Scope of Practice of

Community Pharmacists in
Australia
March 2023
Pharmacy Guild of Australia
Telephone: 13GUILD (13 484 53)

Australian Capital Territory Branch Tasmania Branch

E: [email protected] E: [email protected]

New South Wales Branch Victoria Branch

E: [email protected] E: [email protected]

Northern Territory Branch Western Australia Branch

E: [email protected] E: [email protected]

Queensland Branch National Secretariat

E: [email protected] E: [email protected]

South Australia Branch

E: [email protected]

www.guild.org.au

All the materials, graphics, and other components of ‘Scope of Practice of Community
Pharmacists’ are copyrighted by the Pharmacy Guild of Australia unless otherwise stated.
Any unauthorised use of materials may violate copyright, trademark and other laws and the
intellectual property rights of the Pharmacy Guild of Australia. Material from this booklet
may not be copied or distributed, or republished, uploaded, posted, decompiled, or
transmitted in any way, without the prior written consent of the Pharmacy Guild of Australia.
1. CONTENTS
1. EXECUTIVE SUMMARY.............................................................................................................................................................................................4
1.1 Pharmacists are trusted health professionals and highly trained clinicians .......................................................................................................4
1.2 Benefits of pharmacists working at full scope of practice..............................................................................................................................................5
1.3 Barriers to pharmacists working at full scope of practice...............................................................................................................................................5
1.4 Comparison with the global pharmacist workforce...........................................................................................................................................................7
1.5 The way forward.......................................................................................................................................................................................................................................8

2. DEFINING SCOPE OF PRACTICE.........................................................................................................................................................................9

2.1 Scope of practice – Individual versus profession.............................................................................................................................................................. 10
2.2 International benchmarking.......................................................................................................................................................................................................... 11

3. DOMAINS OF COMPETENCY IN FULL SCOPE OF PRACTICE.....................................................................................................12

3.1 Medication supply and dispensing............................................................................................................................................................................................ 12
3.2 Prescribing................................................................................................................................................................................................................................................. 15
3.3 Medication review................................................................................................................................................................................................................................ 17
3.4 Population health.................................................................................................................................................................................................................................. 18
3.5 Health conditions.................................................................................................................................................................................................................................. 19
3.6 Medicine administration................................................................................................................................................................................................................... 21
3.7 Ordering and interpreting laboratory tests........................................................................................................................................................................... 23

4. THE VISION.....................................................................................................................................................................................................................24
4.1 Current state of play............................................................................................................................................................................................................................ 24
4.2 The journey to prescribing ............................................................................................................................................................................................................. 25

5. CHECKLIST FOR CHANGE....................................................................................................................................................................................26

6. GLOSSARY.......................................................................................................................................................................................................................27
 1. EXECUTIVE SUMMARY
1.1 Pharmacists are trusted health
professionals and highly trained clinicians
Pharmacists are experts in medicines with a professional
responsibility to ensure the quality use of medicines (QUM)
– that is, that medicines are used safely, effectively, and
judiciously. They have a unique and complex knowledge
and skill base including a broad and deep knowledge of
pathophysiology and pharmacotherapeutics.
Pharmacists also have comprehensive training in disease
prevention, management, and treatment. There is
robust evidence of the impact that pharmacists have on
medication safety and adherence and the resulting savings
to the health system, particularly in the case of pharmacists
managing long term conditions through the quality use of • Ahpra Shared Code of Conduct4
medicines.1 • Code of Ethics for Pharmacists5

