One profession, one national registration, eight scopes of practice
A pharmacist registered under national law may treat a urinary tract infection on one side of a state border and not the other. This is the eighth instance of the partial-national pattern in this database and the purest — the profession is regulated nationally and what it may do is not.
Steps this would change
Rationale
A pharmacist is registered by Australian Health Practitioner Regulation Agency under the Health Practitioner Regulation National Law, which applies identically in every jurisdiction. What that pharmacist may actually do is set by eight separate medicines and poisons regimes, and they have diverged substantially:
- Queensland — clinical advice and treatment including prescribing for a range of acute common conditions under an Extended Practice Authority, business as usual since 1 July 2025.
- New South Wales — uncomplicated UTIs, hormonal contraception continuation including certain oral contraceptives, the vaginal ring and DMPA, minor skin conditions, and initiation of oral contraceptives.
- Victoria — statewide pilot from August 2024 covering UTIs, shingles, mild plaque psoriasis and vaccines across more than 760 pharmacies, with initiation of oral contraceptives following.
- Western Australia and others expanding on their own timetables.
The same pharmacist, with the same training, the same registration and the same protocol, treats a condition in one state and refers the patient to a doctor in another.
This is the eighth instance of a pattern this database has now recorded across unrelated domains — NDIS worker screening, occupational licensing, clinical credentialing, working with children checks, community housing registration, controlled-medicine prescribing and water registers. It is the purest of them, because there is no argument here about different local conditions: a urinary tract infection is the same in Cairns and Ballarat.
The Cormack Scope of Practice Review found exactly this: inconsistent regulations, unnecessary restrictions on practice and siloed workforces having a detrimental impact on patients.
What should change. Nationally consistent scope for the conditions where protocols already exist and multiple jurisdictions have independently arrived at the same answer — starting with the ones every expanding state has included. States retain the power to go further; what stops is a patient's access depending on which side of a line they live.
Who acts: health ministers collectively, through the same mechanism that produced the national law in the first place.
What is being traded away
Divergence is how this got started, and it worked. Queensland piloted, then made permanent; Victoria and New South Wales followed with their own designs; each learned from the others. A national scope settled in 2020 would have been narrower than what several states now permit. Federalism as a laboratory is a real argument and this is a real instance of it, and harmonising now freezes the experiment at whatever the negotiated common position turns out to be.
Harmonisation usually lands at the lowest common denominator. Eight health ministers agreeing a national scope will agree the scope the most cautious of them accepts. States that have gone furthest would be the ones asked to stop, and patients in those states would be worse off. This site made the same objection about controlled-medicine prescribing and it applies with equal force here.
Doctors' organisations oppose expansion and the objections are not merely territorial. Fragmentation of care, missed diagnosis where a presentation resembling a UTI is something else, antimicrobial stewardship, and the loss of a consultation that might have surfaced something unrelated — these are stated by clinicians who see the failures. The protocols exist to manage them, and whether they manage them adequately is an empirical question this project cannot settle.
And the Commonwealth's workaround may reduce the pressure to fix it. The national women's health trial from 1 January 2027 delivers national access for two conditions by funding rather than by regulating. That is a good outcome and it relieves exactly the pressure that would otherwise force health ministers to harmonise scope properly — a patch that makes the underlying repair less likely.
Precedent
The Commonwealth's own national women's health pharmacist prescribing trial, announced 13 March 2026 and commencing 1 January 2027, creates de facto national scope for two conditions. The principle that scope should not depend on postcode has already been conceded.
Sources
- Queensland Extended Practice Authority - Pharmacists from 1 July 2025, with scope of practice and hormonal contraception pilots implemented as business as usual
- New South Wales expanded scope services covering uncomplicated UTIs, hormonal contraception continuation and minor skin conditions
- Victoria statewide pilot from August 2024 across more than 760 pharmacies
- National women's health pharmacist prescribing trial announced 13 March 2026, commencing 1 January 2027
- Scope of Practice Review (Cormack): inconsistent regulations, unnecessary restrictions on practice and siloed workforces having a detrimental impact on patients