The Grattan Institute's Future Pharmacy: a better deal for patients and taxpayers report examines the Pharmacy Guild's influence on pharmacy policy and sets out recommendations for reform. It argues Australia should move from a system built around protection, negotiated funding and limited competition to one based on independent pricing, competition, transparency and evidence-based services – while expanding pharmacists' clinical role where there is proven value.
For general practice, the report is particularly relevant as governments continue to consider expanded roles for pharmacists, including pharmacist prescribing.
Future policy decisions should be based on clear evidence of benefit, not service activity alone.
What the report says
The report argues Australia's community pharmacy system has been heavily shaped by the Community Pharmacy Agreements – five-year funding agreements negotiated between government and the Pharmacy Guild of Australia exclusively – along with ownership and location rules that restrict who can own pharmacies and where they can operate. This has resulted in excessive protection, limiting competition and transparency.
Key recommendations
- •Ending the Community Pharmacy Agreements in favour of independent, evidence-based decision making
- •Giving IHACPA responsibility for setting pharmacy fees
- •Reforming dispensing payments and removing unjustified fees and charges
- •Increasing competition by removing ownership restrictions and location rules
- •Allowing greater discounting of medicines
- •Establishing stronger independent monitoring of pharmacy service quality and outcomes
- •Tightening MedsCheck eligibility and repricing dose administration aids to reflect automation gains
The report says pharmacists have an important role in delivering more types of care, but argues funding should follow clear evidence of value – recommending pharmacist prescribing for uncomplicated urinary tract infections, investment in non-dispensing pharmacists within general practice and Aboriginal Community Controlled Health Services, and rigorous national trials before expanding into other areas.
What this means for general practice
Prescribing is not a standalone task. Safe prescribing relies on clinical assessment, diagnosis, understanding a patient's medical history, follow-up, escalation where needed, and communication with the patient's usual GP or treating team.
As governments consider expanded pharmacist roles, the key question is how new models of care can improve access while maintaining patient safety, continuity of care and clinical governance.
The need for robust evaluation
The RACGP has called for high-quality Australian research evaluating independent pharmacy prescribing against usual general practice care – particularly important as pharmacy prescribing trials continue to expand across conditions and patient groups. Future evaluations should include:
- •Comparison with usual GP care
- •Robust prospective study designs, including randomised or quasi-experimental approaches
- •Objective data sources, including clinical or linked data
- •Adequate follow-up periods and sufficient statistical power
- •Assessment of clinical effectiveness, safety, cost-effectiveness, continuity of care and impact on general practice
Spotlight
National Women's Health Trial
The Australian Government's trial to expand access to cheaper medicines – including treatment for uncomplicated urinary tract infections and oral contraceptive pill prescribing – is an important opportunity to strengthen the evidence base for pharmacist prescribing. To meaningfully inform future policy, its evaluation should include:
- •A clear comparator group receiving usual GP care
- •Linked-data using PBS, MBS, emergency department and hospital data
- •Safety measures for UTI treatment – treatment failure, repeat antibiotic prescribing, escalation, ED presentations, hospital admissions, pyelonephritis and STI diagnoses
- •Safety measures for oral contraceptive pill prescribing – prescribing outside protocol, missed contraindications, unwanted pregnancies and adverse events
- •Assessment of cost-effectiveness, value for money and equity impacts
- •Women's health-specific measures, including LARC referral and engagement with broader reproductive and preventive healthcare
A focus on safe, connected care
Improving access to care is important. However, access must be safe – supported by evidence, with appropriate safeguards and strong clinical governance.
The Grattan Institute report provides an opportunity to consider how pharmacy policy can better support patients, taxpayers and the broader health system. For future pharmacist prescribing models, robust evaluation will be essential to ensure policy decisions are based on meaningful health outcomes, patient safety and value for money.