Pharmacists undergo a minimum five-year training as part • National Competency Standards Framework for
of their university education including a one-year intern Pharmacists in Australia (2016)6
program before being registered to practise as pharmacists. • Professional Practice Standards7
They then undertake mandatory continuing professional • National Health (Pharmaceutical Benefits) Conditions of
development (CPD) throughout their careers to maintain approval for approved pharmacists8
currency and competency in contemporary pharmacy • Quality Care Pharmacy program9 accrediting community
practice and their individual scope of practice as it evolves. pharmacies against Australian Standard AS 85000-2017 –
The pharmacy profession and community pharmacy quality management system for pharmacies in Australia.
operate within an extensive professional and ethical quality A 2021 Roy Morgan survey has continued to rank
and safety risk management framework which includes: pharmacists in the top three professions for ethics and
• The Pharmacy Board of Australia registration standards, honesty, despite most professions suffering from a loss of
codes, guidelines, and policies2. trust during the SARS CoV-2 (COVID-19) pandemic10.
• The Australian Health Practitioner Regulation Agency
(Ahpra) which supports the Pharmacy Board in its role
of protecting the public and setting standards and
policies that all registered health practitioners, including
pharmacists, must meet.3

1 Ernst & Young Report Scope of Practice Opportunity Assessment February 2020
2 Pharmacy Board of Australia, Codes, Guidelines and Policies: https://www.pharmacyboard.gov.au/Codes-Guidelines.aspx
3 Ernst & Young Report Scope of Practice Opportunity Assessment February 2020
4 Australian Health Practitioner Regulation Agency, Shared Code of Conduct https://www.ahpra.gov.au/Resources/Code-of-conduct/Shared-Code-of-conduct.aspx, June 2022
5 Pharmaceutical Society of Australia, Code of Ethics: https://my.psa.org.au/s/article/Code-of-Ethics-for-Pharmacists February 2017.
6 Pharmaceutical Society of Australia, National Competency Standards: https://www.psa.org.au/practice-support-industry/national-competency-standards/ 2016.
7 Pharmaceutical Society of Australia, Professional Practice Standards: https://www.psa.org.au/practice-support-industry/professional-practice-standards/ 2017.
8 Australian Government, National Health (Pharmaceutical Benefits) (Conditions of approval for approved pharmacists) Determination 2017 (PB 70 of 2017): https://www.
legislation.gov.au/Series/F2017L01297, 25 September 2017.
9 Quality Care Pharmacy Program: www.qcpp.com 2017.
10 Roy Morgan, Image of Professions Survey 2021: https://www.roymorgan.com/findings/roy-morgan-image-of-professions-survey-2021-in-a-year-dominated-by-covid-19-
health-professionals-including-nurses-doctors-and-pharmacists-are-the-most-highly-regarded-but-almost-all-professions-d, 27 April 2021

4 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

1.2 Benefits of pharmacists working at full professionals as necessary, depending on the level of care
scope of practice required. Community pharmacy is also a gateway for health
promotion and prevention measures, boosting distribution
Australia’s health system is recognised as one of the
of self-management information and resources on physical
best in the world, ranking at number three for its health
and mental health and wellbeing.
system, with particularly high performance in areas
of Administrative Efficiency, Health Care Outcomes 1.3 Barriers to pharmacists working at full
and Equity, but a low performance in Access to Care11. scope of practice
Australia’s low performance in access to care reflects
the need to improve the timeliness and convenience of The pharmacy university curriculum provides pharmacists
primary care access in local communities. with the required competencies; that is, the knowledge
and skills, to operate as medication managers. Registration
Community pharmacy location rules mean there is with the Pharmacy Board of Australia provides the
equitable distribution of community pharmacies across professional authority to practise pharmacy across the
Australia, providing the community with easy access full scope of pharmacy practice, which includes the
to a healthcare professional. Community pharmacies prescribing, dispensing, administering, and reviewing of
are the most frequently accessed and most accessible medicines.
health destination, making pharmacists the most visited
and accessible healthcare professional in Australia12. 1.3.1 Legislative authority
Community pharmacists see patients on a regular basis At present, pharmacists in Australia do not practise
without the need for an appointment. As such, community according to their full scope of practice, because they do
pharmacies are ideally placed to provide person-directed not have the legislative authority to do so. This means that
care to support people with their health concerns. they are unable to contribute to the healthcare system at
an optimum level, in accordance with their acquired and
In 2020-2021, approximately 1 in every 18 hospitalisations
assessed competencies. Because the existing pharmacy
in Australia was classified as potentially preventable.
university program facilitates the necessary competencies,
Measuring potentially preventable hospitalisations (PPH)
the impact of legislative authority changes would quickly
can provide valuable information on the effectiveness of
achieve a scale that would positively impact access to
health care in the community. Lack of timely, accessible,
quality health services and improve health outcomes
and adequate primary care all contribute to higher rates
significantly.
of PPH13. Data from 2021-22 shows increasing Emergency
Department (ED) wait times and a smaller portion being In 2014, the Grattan Institute stated that pharmacists
seen on time14. The quantifiable benefits of reducing PPH should be authorised ‘to give repeat prescriptions and help
and improving ED efficiency, to both the economy and to manage chronic care. Pharmacists should also be able to
the health of the community, through increased access to administer vaccinations.’16. While pharmacists are currently
quality health services and improved health outcomes can able to administer some vaccinations in community
be achieved by utilising community pharmacists working pharmacy dependent on jurisdiction, there is patient
to full scope of practice. demand beyond what is currently accessible. For example,
market research conducted in July 2022 by Orima
The accessibility and skills that pharmacists bring to
Research17 found that most consumers would be likely to
the health sector are valuable and should be optimised
obtain other types of vaccinations or wound care services
to improve the overall function of the health system15.
from their local pharmacy if such services were available18.
Community pharmacists being the most accessible health
professionals in the community are well placed to triage
patients and either treat or refer them to other health

