For thousands of women who have already used this service, the outcome is straightforward: they were assessed, treated within protocol and, most importantly, they got better.
The suggestion that the NSW pharmacist-led UTI trial was merely a “dysuria detection trial” misrepresents both the model of care and the evidence it generated.
Uncomplicated urinary tract infections are routinely diagnosed and managed empirically across primary care, including in general practice. Symptom-based diagnosis is not a shortcut – it is standard clinical practice for appropriate patients.
The relevant question, therefore, is not whether every patient had a urine culture, but whether care was delivered safely, appropriately and within evidence-based parameters.
More than 17,000 women accessed pharmacist-led UTI care across NSW and the ACT in under a year, with the majority experiencing symptom resolution within days and nearly 80% reporting complete resolution at one week.
Tightly controlled clinical model
Pharmacists were required to operate under a strict, state-approved clinical protocol, which mandated:
- structured clinical assessment;
- defined eligibility criteria;
- clear inclusion and exclusion pathways; and
- specific antibiotic selection guidance.
Only women aged 18-65 with classic symptoms of uncomplicated UTI were eligible for treatment. Patients outside these criteria were not prescribed antibiotics – they were counselled and referred to a GP or emergency department where appropriate.
This context is essential when interpreting prescribing rates.
Because the model deliberately filters for patients most likely to have uncomplicated UTI, a high rate of antibiotic supply was not unexpected in this setting. Suggesting otherwise overlooks the impact of pre-selection via protocol.
In fact, the trial points to appropriate clinical judgement in practice.
Around 7% of patients were referred to general practice or emergency care based on clinical assessment and the presence of high-risk factors. Protocol adherence was high, with low rates of deviation. Linked data showed low levels of escalation to hospital care.
Together, these findings indicate that pharmacists are not only identifying appropriate patients for treatment, but also recognising when not to treat – a critical component of safe care.
Safety and antimicrobial stewardship
Concerns around safety and antimicrobial resistance were central to opposition prior to implementation. The evidence does not support those concerns.
The trial identified:
- no significant safety signals;
- prescribing aligned with best-practice guidelines; and
- no meaningful impact on antimicrobial resistance.
Antibiotic choice itself was not discretionary. It was tightly governed by protocol, further reinforcing consistency and stewardship.
Training
Pharmacists delivering the service were required to complete specific training before participation, ensuring their capability aligned with the clinical requirements of the model.
All participating pharmacies also operate under the QCPP, which provides an additional layer of audit, governance and continuous improvement.
This is a highly structured, regulated environment.
Pathology is a false benchmark
The assertion that the absence of universal pathology means “we don’t know who has got an infection” sets a benchmark that is not applied consistently across primary care.
Urine testing plays an important role in complicated or atypical cases. However, for clearly defined uncomplicated presentations, symptom-based management is widely accepted and clinically appropriate.
Related
The pharmacist model does not attempt to replace comprehensive GP assessment. It is deliberately designed for low-risk, protocol-defined cases, with clear referral pathways when red flags are present.
The appropriate comparison is therefore not with full-scope GP care, but with timely access to care versus delayed access. This distinction matters to patients experiencing acute symptoms.
Access, demand and system impact
The scale of uptake (more than 17,000 presentations in under a year) reflects substantial patient demand. There are thousands of pharmacists able to provide treatment for UTI across Australia – and around 8000 women each month are treated in a community pharmacy.
At a system level, the model also demonstrated reduced pressure on emergency departments and cost savings to government, by diverting patients to appropriate community-based care.
Complementary care, not competitive care
Enabling trained pharmacists to treat straightforward presentations redistributes workload and enables each part of the system to operate at the top of scope.
A more constructive way forward is to consider how models like this can be integrated to improve access, maintain quality, and better meet patient demand.
For thousands of women who have already used this service, the outcome is straightforward: they were assessed, treated within protocol and, most importantly, they got better.
The status quo wasn’t working – one in five women aged 18-34 reported waiting over three weeks for a GP appointment and 45% of women say the wait to see a GP is unacceptable.
More GPs is part of the solution to this crisis of care.
The other part of the solution is trained pharmacists, being able to work to their full scope.
Mario Barone is a community pharmacist and NSW branch president of the Pharmacy Guild of Australia.
