As scope of practice reforms are debated, frontline workers share their experiences

While health and medical groups debate scope of practice recommendations released this week, Jason Staines investigates the experiences of frontline workers, from Far North Queensland to regional Victoria.

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Jason Staines writes:

Professor Mark Cormack’s final report into expanding scope of practice for primary healthcare workers has been released, with the potential to drive significant changes across Australia’s healthcare landscape.

The report, Unleashing the Potential of Our Health Workforce – Scope of Practice Review, makes 18 recommendations that aim to create a more adaptable, equitable, and team-oriented primary care system.

By enabling healthcare professionals, such as pharmacists, dental hygienists, nurse practitioners, and allied health workers, to work at their full scope of practice, the report pictures a system that maximises workforce capabilities, reduces bottlenecks, and enhances patient access to care, especially in rural and remote communities.

Key recommendations include a National Skills and Capability Framework, consistent legislation across jurisdictions, and new funding models to support multidisciplinary, patient-centred care.

Port Douglas perspectives

The report is especially relevant for regional and remote areas of Australia, where limited access to healthcare services creates significant challenges for residents and visitors alike.

Port Douglas, in Queensland’s Far North, faces such challenges, with only a handful of medical facilities, and these often are overwhelmed by both residents and a seasonal influx of visitors.

The State Government’s program of expanding pharmacists’ scope of practice enables pharmacists to diagnose and treat certain health conditions without the need for a doctor’s immediate oversight.

James Buckley, a local pharmacist, was one of the first participants in the program, and has seen first-hand the impact it has had on his community.

As Buckley explains, the town’s tourist base and rural setting contribute to an unusually high number of patients with acute issues, including injuries and infections that require immediate attention.

Yet, patients can wait up to four weeks to see a GP, and even the local medical practices have had to close on certain days due to staffing shortages.

“When the pilot program came out,” he told Croakey, “we thought, oh my gosh, this is literally built for our community.”

Under the pilot, pharmacists in Queensland are able to treat 20 conditions. Buckley, for instance, frequently addresses ear infections, provides travel health consultations (including travel vaccinations and malaria prophylaxis), and treats a variety of skin conditions such as dermatitis.

Since beginning the program, he has conducted over 170 consultations, making his pharmacy a critical access point for timely care.

The program also requires additional training for participating pharmacists. “The service already existed in part,” he says, referring to the pharmacy assistants who would gather preliminary patient information.

However, this new model enabled Buckley and his team to expand their diagnostic skills and develop comprehensive protocols, further professionalising the level of service offered. This streamlined process allows his team to manage these conditions independently within the scope permitted, providing essential treatments quickly and effectively.

This expanded role has significantly improved patient care by reducing wait times and giving immediate relief for common health concerns. One example illustrates the impact: a man visited the pharmacy on a Sunday evening with a painful ear infection. Buckley examined him, prescribed antibiotics according to protocol, and arranged for the patient to see a doctor the following day.

The doctor agreed with the treatment plan, thanking Buckley for providing essential care over the weekend. “It’s incredibly rewarding to know we can prevent patients from suffering longer or needing to travel far for treatment,” he says.

Buckley has also noticed positive responses from his regular clientele, many of whom are now turning to him first for health advice. The ability to provide timely care through expanded pharmacy services not only relieves pressure on local clinics and the emergency department, but also empowers the community to manage their health more effectively.

Port Douglas is home to a small Indigenous community and a high number of multicultural visitors. Buckley says that while Indigenous patients from more populated towns such as Cairns have greater access to culturally appropriate services, providing accessible and clear communication remains essential in Port Douglas.

He says pharmacists are trained to assess health literacy levels quickly, adjusting explanations as needed to ensure patients understand their diagnoses and treatments.

“In the first few seconds, we can assess a patient’s health literacy and adapt our communication accordingly,” he says.

Collaborative relationships

Despite initial concerns from some in the medical community, Buckley says he has built a collaborative relationship with local GPs and hospital pharmacists.