11 Mirror, mirror 2021: Reflecting Poorly. Health Care in the U.S. compared to other high-income countries. (2021) Mirror, Mirror 2021: Reflecting Poorly | Commonwealth Fund
12 GuildLink data
13 Australian Institute of Health and Welfare, Disparities in potentially preventable hospitalisations across Australia, 2012-13 to 2017-18 https://www.aihw.gov.au/reports/primary-
health-care/disparities-in-potentially-preventable-hospitalisations-australia/contents/summary
14 Australian Institue of Health and Wellness, Emergency Department Care: https://www.aihw.gov.au/reports-data/myhospitals/sectors/emergency-department-care 2022.
15 QUT submission No 167 to the Queensland Government Inquiry into the establishment of a Pharmacy Council and pharmacy ownership in Queensland 11 July 2018
16 QUT submission No 167 to the Queensland Government Inquiry into the establishment of a Pharmacy Council and pharmacy ownership in Queensland 11 July 2018
17 The Pharmacy Guild of Australia commissioned Consumer Survey July 2022 wave (n=1,267); Orima
18 The Pharmacy Guild of Australia Commissioned Community Pharmacy 2025, Market Research Integrated Summary Report, Orima Research July 2022

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 5

 Additional research conducted by Insightfully in Professional services beyond dispensing and medication
September 2022 found that 88 percent of Australians management are generally self-funded by the patient,
“support community pharmacists being able to provide more even where there is recognition of the need to provide
health services to their patients, provided they are trained and Government subsidisation when the equivalent service
follow professional standards and guidelines”19. 77 percent is provided in other healthcare settings. This effectively
of respondents said they would feel comfortable with their denies access to these services for vulnerable populations
pharmacist monitoring their cholesterol levels and renewing who may not be able to afford private service fees and
relevant prescriptions, and 81 percent were comfortable with restricts all patients’ ability to choose the setting in which
receiving assessment, administration and/or supply of travel- their healthcare is delivered. Where a pharmacy operates
related vaccinations or preventive medicines. in a lower socioeconomic region, the service may not be
viable at all due to limited numbers of patients able to
Restrictive state and territory legislation is one of the
self-fund professional pharmacy services, thereby denying
main barriers to mobilising the 31,720 strong pharmacist
access to all patients in that area.
workforce20 to deliver additional health services to the
community. There are simple ways these restrictions can A prime example of this is access to National Immunisation
be addressed. For example, in Queensland, although Program (NIP) funded vaccines (e.g., influenza vaccine).
prescribing is not currently included in the regulations21 People eligible for NIP-funded vaccines may choose to get
describing a pharmacist’s role, the extended practice vaccinated at a community pharmacy due to easy access,
authority22 enabled under Queensland’s Medicines and convenience, and preference for the community pharmacy
Poisons Act 2019 allows appropriately trained pharmacists as a healthcare provider for vaccination. However, while
to dispense Prescription Only antibiotics for uncomplicated the cost of the NIP vaccine to pharmacy is covered by the
cystitis in females without the need for a prescription. Government, pharmacies must charge patients a service
fee for the administration of the vaccine, while an identical
However, to effectively utilise the Australian pharmacy
service provided by other healthcare providers such as
workforce and empower pharmacists to reduce
nurse practitioners includes a Government subsidised
preventable hospitalisations and avoidable emergency
service fee. This challenges the government’s policy intent
department presentations, a legislative approach to
of universal access for all Australians and disadvantages
facilitate the full scope of pharmacy practice across all
those eligible patients who choose to have their NIP
patient presentations (acute conditions, chronic conditions,
vaccination in a community pharmacy.
and preventive health matters) is required, rather than
limiting pharmacists’ scope of practice to management of More efficient access to healthcare services can
