliance levels [as doctors], they could be expected to move to similar cost and time structures,” ACRRM’s position statement reads.
“The College considers that facilitating the issuing of repeat prescriptions by pharmacists and any other initiative that seeks to cut costs by discouraging these people from interacting with their doctor is a regressive policy, diminishing healthcare for those most needing it,” the statement read.
Patients in rural communities can wait up to 12 weeks for a GP appointment, according to an AMA report, but Dr Martin said convenience alone shouldn’t drive prescribing reform.
“Access on demand … might make the patients feel happier, but it won’t necessarily make them healthier overall,” he said.
With health ministers set to review the proposed endorsement, ACCRM called for nationally consistent standards, robust monitoring and independent evaluation.
Pharmacy Guild’s recent Rewriting the Script report claimed pharmacist-led prescribing would deliver $1.5 billion in savings, free up more than 10 million GP appointments for more complex consultations, and prevent more than 30,000 hospitalisations – impacts the report said likely underestimate the total system benefits.
ACRRM’s submission to the Pharmacy Board was among several opposing the proposed endorsement, alongside the RACGP, Avant Mutual, and nurse practitioners.
The Royal Australasian College of Physicians’ submission also criticised the prescription of Schedule 8 and 4D medicines by pharmacists.
“There are no appropriate safeguards for pharmacists prescribing on these medicines,” its submission read.
AMA President Dr Dannielle McMullen announced today that the peak body would publicly release its submission next week to the Pharmacy Board consultation on endorsement for scheduled medicines for pharmacists.
The Pharmacy Board’s consultation period closed on 15 June.
