Pharmacy Guild Response to the Sax Institute Report

 

Pharmacy Guild Response to the Sax Institute Report

 

Reviewing the Pharmacy Guild's response to the Sax Institute report

Following the publication of the Sax Institute report on 6 July 2026, the Pharmacy Guild of Australia ("the Guild") released a referenced media response challenging the report's findings. As an organisation committed to evidence-based healthcare, the RACGP reviewed the references cited in the Guild's response. Our review raises important questions about the credibility of the Guild's media release and whether the cited evidence supports the claims being made about autonomous pharmacist prescribing in community pharmacy settings.

Based on the RACGP's analysis, the Pharmacy Guild has not been able to produce any evidence further to that already identified and dismissed by the Sax Institute that would alter the outcome of the report.

What we found

Our review identified consistent themes across the evidence cited by the Guild.

1

Incorrect and unverifiable references

Refer to Table 1. References and links were inconsistent, making independent verification of evidence difficult. For example, Reference 7 could not be found. Reference 5 was cited as a systematic review. It is not.

2

Most of the evidence does not analyse prescribing in community pharmacy setting

Refer to Table 2. A number of the studies cited by the Guild were conducted in hospitals, general practice settings, residential aged care facilities, or multidisciplinary healthcare teams – not in autonomous retail community pharmacy settings.

3

The strongest evidence relates to collaborative care

Most cited studies examine pharmacists practising collaboratively within integrated healthcare teams, supported by shared records, clinical governance and collaboration with medical practitioners.

4

Some cited studies had already been assessed by the Sax Institute

Refer to Table 2 below. Several references cited by the Guild were Australian trials that had already been reviewed by the Sax Institute. The Sax Institute considered these studies during its evidence review and determined that they provided low-quality evidence. Citing these studies therefore does not address the review's conclusion regarding the limited quality of evidence supporting autonomous prescribing in retail community pharmacy settings.

Table 1: Reference examples which question the accuracy of the Guild's media release

Reference 5 — Misrepresented reference and unable to verify

Systematic Review of Pharmacist Prescribing

Anderson S et al.

pmc.ncbi.nlm.nih.gov/articles/PMC9926330/

  • The Guild reference title states this is a systematic review and names "Anderson S et al" as authors.
  • RACGP search for a paper first authored by an "Anderson S" on a topic phrase "Systematic review of pharmacist prescribing" could not be found. Unclear what systematic review they are trying to cite.
  • The Guild reference title states this is a systematic review. It is not – the hyperlink is to a randomised controlled trial.
  • The Guild reference hyperlinks to a different article: "Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial" authored by Holland R et al. None of the authors are "Anderson S".

Reference 6 — The existence of this reference is unable to be verified

The Impact of Pharmacist Prescribing Policies on Health Outcomes: A Systematic Review

Jebara T et al. — PLOS One

journal.plos.org/plosone/article?id=10.1371/journal.pone.0214630

  • The Guild reference title and author cannot be verified – PLOS One has not published a paper with this title and author name.
  • The Guild reference hyperlinks to a different article: "Non-medical prescribing in the United Kingdom National Health Service: A systematic policy review" authored by Graham-Clarke E, Rushton A, Noblet T, Marriott J. None of the authors are "Jebara T".

Reference 7 — The existence of this reference is unable to be verified

Prescribing Errors and Associated Factors in Pharmacist Independent Prescribing

Baqir W et al., European Journal of Hospital Pharmacy 28(3): 149-154

  • The Guild reference title and author cannot be found, because there is no European Journal Hospital Pharmacy article by Baqir et al with this name and title. The page range belongs to a different article by Turner et al.
  • There is a 2015 paper by Baqir W et al called "Pharmacist prescribing within a UK NHS hospital trust: nature and extent of prescribing and prevalence errors."
  • The prescribing error rates quoted in the Guild's media release were found in this reference "An investigation into prescribing errors made by independent pharmacist prescribers and medical prescribers at a large acute NHS hospital trust: a cross-sectional study" by Turner E, Kennedy M and Barrowcliffe A.
  • The medical prescribers were Foundation Year 1 and Foundation Year 2 trainee doctors (equivalent of intern and resident medical officer in Australia). This is not a fully trained specialist doctor. The pharmacists were qualified hospital pharmacists with over 2 years' experience.