discrete conditions. be enabled through subsidisation of community
pharmacy services for vulnerable or target
1.3.2 Funding and remuneration
populations, and allow pharmacies to offer a wider
Another barrier to pharmacists working to full scope range of services to patients, improving access to
of practice is ensuring appropriate funding is available services for the community as a whole.
to support equity of access for all patients. While some
community pharmacy programs exist through the 7th Appropriate funding mechanisms equivalent to other
Community Pharmacy Agreement, which provide funding healthcare providers for the delivery of preventive
for patient medication management services, these health care would support increased and affordable
programs are limited in scope and operate under capped access to these services and better preventive health
budgets, meaning there is often unmet patient demand for outcomes for the community.
these services.

19 The Pharmacy Guild of Australia commissioned Full Scope of Practice, Community Pharmacists – National Opinion Research, Insightfully September 2022
20 Pharmacy Board of Australia, Registrant data (General registration): https://www.pharmacyboard.gov.au/About/Statistics.aspx, September 2022.
21 Queensland Government, Medicines and Poisons (Medicines) Regulation 2021: https://www.legislation.qld.gov.au/view/whole/html/inforce/current/sl-2021-0140 March 2023.
22 Queensland Government, Medicines and Poisons Act 2019 - Extended Practice Authority ’Pharmacists’: https://www.health.qld.gov.au/__data/assets/pdf_file/0027/1108944/epa-
pharmacists.pdf 1 March 2023.

6 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

1.3.3 Pharmacy classification and recognition 1.4 Comparison with the global pharmacist
As the most accessible primary health care profession, workforce
pharmacy should be classified as a primary health Pharmacists are among the most trusted of all
discipline like medical practice, nursing and dentistry, professionals, are found in most communities throughout
rather than being grouped with allied health disciplines. Australia and are accessible to patients without a long wait.
With this, pharmacy in general and community pharmacy Yet, compared to several other countries, pharmacists in
in particular must be recognised as an integral part of Australia are still not able to practise to their full scope of
the primary health care system and acknowledged as practice24. Despite some progress in pharmacist scope of
primary health care providers, including in health planning practice in various Australian states and territories, Australia
documents. continues to lag behind our international counterparts,
For the purposes of the Australian and New Zealand with other countries forging ahead and utilising
Standard Industrial Classification (ANZSIC, 2006), pharmacists practising to full scope to address healthcare
community pharmacies are currently included within access issues.
Division G (Retail Trade) and within a class (4271) that The main gaps are in areas such as the administration of
“consists of units mainly engaged in retailing prescription injectable medicines (including vaccines), therapeutic
drugs or patent medicines, cosmetics or toiletries”23. substitution and adaptation, medication continuance,
This classification of community pharmacy activities prescribing and laboratory testing. Australia lags behind
is inappropriate and misrepresentative. Community countries with equivalent economies and health systems
pharmacy activities should be reclassified to health care such as Canada, the UK, Ireland, the USA and New Zealand
(Division Q of the ANZSIC) as the principal activity is where there are examples of these practices being
dispensing and supply of medicines and the value added undertaken by pharmacists.
to the product by a community pharmacy enterprise is
undoubtedly a health-related value. This view is shared by a As stated in the International Pharmaceutical Federation
number of pharmacy organisations around the world and (FIP) Vision statement 2020-2025, “the COVID-19 pandemic
work is underway to seek a change at a global level. has demonstrated the essential role of pharmacies and
pharmacists in our communities and their ability to innovate
healthcare solutions. We must ensure their role continues to be
recognised beyond the pandemic”25.