By taking a step-by-step approach, he has been able to offer expanded services without creating tension, proving that pharmacists and doctors can work in tandem to deliver cohesive care.

“We’re not here to replace doctors; we’re here to support them by managing the most common cases,” he says.

Buckley regularly consults with nearby healthcare providers on more complex cases, reinforcing a collaborative model that prioritises patient care above all.

Integrating expanded services has required adjustments in the pharmacy’s workflow. Buckley has designated specific days for consultations and carefully coordinates with his team to balance clinical and administrative tasks.

“Managing the extra responsibilities with my regular duties has been tricky,” he admits. Training staff to handle referrals and communicate effectively with patients has also been key, ensuring that all team members understand when to escalate cases to Buckley or to outside providers.

Concerns from doctors about continuity of care and the adequacy of pharmacists’ training are common.

Buckley acknowledges these criticisms but says the program includes stringent assessment protocols and requires pharmacists to refer cases outside their scope. “We’re not trying to replace GPs,” he says, noting that expanded training has prepared him to handle cases carefully and conservatively.

He strives for responsible use of the expanded scope, maintaining continuity of care by involving doctors when necessary.

Looking ahead, he sees a future where expanded pharmacy roles become standard, likening it to the widespread adoption of vaccination services by pharmacists.

Buckley hopes that in the next few years, expanded scope will be incorporated into pharmacy degrees, ensuring new pharmacists are fully prepared to provide comprehensive primary care. “Eventually, I see most pharmacists offering these services as business as usual,” he says, seeing this shift as a natural progression for the profession.

Not only does expanded scope of practice allow professionals to make the most of their training to perform more tasks, such as administering vaccines, diagnosing minor ailments, and providing preventive care, it also helps to address gaps in healthcare delivery and create a more efficient, patient-centred system, particularly in areas where access to general practitioners and specialists is limited.

Reform needed

The scope of practice review is part of broader reforms to reimagine the delivery of primary care in Australia, and to address bottlenecks in care, that result in patients facing long wait times for GP appointments or specialist referrals.

Persistent shortages and maldistribution of doctors and specialists have not only led to significant delays in treatment, but are also leading to a growing disparity between urban and rural healthcare access.

Patients often travel long distances for routine care that could be handled locally by other healthcare providers.

Meanwhile, the rise of chronic conditions and an ageing population are placing further strain on the system.

Those who advocate for greater scope of practice say this enables professionals to share responsibilities, improving patient outcomes, reducing healthcare system burdens, and ensuring more equitable, cost-effective care, especially in underserved regions.

The Scope of Practice Review, funded through the 2023-24 Budget, stems from recommendations of the Strengthening Medicare Taskforce, which highlighted the need to remove barriers preventing healthcare professionals from working to their full potential.

The review’s consultations involved over 1,100 stakeholders and identified key opportunities to improve patient care through expanding the roles of healthcare professionals.

A major finding has been legislative inconsistencies across Australian states and territories, limiting the scope of practice for professionals such as pharmacists and Aboriginal Health Practitioners (AHPs).

For example, while pharmacists in some regions can administer vaccines, others are restricted by law.

Similarly, Aboriginal Health Practitioners in Queensland face legislative barriers to performing immunisations, despite having the necessary training. These discrepancies contribute to inequities in healthcare access and increase workforce strain, particularly in rural and Indigenous communities.

The review has also stressed the importance of multidisciplinary care, encouraging collaboration between healthcare professionals to offer more holistic and integrated patient care.

However, it has raised concerns about care fragmentation and safety, urging strong clinical governance frameworks.

Inter-jurisdictional differences

These inter-jurisdictional differences stem from a range of historic, demographic, and political factors, leading to diverse responses.

While some regions have embraced reforms to empower healthcare professionals with new roles, others remain cautious, balancing workforce needs with concerns over safety and regulatory barriers.

Victoria is advancing scope of practice reforms, focusing on pharmacists and allied health professionals. A pilot program, which started in October 2023 and was recently extended until July 2025, is letting  pharmacists treat uncomplicated urinary tract infections, minor skin conditions, and reissue contraceptive prescriptions, backed by $20 million from the 2023-24 Budget.

