Pharmacist-led prescribing is now business as usual across all states and territories, yet GPs still see a moral imperative to keep fighting. Trouble is, the current tactics simply are not working.
They say the definition of insanity is doing the same thing over and over again but expecting a different result.
Earlier this week, a coalition of five medical peaks announced that they had written a letter to the NSW state government demanding a halt to any further expansion of pharmacist-led prescribing services in the interests of patient safety, until it could produce evidence that scope of practice expansion was justified or warranted.
The premier and the health minister are yet to respond.
Perhaps they were busy.
In any event, NSW health minister Ryan Park still took the time out of his day later in the week to announce that another 250 pharmacist prescribers would soon be eligible to prescribe for more complex conditions.
Discussing the letter among our team, one of our reporters remarked that it felt like we had written the same story hundreds of times: government announces pharmacist prescribing expansion, AMA and RACGP express shock and outrage, government goes ahead with it anyway.
The first pharmacist-led prescribing trial began in Queensland in June 2020 for urinary tract infections. The arguments against it then were almost exactly the same as the arguments the college is still levelling today.
Nothing that any medical advocacy body has tried so far has worked to stop the rollout of pharmacist-led prescribing.
At best, they have succeeded in changing the type of antibiotics on offer or in influencing the state government to run the pilot as a registered clinical trial.
Why keep beating what is, at best, a terminally ill horse?
When I put that question to RACGP president Dr Michael Wright earlier this week he said patient safety was at the heart of what GPs did, and that many doctors saw it as their responsibility to the health system.
If doctors are going to continue to rail against pharmacist-led prescribing – as it appears many feel duty-bound to do – then maybe it is time to try something new.
Here are some of the ways that Australia’s other health industry professionals have handled what they saw as unacceptable risks to patient safety in recent years.
Who: NSW Junior doctors
What: The “clinical marshmellow” debacle.
Success: Unclear whether it shifted the dial, but it did provide a rallying point.
How: Back in January 2025, a staff member at John Hunter Hospital wrote an email excoriating junior doctors who questioned rostering decisions, calling them “a workforce of clinical marshmellows [sic]”.
That email was accidentally sent to the junior doctor who had questioned the rostering decisions. Oops.
Junior doctors embraced the insult, though, and the incident ultimately brought new attention to junior doctor fatigue, burnout and unfair rostering practices.
Media attention ultimately forced the hospital to issue an apology to all junior doctors.
A popular online forum for junior doctors, r/AusJDocs, still uses a marshmallow for its mascot almost two years later.
While there was huge public uproar at the time, it’s unclear whether much changed at NSW Health as a whole.
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Just 18 months later, the Nepean Blue Mountains Local Health District had to apologise after sending out an email which implied that junior doctors struggling with fatigue should leave the profession.
Who: Psychologists
What: Changes to training which will effectively shave a year off training.
Success: Decision on changes delayed.
How: One of the interesting aspects of the psychologist resistance to training changes has been that it was incredibly decentralised, and incredibly grassroots.
Rather than waiting for any one of the numerous peak bodies to act, Sydney psychologist and clinic owner Leanne Clarke took matters into her own hands and organised a meeting right in parliament house.
The meeting coincided with an unfortunate comment from AHPRA CEO Justin Untersteiner during senate estimates, in which he described the opposition to training changes as “pockets of acute noise”.
Like the NSW junior doctors before them, psychologists have turned an insult into a rallying cry. Many have changed their LinkedIn bio to read “pocket of acute noise”.
There’s even merch on the way.
The Department of Health has now reportedly deferred its decision on whether to change psychology training until next year.
Who: The Pharmacy Guild of Australia
What: 60-day dispensing.
Success: They didn’t get what they wanted, but they did get something better.
How: The image of Pharmacy Guild of Australia president Associate Professor Trent Twomey crying outside parliament house on national television in 2023 is difficult to remove from one’s memory.
As part of a campaign against 60-day dispensing, which pharmacists argued would result in widespread job losses across the industry and harm to patients, the guild and an organisation called Community and Pharmacy Support Group organised several public demonstrations in Canberra.
The guild was not able to stop the rollout of the policy, but there was enough pressure that it got something equally valuable: the federal government agreed to enter negotiations for the eighth community pharmacy agreement ahead of schedule.
All three case studies have a few things in common – using insults as a rallying cry, creating enough of a stink to get mainstream press interested and uniting different sections of the profession under one message online.
But the biggest factor is that they weren’t afraid to look foolish.
They recognised that appealing to emotions was more effective than spurting facts and evidence.
Were they successful? Not entirely. But they are more memorable movements than anything that the medical peaks have managed.