23 Australian Bureau of Statistics, 1292.0 - Australian and New Zealand Standard Industrial Classification (ANZSIC), 2006 (Revision 1.0): https://www.abs.gov.au/ausstats/abs@.
nsf/0/38B020E62EB7934ECA25711F00146F09 2008.
24 Grattan Institute submission No 21 to the Victorian Legislative Council, Letting pharmacists do more: https://www.parliament.vic.gov.au/images/stories/documents/council/
SCLSI/Community_Pharmacy/Submissions/Sub_21_Grattan_Institute_30062014.pdf, June 2014.
25 International Pharmaceutical Federation (FIP), Vision 2020-2025 - Pharmacists at the heart of our communities. Community Pharmacy Section: https://www.fip.org/community-
pharmacy, August 2020.

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 7

 1.5 The way forward 1.5.2 Towards achieving full scope of practice in
Australia
1.5.1 The need to address gaps
In recognition of pharmacists as the experts in medicines,
Pharmacist competency training they must be afforded all appropriate authorities to
Recently registered pharmacists in Australia who have contribute fully to the Australian health care system by
studied under the current pharmacy curriculum already practicing at full scope of practice.
have the competencies to practise across the full scope of
The competencies of pharmacists are being underutilised
pharmacy practice as defined in the current Competency
by the legislative barriers that are currently limiting
Standards. Additional training is only required to familiarise
their scope of practice, and therefore their value to the
pharmacists with standardised professional guidelines
health system and all Australians is not being used to full
to undertake a task, pharmacy procedures or where an
advantage.
individual pharmacist identifies a gap in their competency
due to recency of practice or to reinforce previous The Guild is committed to working with all levels of
knowledge. governments to address competency, training, professional
standards, and any international or national precedents
Registered pharmacists that have been practising for many
to support the required regulatory amendments as the
years in the community need to assess their competency
profession of pharmacy evolves to meet health system and
in relation to any new, or additional task they undertake.
societal needs.
They need to access appropriate education, training,
or professional development to ensure they have the
contemporary knowledge and skills to perform the task or
additional services and meet any legislative or professional
requirements. This could be considered ‘retrofitting’ of
the workforce to ensure they have the competencies of
contemporary pharmacy practice, noting the evolving
nature of medicines, therapeutics, and health service
delivery. This retrofitting practice is common with all health
professions.
Pharmacist authorisation
Authorisation to undertake these additional tasks would
need to be enabled through amendments to relevant
federal, state and/or territory legislation.
These may include state and territory poisons regulations,
extended practice authorities or pharmacist standards and
codes, and Federal laws and legal instruments such as the
National Health Act (1953) and its subsidiary instruments
and the Poisons Standard.