Reference 10 — Inconsistent reference

Pharmacist Independent Prescribing in Care Homes: Cluster Randomised Controlled Trial

Zermansky AG et al. — BMJ 2023;380:e071883

bmj.com/content/380/bmj-2022-071883

The Guild reference title and author cannot be verified.
  • RACGP search could not find a paper with this name and title.
  • The Guild reference hyperlinks to a different article.
  • Hyperlinks to the same article that reference 5 hyperlinked to: "Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial" authored by Holland R et al.
  • "Zermansky AG" is listed as the second last author (not a first author) in a long list of authors.

Reference 11 — Inconsistent reference

Clinical Outcomes of Community Pharmacy Services: Systematic Review and Meta-analysis

Jokanovic N et al. — Health & Social Care in the Community

onlinelibrary.wiley.com/doi/pdfdirect/10.1111/hsc.12794

  • The Guild reference author cannot be verified.
  • It is unclear what systematic review they are trying to cite – RACGP search could not find a paper with this author name and title.
  • The Guild reference hyperlinks to a different article.
  • "Clinical outcomes of community pharmacy services: a systematic review and meta-analysis" authored by Yuan C, Ding Y, Zhou K, Huang Y and Xi X.

The remaining references cited by the Guild do not strengthen the evidence for autonomous prescribing in retail community pharmacies. In fact, they demonstrate support for collaborative models integrated within teams that include doctors. The RACGP has consistently supported collaborative models of care.

Table 2: Guild hyperlinks show the strongest evidence relates to collaborative care models

Guild reference Relates to autonomous prescribing in retail community pharmacy? Key takeaway message
Ref 1 Yes Not high-quality evidence
Ref 2 Yes Not high-quality evidence
Ref 3 Yes Not high-quality evidence
Ref 4 No Evidence supports pharmacists embedded in teams, not autonomous prescribing.
Ref 5 hyperlink — no prescribing, aged care setting
"Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial" — Holland R et al.		 No Evidence supports pharmacists embedded in teams performing tasks other than prescribing.
Ref 6 hyperlink
"Non-medical prescribing in the United Kingdom National Health Service: A systematic policy review" — Graham-Clarke E, Rushton A, Noblet T, Marriott J.		 No UK policy evolution was not toward stand-alone community pharmacy prescribing for minor ailments. Evidence concludes prescribing appears more easily adopted where it forms part of the overall care of the patient. Policy direction became autonomous prescribing (in terms of prescribing authority) but pharmacists were embedded in multidisciplinary teams with heavy use in general practice and hospital settings.
Ref 7 No Zero relevance to the current policy question.

The authors of this single-centre observational study explicitly cautioned this was not a controlled comparison as the pharmacists and doctors had different roles, workloads, prescribing responsibilities and levels of experience (the doctors were trainee doctors whereas the hospital pharmacists were fully qualified with greater than two years' experience).
 
The results show an association rather than proving that pharmacist prescribers are inherently safer than doctors.
Ref 8
Irish systematic review assessed very different prescribing models — "Effectiveness, Safety and cost-effectiveness of pharmacist prescribing: A systematic review of 52 studies" — Health Research Board (Ireland)		 Mostly no GRADE rating: Very Low Certainty for the 3 studies that were in community pharmacy.
Ref 9
"Identifying outcomes for evaluating the impact of pharmacist prescribing: A rapid overview of reviews" — Hassan Ali A et al.		 Mostly no Finding is consistent with the broader observation that the strongest evidence base relates to integrated healthcare models rather than autonomous retail pharmacy prescribing.
Ref 10 No Limited direct relevance to the retail pharmacy prescribing model in Australia.
Ref 11
"Clinical outcomes of community pharmacy services: A systematic review and meta-analysis" — Yuan C, Ding Y, Zhou K, Huang Y, Xi X.		 Negligible Most of the positive outcomes reported were from education, medication review, adherence support, monitoring and collaborative care – not prescribing itself.

Guild media release