Tag: Patient Safety

  • What happens when political decisions override clinical governance?

    What happens when political decisions override clinical governance?

    One of the most important lessons from the COVID pandemic had very little to do with viruses.

    It was a lesson about decision-making, specifically:

    What happens when political leaders begin making clinical decisions that sit outside established medical, scientific and regulatory frameworks?

    The Australian Human Rights Commission’s recent Collateral Damage report documented many of the unintended consequences of pandemic policy, finding that human rights impacts were not always adequately considered or protected.

    For many Australians, those consequences remain deeply personal.

    For healthcare professionals, they should also serve as a reminder of why clinical governance matters.

    The cost of getting it wrong

    Throughout the pandemic, Australia witnessed a series of decisions that continue to be debated today.

    • The hotel quarantine failures that contributed to Victoria’s second wave.
    • The North Melbourne and Flemington tower lockdowns, later found by the Victorian Ombudsman to be incompatible with human rights protections.
    • Border closures that separated families and, in some cases, had devastating personal consequences.
    • Extended lockdowns that left vulnerable people isolated from support networks, healthcare and community connection.

    Reasonable people may disagree about the decisions themselves, but these examples highlight an important truth:

    When decisions affect health, liberty and wellbeing, robust governance matters.

    Why this matters today

    That is why I become concerned when governments increasingly override established clinical and regulatory advice in favour of political solutions.

    The latest example is the expansion of pharmacist-initiated prescribing of the oral contraceptive pill in Victoria.

    This is not a debate about pharmacists, nor is it a debate about access. It is a debate about clinical governance.

    In 2021, the Therapeutic Goods Administration reviewed the oral contraceptive pill and maintained the requirement for medical practitioner initiation based on considerations of safety, assessment and ongoing clinical care.

    When governments choose a different path, Australians should reasonably ask:

    1. What evidence has changed?
    2. Who is accountable if harm occurs?

    Healthcare is more than a transaction

    Access to medication is important and so is convenience, but healthcare is rarely as simple as treating a symptom or supplying a medicine.

    A consultation about contraception may also involve:

    • Cancer screening.
    • Sexual health assessment.
    • Screening for contraindications.
    • Discussion of long-acting reversible contraception.
    • Continuity of care.
    • Preventive healthcare.

    These are not administrative tasks–they are important elements of quality clinical care.

    The question is not whether pharmacists are capable professionals. They are.

    The question is whether healthcare reforms strengthen or fragment the systems that help identify risk, coordinate care and keep patients safe.

    The ADHD example

    Only weeks before the pharmacy prescribing announcement, the Victorian Government announced changes allowing stimulant medications for ADHD to be accessed through the Victorian Virtual Emergency Department.

    Again, the issue is not access, the issue is governance.

    Stimulants are medications with significant risks, including misuse, diversion and dependency.

    Changes involving medicines of this nature should be accompanied by clear evidence, strong clinical oversight and careful evaluation. That is how public confidence is maintained.

    The principle that matters

    Medicine should never become a political football, nor should healthcare policy be driven primarily by convenience, popularity or election cycles.

    The role of governments is important, the role of regulators is important and the role of healthcare professionals is important.

    The strongest healthcare systems emerge when those groups work together, respecting both evidence and expertise.

    As Australians continue to debate healthcare reform, perhaps the most important question is not whether a proposal is popular.

    It is whether it improves patient outcomes while maintaining the standards of safety, accountability and clinical governance that patients deserve.

    Because once trust in those systems is lost, it can be very difficult to rebuild.

  • Independent Pharmacy Prescribing is not about a turf war – the phrase that shuts down the conversation

    Independent Pharmacy Prescribing is not about a turf war – the phrase that shuts down the conversation

    Every time concerns are raised about independent pharmacy prescribing, the response is often immediate “This is just a turf war.”

    It is a clever line because once concerns are dismissed as professional protectionism, there is little need to engage with the substance of the argument.

    But the real issue is not professional territory. It’s patient safety.

    Why prescribing and dispensing were separated in the first place

    One of the fundamental safeguards in healthcare is that prescribing and dispensing medicines are typically separated. Doctors prescribe. Pharmacists dispense. That separation exists for a reason. It provides an additional layer of scrutiny that helps identify errors, interactions and potential risks before harm occurs.

    As a GP, I value that relationship enormously. This is why I believe the current debate about independent pharmacy prescribing deserves more careful consideration than simply being labelled a turf war.

    This is not about whether pharmacists are valuable

    Pharmacists are highly skilled healthcare professionals and play a critical role in Australia’s healthcare system. GPs do not want pharmacies to disappear, in fact, the opposite is true.

    The current model works because each profession contributes different expertise and acts as a safeguard for the other. The concern is not pharmacists but rather system design.

    Access matters, but patient safety matters too

    One of the arguments used to justify pharmacy prescribing is that patients struggle to access a GP. Yet available data suggests that approximately 99% of Australians can access a GP when they need one.

    The debate therefore shouldn’t simply be about access. It should be about what type of care patients receive once they access the system.

    Healthcare is not a retail transaction. A patient presenting with symptoms may have an underlying condition that requires investigation, diagnosis, follow-up and continuity of care.

    Treating symptoms and diagnosing illness are not always the same thing.

    The conflict of interest question

    For decades, Australian healthcare regulation has recognised the importance of separating prescribing from financial gain.

    The Medical Board of Australia, AHPRA and Medicines Australia all have provisions designed to minimise conflicts of interest and ensure prescribing decisions are driven by clinical need rather than commercial considerations.

    These principles exist for a reason. Patients deserve confidence that treatment recommendations are based solely on what is best for their health.

    Have we forgotten the lessons of codeine?

    In 2018, the Therapeutic Goods Administration up-scheduled low-dose codeine because of concerns about misuse, dependence and patient harm. The result was a 50% reduction in codeine supply.

    That decision reflected an important principle: When evidence demonstrates a risk to patient safety, governments are willing to restrict access.

    The question today is whether the same principle is being applied consistently.

    The politics cannot be ignored

    The Pharmacy Guild has openly articulated a vision where pharmacists administer, prescribe, supply and review medicines within their own scope of practice. At the same time, the Guild reportedly contributed approximately $600,000 in political donations last year.

    Australians are entitled to ask questions about how major health policy decisions are made and whose interests are being prioritised.

    The question we should really be asking

    This debate shouldn’t be reduced to a contest between professions, and it shouldn’t be about turf or convenience alone.

    It should be about whether proposed reforms improve patient outcomes while maintaining the safeguards that Australians expect from their healthcare system.

    Convenience and access matter – but safety matters too.

    When legitimate questions about patient safety are dismissed as a “turf war”, we risk having the wrong conversation entirely.