8 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

2. DEFINING SCOPE OF
PRACTICE
2. DEFINING SCOPE OF
Scope of practice is defined in the National Competency
Standards Framework for Pharmacists in Australia 201626
PRACTICE
(Competency Standards).
Scope of practice is defined in the National Competency
Standards Framework for Pharmacists in Australia 2016.16
Scope of practice is a time sensitive, dynamic aspect
of practice which indicates those professional
activities
Scopethat a pharmacist
of practice is a time is educated,
sensitive, competent
dynamic aspect
of practice which indicates those professional
and authorised to perform, and for which they are
activities that a pharmacist is educated, competent
accountable
and authorised to perform, and for which they are
accountable
Figure 1 illustrates the components of Scope of Practice programs. Foundational core knowledge is achieved
andFigure
how 1these are the
illustrates achieved.
components of Scope of Practice and how
through a curriculum mapped to the Competency
knowledge is achieved through a curriculum mapped to the
these are achieved. Standards and the Australian
National Competency Pharmacy
Standards Framework forCouncil (APC)
Pharmacists and
Competency, that is, the required knowledge, skills, and
Performance Outcomes
the Australian Pharmacy Framework.
Council PracticalOutcomes
(APC) Performance competency
attributes
Competency,to prescribe,
that is, thedispense, administer
required knowledge, and
skills review
and attributes
to prescribe, dispense, administer and review medicines (Figure
assessments and work
Framework. Practical integrated
competency learning
assessments and(WIL)
work
medicines demonstrated in the Medication Management integrated learning (WIL) components of degree programs, and
2) is initially achieved through completion of an accredited components of degree programs, and the supervised
Cycle (Figure 2) is initially achieved through completion the supervised practice requirements of provisional registration
program of study that is approved by the Pharmacy Board of practice requirements of provisional registration further
of an accredited program of study that is approved by further develop knowledge and allow for demonstration of the
Australia. These programs of study include university degree develop knowledge and allow for demonstration of the
the programs
Pharmacy andBoard
internof Australia.
training These
programs. programscore
Foundational of study required skills.
required skills.
include university degree programs and intern training

General level training Specific training Professional

through accredited through acccredited Competency Legislation
program of study program of study Standard

“Knowledge” “Skill” Accountability Authority

to prescribe, dispense, to prescribe, dispense, to prescribe, dispense, to prescribe, dispense,
administer and review administer and review administer and review administer and review
medicines medicines medicines medicines

Scope = Competency (knowledge and skill),

accountability and authority to prescribe, dispense, administer and review medicines

Fig1.1.Understanding
Fig Understanding pharmacist
Pharmacist scope
Scope of practice,
of Practice, adapted
adapted fromfrom Poudel
Poudel A, LauA, LauCampbell
ETL, ETL, Campbell C, LM
C, Nissen Nissen
17
. LM
27

The Competency Standards give pharmacists the accountability to prescribe, dispense, administer, and review medicines
The Competency Standards give pharmacists the accountability to prescribe, dispense, administer, and review medicines as they form the28
as they form the basis of what is considered the acceptable standard of contemporary professional practice in Australia .
basis of what is considered the acceptable standard of contemporary professional practice in Australia.18
It is Itthrough state
is through stateand
and territory legislation,
territory legislation, thatthat the authority
the authority is given
is given for for pharmacists
pharmacists to prescribe,
to prescribe, dispense, dispense,
administer, administer, and
and review
review medicines.
medicines. It legislative
It is this is this legislative authority
authority that that also
also currently currently
restricts restricts
pharmacists frompharmacists fromfullpracticing
practicing to their scope. to their full scope.

16
National Competency Standards Framework for Pharmacists in Australia 2016
26 Pharmaceutical Society of Australia, National Competency Standards Framework for Pharmacists in Australia: https://www.psa.org.au/practice-support-industry/national-
17
Poudel A, Lau ETL, Campbell C, Nissen LM. Unleashing Our Potential- Pharmacists’ Role in Vaccination and Public Health.
competency-standards/, 2016.
Sr Care Pharm. 2020 Sep 1;35(9):372-378. https://pubmed.ncbi.nlm.nih.gov/32807260/
27 Poudel A, Lau ETL, Campbell C, Nissen LM. Unleashing Our Potential- Pharmacists’ Role in Vaccination and Public Health. Sr Care Pharm. 2020 Sep 1;35(9):372-378. https://
18
National Competency Standards Framework for Pharmacists in Australia 2016
pubmed.ncbi.nlm.nih.gov/32807260/
28 Pharmaceutical Society of Australia, National Competency Standards Framework for Pharmacists in Australia: https://www.psa.org.au/practice-support-industry/national-
competency-standards/, 2016.
Scope of Practice of Community Pharmacists 5
The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 9
 REVIEW PRESCRIBE

