GP-Pharmacist turf war reignites as UTI data fuels fresh battle over prescribing debate

A simmering professional turf war over prescribing rights has erupted again, with the Royal Australian College of GPs (RACGP) moving quickly to shut down any attempt to use the NSW PATH-UTI evaluation as political cover for expanding pharmacist prescribing.

The RACGP’s warning lands squarely against a backdrop of rising tension between GPs and pharmacists, with the AMA (NSW) also taking a hard line.

“But let’s be clear: this evaluation is not a green light for broader pharmacist prescribing,” said AMA (NSW) President Dr Fred Betros.

The trial, conducted by the University of Newcastle (University of Newcastle), enrolled more than 17,000 participants and is already being selectively cited in the policy debate. More than 9 in 10 episodes resulted in an antibiotic being supplied, while 7.3% were referred to a GP or emergency department.

But critics argue that the headline efficiency masks a deeper clinical risk profile.

“It risks fragmenting care, weakening general practice and increasing pressure on antimicrobial stewardship at the worst possible time,” Dr Betros said.

Australia already carries an uncomfortable global distinction: it has the highest total volume of antibiotics prescribed for systemic use among OECD countries, at 27.6 defined daily doses per 1,000 people per day.

“The last thing we need is a model that makes antibiotics easier to hand out without proper medical oversight,” said Dr Betros. “UTI symptoms are common, but they are not always simple. They can overlap with sexually transmitted infections, pregnancy-related issues, kidney infections and other conditions that require proper medical assessment.”

The report’s data reveals the trial population was skewed significantly toward advantaged groups. Nearly 40% of participants came from socioeconomically advantaged postcodes, compared to fewer than 9% from the most disadvantaged. Most participants (72%) lived in metropolitan areas, 80% were employed, and 58% had education beyond Year 12.

Then there is the cost question, politically sensitive and operationally unresolved. The consultation fee, subsidised by NSW Health during the trial, will shift entirely to patients in any future rollout, with costs estimated at $19.50 – $70.50 per consultation.

On the other side of the dispute, the Pharmacy Guild of Australia, NSW Branch has seized on the findings as validation rather than caution tape. Its leadership is framing the results as overdue recognition of pharmacists as frontline primary care providers.

“Busy women shouldn’t have to wait days for a GP appointment or spend hours in an emergency department for straightforward care,” stated Pharmacy Guild NSW Branch President Mario Barone. “The data is clear, pharmacists are prescribing at the same rate as other healthcare providers and adhering to strict protocols. This model is not only safe – it’s smart health policy.”

But even the RACGP is not dismissing the trial outright. Instead, it is drawing a sharp line between controlled evaluation conditions and real-world system redesign. While acknowledging that the PATH-UTI trial adds to understanding of how these models operate under tightly governed trial conditions, it argues there are still significant blindspots.

RACGP President Dr Michael Wright said, “It does not establish whether these services deliver better outcomes than GP-led care, reduce overall demand for the health system, or do so without compromising patient safety. These are critical questions that must be addressed before broader policy decisions are made.”

Critically, not a single pharmacy in a very remote area participated in the trial.

“The most vulnerable patients deserve the same standard of care as everyone else – not a lower-cost alternative that bypasses proper clinical assessment,” emphasised Dr Wright.

As the Pharmacy Guild continues to push for expanded scope of practice, the RACGP remains firmly opposed, with both sides effectively locked in a policy standoff. And beneath the competing claims of access, equity and safety, what do patients actually want?

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