The initiative aims to alleviate healthcare system pressure by providing routine care without requiring a GP. Victoria’s Health Workforce Strategy also promotes advanced practice roles for dietitians, nurses, and allied health workers, particularly in rural areas.

(Editor’s note: The section above was corrected, thanks to feedback from a reader. The dates were wrong.)

Queensland has led the way with the Community Pharmacy Scope of Practice Pilot, enabling pharmacists to prescribe and administer vaccines. This initiative addresses GP shortages in rural areas and has been widely successful.

The state has also expanded nurse practitioners and allied health roles in underserved regions to improve primary and preventive care.

New South Wales has taken a cautious approach, focusing on integrated care models rather than expanding scope of practice. A pilot in regional areas employed paramedics in emergency departments to reduce strain but did not expand their practice scope. The state remains focused on collaboration to address healthcare demands.

Australian Capital Territory has nurse-led clinics that provide free services for minor illnesses, preventive care, and chronic disease management. These clinics have reduced emergency department visits but face criticism from GPs concerned about the quality of care. The ACT Government defends the clinics as vital to improving healthcare access.

South Australia expanded the role of pharmacists to prescribe for minor conditions such as ear infections and nausea, despite concerns from GPs. The state also integrates multidisciplinary care teams with nurse practitioners and allied health workers, focusing on rural and remote healthcare access.

lutruwita/Tasmania is expanding nurse practitioners’ roles in rural areas, where GPs are scarce, with nurse-led clinics the key to providing care. Discussions are ongoing about pharmacy scope expansion, but no large-scale initiatives have begun.

Western Australia is gradually expanding scope of practice, particularly for pharmacists and Aboriginal Health Practitioners, to address healthcare shortages in remote areas. Nurse-led models are also being introduced to improve care delivery.

The Northern Territory relies heavily on Aboriginal Health Practitioners in remote Indigenous communities. Expanding their scope, particularly in vaccination and chronic disease management, is central to addressing healthcare inequities.

Multidisciplinary care teams are also being implemented to improve access to holistic care.

Aboriginal health sector

The Australian Institute of Health and Welfare (AIHW) notes that “Aboriginal and Torres Strait Islander people do not always have the same level of access to health services as non-Indigenous Australians”.

Barriers include “services not being available in their area (especially for those living in remote areas), services being too far away, lack of transport, cost, waiting times, and the availability of culturally safe and responsive health services”.

Aboriginal Community Controlled Health Organisations (ACCHOs) have long advocated for a culturally safe, holistic approach to primary healthcare. However, shortages of healthcare providers persist, particularly in remote regions.

Expanding the scope of practice for Aboriginal Health Practitioners could improve access to care. They often come from the communities they serve, provide culturally informed care but are limited by restrictive legislation. Empowering Aboriginal Health Practitioners to administer vaccines and manage chronic conditions could relieve pressure on overburdened doctors and improve patient outcomes.

Expanding the roles of pharmacists and nurses to manage chronic diseases such as diabetes and cardiovascular disease –  which disproportionately affect Indigenous Australians – could also help to bridge healthcare gaps. Meanwhile, pharmacy-led programs and nurse-led clinics can deliver preventive care and chronic disease management, reducing the need for specialist appointments in remote areas.

Expanding scope of practice for health professionals within ACCHOs, operating with multidisciplinary teams, can enhance their ability to provide culturally safe, comprehensive care.

In addition, addressing legislative barriers and overcoming cultural biases will be critical to ensuring these reforms succeed and build trust in Indigenous communities.

In its submission to the Cormack Review, the National Aboriginal Community Controlled Health Organisation (NACCHO) said it supports extending scopes of practice across the medical workforce.

“However, it is critical that changes are made in a way that supports multidisciplinary teams working to their collective scope of practice, and extensions to scopes of practice that are appropriately and consistently assessed, implemented and regulated,” it said.