REVIEW PRESCRIBE
Transfer Decision to
of verified prescribe
DECISION ON
information
Transfer medicine
Decision to TREATMENT
of verified prescribe
Monitor for Record medicine DECISION ON
information medicine TREATMENT
response order (prescribe)
Monitor for Record medicine
response
Administration of medicine Review of
order (prescribe)
(reassessment preparation medicine order
Data collection
administration
Administration and recording)
of medicine Review of
Issue order and reporting.
(reassessment preparation Provision of medicine
medicine Audit review
Data collection
administration and recording)
Distribution and medicine
Issue of
andquality and
reporting.
storage of medicine information
Provision of
medicine safety
Audit review
Distribution and medicine of quality and
ADMINISTER storage of medicine information DISPENSE
safety

ADMINISTER Fig2.2.The
TheMedication
medicationManagement
management cycle(adapted)
29 DISPENSE
Fig Cycle 19

2.1 Scope
2.1 Scopeof
ofPractice
practice– –Individual versus
Individual versus Profession
Fig 2. Theprofession
Medication Management Cycle (adapted)19
Scope of practice defines the boundaries of professional practice (Figure 3).
Scope of practice defines the boundaries of professional practice (Figure 3).
2.1 Scope of Practice – Individual versus Profession
An individual’s scope of practice is influenced by the professional roles they perform, or services they provide. Maintaining competency
An individual’s
Scope of practicescope ofthe
defines practice is influenced
boundaries by the
of professional professional
practice roles they perform, or services they provide. Maintaining
(Figure 3).
in one’s scope of practice is achieved through ongoing education and mandatory continuing professional development requirements.
competency within one’s scope of practice is achieved through ongoing education and mandatory continuing professional
This involves creating
An individual’s scope ofanpractice
individualised professional
is influenced by thepractice profile
professional andthey
roles selecting relevant
perform, competencies
or services fromMaintaining
they provide. the 2016 Competency
competency
development
Standards. requirements. This involves creating an individualised professional practice profile and selecting relevant
in one’s scope of practice is achieved through ongoing education and mandatory continuing professional development requirements.
competencies from an
This involves creating theindividualised
Competency Standards.practice profile and selecting relevant competencies from the 2016 Competency
professional
A pharmacist working to their full scope of practice is only limited by their individual training, experience, expertise and demonstrated
Standards.
Acompetency,
pharmacistwithin
working to theiroffull scope
the context their placeofofpractice
practice, is only limited
workplace by and
policies theirthe
individual training,
health care needs ofexperience,
patients. expertise and
demonstrated competency,
A pharmacist working within
to their full scopethe contextisofonly
of practice their placebyoftheir
limited practice, workplace
individual training, policies andexpertise
experience, the health care needs of
and demonstrated
patients.
competency, within the context of their place of practice, workplace policies and the health care needs of patients.
PROFESSIONAL SCOPE
Legislation, Regulation, Standards (Ethics)
PROFESSIONAL SCOPE
Legislation, Regulation, Standards (Ethics)
INDIVIDUAL SCOPE

Skills SCOPE
INDIVIDUAL
Knowledge
Attributes
Skills
Experience
Knowledge
Ethics
Attributes
Accountability
Experience
Ethics
Accountability
Fig 3. Scope of Practice of the Profession versus that of the Individual, adapted from National
Competency Standards Framework for Pharmacists in Australia20
Fig 3. ScopeFig
of 3.
practice ofPractice
Scope of the profession versus that
of the Profession of the
versus individual,
that adaptedadapted
of the Individual, from thefrom
Competency
National Standards
Competency Standards Framework for Pharmacists in Australia20
19
Adapted from Stowasser D, Understanding the Medicines Management Cycle, in The Dispensing Process (PGA)
20
National Competency Standards Framework for Pharmacists in Australia 2016.
19
Adapted from Stowasser D, Understanding the Medicines Management Cycle, in The Dispensing Process (PGA)

