The Royal Australian College of GPs (RACGP) has cautioned against using findings from the NSW PATH-UTI evaluation to justify a broader expansion of pharmacy prescribing scope.
While the report, commissioned by NSW Health and led by the University of Newcastle, found high patient satisfaction and symptom resolution rates, a lack of substantial evidence makes it difficult to fully assess these findings.
RACGP President Dr Michael Wright said the College was committed to evidence-based health policy.
“Disappointingly, this was another pharmacy trial evaluation that failed to provide the necessary clinical outcomes,” he said.
“It involved an unrepresentative patient cohort, lacked a clinical control group, and was more focused on measuring the dispensing of medicines rather than whether patients received the healthcare they needed.
“These limitations make the evaluation findings too premature to base policy decisions on.
“The PATH-UTI trial adds to our understanding of how these models operate under tightly governed trial conditions, and we acknowledge the contribution of the research team.
“However, 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.
“It’s also important to acknowledge that the evaluation shows there is no substitute for high-quality specialist GP care delivered by a GP who knows you and your history.”
A trial cohort that does not reflect all Australians
The report’s own 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.
Critically, not a single pharmacy in a very remote area participated in the trial.
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. The report itself acknowledges these costs could deter women from lower socioeconomic backgrounds from using the service.
“The findings demonstrate that a tightly governed, subsidised service to a group of predominantly highly educated, employed women in wealthier postcodes can achieve acceptable results. It does not tell us whether this model is safe and equitable for all Australians,” Dr Wright said.
“The most vulnerable patients deserve the same standard of care as everyone else – not a lower-cost alternative that bypasses proper clinical assessment.”
No control group: a fundamental gap in the evidence
The report explicitly acknowledges the absence of a comparison group as a key limitation. Without a randomised controlled trial or a properly matched comparator, it is not possible to determine whether outcomes differed meaningfully from standard GP-led care.
The RACGP notes that around one in four participants saw a GP within seven days of their pharmacy consultation, and 43% had a GP consultation within 28 days. GP consultation rates also increased significantly in the six months following the trial compared to the 12 months prior (15.9 per 100 vs 11.6 per 100).
While the report suggests these referrals were appropriate, it also indicates many patients still needed follow-up care from a GP after their pharmacy consultation, raising questions about whether these services make it easier for patients to get the right care or simply delay appropriate care by creating an extra stop before they see a GP.
Antibiotic prescribing and AMR concerns remain unresolved
Given the serious threat posed by antimicrobial resistance (AMR) – or superbugs – the RACGP is concerned the AMR analysis in this report remains incomplete.
Expanding community pharmacy antibiotic prescribing without a completed AMR assessment – particularly given more than one-in-four study participants were already resistant to first-line antibiotics – would be irresponsible.
The RACGP is concerned the PATH-UTI report will be used to justify not only a permanent UTI prescribing service, but a further broadening of pharmacy prescribing to other conditions. The RACGP strongly opposes this approach.
The RACGP calls on the NSW Government to:
- commission further research with a genuine comparison group and a representative patient cohort before making any permanent policy decision
- complete the AMR analysis before drawing any conclusions about antibiotic prescribing safety
- fully assess the equity implications of shifting consultation costs to patients, particularly for concession card holders, Aboriginal and Torres Strait Islander communities, and women in rural and remote areas
- ensure any future service models are genuinely integrated with general practice – not positioned as an alternative to it
- resist pressure to use this trial as justification for further expansion of pharmacy prescribing into other clinical areas
- require pharmacist prescribers to complete accredited post-graduate pharmacist prescribing training rather than relying on basic 1.5–3-hour online modules.
~ENDS
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