“Without such measures, fragmentation of care is a significant risk. While scope harmonisation needs to be coordinated at the national level, at the local level, clinicians working to expanded/full scope of practice cannot work in silos, they must continue to work as an integrated team,” NACCHO added.

Professional groups

The expansion of scope of practice has sparked debate among professional groups, with the views of medical organisations often diverging from those representing pharmacists, nurses, and allied health professionals.

Organisations such as the Royal Australian College of General Practitioners (RACGP) and Australian Medical Association (AMA) have raised concerns about patient safety, arguing that healthcare workers without extensive medical training, such as pharmacists and nurse practitioners, may struggle to accurately diagnose complex conditions.

In one of its submissions, the AMA said the review was “failing in its core objectives of supporting collaborative models of primary care”.

The AMA said that it “can no longer accept hollow assurances that this is not about expanding scope when the paper includes this as a mid-term goal, nor will we accept that it is about collaboration when the paper offers nothing but fragmentary models that rely on cashing out core general practice funding”.

However, groups representing pharmacists, nurse practitioners, and allied health professionals argue that expanding their roles is both safe and necessary, especially in rural areas facing workforce shortages. They highlight the evolving nature of healthcare and the benefits of involving a wider range of professionals in patient care.

The Australian College of Nursing (ACN) and the Pharmaceutical Society of Australia (PSA) both praised the report for recognising the need to empower nurses and pharmacists, respectively, to improve accessibility and efficiency in healthcare.

However, the AMA advised caution, warning that certain recommendations could fragment patient care and undermine the role of GPs. The AMA stressed the importance of independent, profession-led standards and called for a focus on bolstering the GP workforce rather than implementing quick fixes.

Community-based healthcare

Community-led healthcare models, particularly in underserved areas, are showing the positive impact of expanded scope of practice, according to advocates.

ACCHOs lead in providing culturally appropriate care, with Aboriginal Health s, nurses, and allied health workers collaborating with doctors to deliver holistic services to Indigenous Australians.

Programs such as the Integrating Pharmacists within Aboriginal Health Services (IPAC) have demonstrated that expanded roles for pharmacists can improve medication adherence and chronic disease management. By embedding pharmacists in multidisciplinary teams, ACCHOs offer more coordinated care for conditions such as diabetes and cardiovascular disease.

Nurse-led clinics in the ACT and rural areas also play a vital role, with nurse practitioners providing accessible primary care, reducing strain on hospitals and emergency departments.

Transforming dental healthcare

In regional Victoria, expanded scope of practice reforms for dental hygienists are transforming access to preventive dental care, according to dental hygienist, Pam Arar.

These changes, allowing hygienists to work more independently, have been pivotal for one local hygienist who now brings dental services directly to patients in underserved communities.

Arar serves the regional Victorian community of Warrnambool, where access to dental services is often limited by long waiting times, costs, and a lack of education on oral health.

Patients frequently face up to even-year waits for preventive services in public clinics due to resource limitations, while private care remains unaffordable for many.

“The children receive priority, but adults are often left to wait for vouchers to cover basic preventive care,” Arar told Croakey.

In private practices, routine services are more accessible, but these are typically not an option for those dependent on the public system.

Additionally, many community members lack basic oral health knowledge, with few understanding the impact of gum disease or the benefits of preventive products. Arar says that many patients are surprised to learn how accessible preventive treatments can improve their oral health, highlighting a critical need for awareness and education in the region.

Historically, dental hygienists in the region operated under the supervision of a dentist, with significant limitations on the procedures they could perform. Even basic treatments such as applying fissure sealants or teeth whitening were restricted depending on the clinic’s protocols and the supervising dentist’s approval.

“The restrictions placed on us meant we couldn’t use our training to its fullest potential, often leading to suboptimal patient outcomes,” Arar says.

Such constraints not only limited the range of care offered but also diminished the efficiency of the clinic, as even straightforward preventive treatments required a dentist’s direct involvement.

This traditional structure placed unnecessary burdens on dental clinics and prevented hygienists from fully utilising their expertise.

Supporting prevention

Recent reforms have shifted this landscape by granting dental hygienists greater autonomy, allowing them to make independent treatment decisions and carry out certain procedures without needing a dentist’s oversight.

This expanded scope has allowed Arar to offer services such as fluoride treatments, dental cleanings, and more specialised preventive care directly to patients in various community settings, including aged care facilities, special needs units, and mobile dentistry services.

The ability to develop treatment plans independently has been a game-changer.

“I can assess what’s best for the patient within my level of training and, if something is beyond my scope, I still refer them to other practitioners,” Arar says. This flexibility has made it possible to bring preventive dental care to high-need areas that were previously underserved.

The expanded scope of practice has markedly improved access to preventive services in the community, reducing wait times and broadening options for patients who previously faced barriers to care. For example, Arar’s mobile dentistry service has been welcomed by aged care facilities, where residents benefit from convenient access to regular dental cleanings and check-ups.

“Patients appreciate the option to receive preventive care locally,” she says. “Once they understand the role of a hygienist, they’re eager to improve their oral health.”

The community response has been overwhelmingly positive, especially as Arar engages with local organisations to raise awareness. By visiting professional groups and community clubs, she has educated people on the preventive services hygienists can offer and the importance of maintaining oral health.

“Many people had no idea what a hygienist does, but they’re very committed to improving their oral health once they learn more,” she says.

Despite the success of expanded practice, challenges remain, particularly in maintaining adequate training and resources. In rural areas, accessing in-person professional development can be difficult due to travel distances and associated costs.

Arar has turned to online webinars and networking with other practitioners as a way to stay updated.

“Living in a regional area limits my ability to attend city-based courses, so online resources have been invaluable for keeping my skills current,” she says.

Staffing is another hurdle; the area has few qualified dental professionals, which impacts clinic operations. Finding and retaining support staff, such as dental nurses, is challenging.

Support networks are also essential for dental hygienists working in remote areas. Limited access to immediate professional guidance can lead to anxiety and burnout, especially for those working independently.

Arar says networking with peers across the state to share best practices and address common challenges is important. “Without support, it’s easy to lose confidence and feel isolated,” she says. “Connecting with colleagues helps me stay focused and motivated.”

Arar is optimistic about the future of expanded practice, seeing further opportunities for dental hygienists to broaden their roles. “With the right training, we could offer even more services that would greatly benefit our patients,” she says.

However, she recognises the criticisms raised by some in the medical community, particularly concerns from GPs about continuity of care. Some argue that expanded scope could fragment dental and medical treatment, leading to disjointed care for patients.

In response, she notes the collaborative approach taken within the trial framework, where referrals are made when issues fall beyond her expertise.

“We refer patients for additional care when necessary, so there’s still continuity,” she explains, countering the notion that expanded roles lead to gaps in care.

Fundamental rethink

The expanded scope of practice is not just a shift in the roles of healthcare professionals; it represents a fundamental rethinking of how healthcare is delivered in Australia.

As the Scope of Practice Review recommendations are considered, debated and contested, it is clear that expanding the roles of pharmacists, dental hygienists, and other health professionals is essential to addressing workforce shortages and growing healthcare demands, particularly in rural and remote areas of Australia.

While challenges remain, including regulatory barriers and concerns about care coordination, the evidence gathered through the review and the experiences of healthcare providers suggests that expanded scope of practice, when implemented with proper oversight, could significantly improve patient outcomes and the sustainability of the country’s healthcare system.

Responses to the review

Royal Australian College of GPs and Australian Medical Association urge caution about the recommendations.

The Australasian College of Paramedicine welcomes the recommendations.

Australian Physiotherapy Association says the report “offers the structural reform needed to strengthen care and collaborative practice, making multidisciplinary care a reform reality”.

Australian Nursing and Midwifery Federation welcomes the report.

Australian College of Mental Health Nurses supports the report’s recommendations.

Private Healthcare Australia welcomes the report.

Acknowledgement

This article was produced with funding support from a Local and Independent News Association micro-grant.