629 National Competency Standards Framework for Pharmacists in Australia 2016.

20
Scope
Adapted ofStowasser
from Practice of Community
D, Understanding Pharmacists
the Medicines Management Cycle, in The Dispensing Process (PGA)

10 6ScopeScope ofofPractice
of Practice Communityof Community
Pharmacists Pharmacists
in Australia The Pharmacy Guild of Australia
The scope of practice for the pharmacy profession is 2.2 International benchmarking
defined within the Competency Standards. Pharmacists
The scope of practice for pharmacists in countries with
must register with the Pharmacy Board of Australia to
comparable economies and health systems highlights that
practice as a pharmacist, requiring pharmacists to meet
some countries are more advanced than Australia in the
registration standards30 that recognise and assess against
tasks they are authorised to perform.
the Competency Standards31,32.
As an example, in Canada33, the United Kingdom34 and
As professional practice evolves and the profession
New Zealand35, community pharmacies manage common
matures to meet the needs of the health care system, and
ambulatory conditions, including conditions such as
society in general, so do the Competency Standards due to
urinary tract infections, back pain and eczema.
their dynamic nature and regular review cycle. The capacity
of the Competency Standards to support and enable In Canada36, Scotland37 and New Zealand38, pharmacists’
professional practice and growth over time is invaluable to scope of practice includes prescription renewal and
championing full scope of practice for pharmacists now, the management of the ongoing supply of prescribed
and in the future. medicines for stable, chronic conditions without the need
to necessarily return to the prescriber.
Therefore, ‘Full Scope of Practice’ for the profession
is supported by the competencies defined in the In New Zealand39, Canada40 and the United Kingdom41,
current version of the Competency Standards and pharmacist prescribing programs enable pharmacists to
explained using specific roles and activities performed prescribe a wide range of medicines within their clinical
by pharmacists registered with the Pharmacy Board competence, including but not limited to antibiotics
of Australia, currently authorised or requiring for urinary tract infections, oral contraceptives and oral
authorisation under relevant legislation in each state COVID-19 antivirals. New Zealand and United Kingdom
and territory. pharmacists can prescribe for a range of chronic long term
health conditions including hypertension, cardiovascular
disease, Parkinson’s’ Disease, epilepsy as well as mental
health and respiratory conditions.

30 Pharmacy Board of Australia, Registration Standards: https://www.pharmacyboard.gov.au/Registration-Standards.aspx, 2016.

31 Pharmacy Board of Australia, Registration Standard: Examinations for eligibility for general registration: https://www.pharmacyboard.gov.au/Registration-Standards.aspx, 1 Dec
2015.
32 Pharmacy Board of Australia, Registration Standard: Continuing Professional Development: https://www.pharmacyboard.gov.au/Registration-Standards.aspx, 1 Dec 2015.
33 Canadian Pharmacists Association, Scope of Practice: https://www.pharmacists.ca/advocacy/scope-of-practice/, January 2023.
34 National Health Service, NHS Inform - NHS Pharmacy First Scotland: https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/nhs-pharmacy-first-scotland,
February 2023.
35 Pharmaceutical Society of New Zealand Incorporated, Pharmacy Healthcare Services: https://www.psnz.org.nz/healthservices, 2023.
36 Canadian Pharmacists Association, Scope of Practice: https://www.pharmacists.ca/advocacy/scope-of-practice/, January 2023.
37 National Health Service, NHS Inform - NHS Pharmacy First Scotland: https://www.nhsinform.scot/care-support-and-rights/nhs-services/pharmacy/nhs-pharmacy-first-scotland,
February 2023.
38 Pharmaceutical Society of New Zealand Incorporated, Pharmacy Healthcare Services: https://www.psnz.org.nz/healthservices, 2023.
39 Parliamentary Counsel Office - New Zealand Legislation, Medicines (Designated Pharmacist Prescribers) Regulations 2013: https://www.legislation.govt.nz/regulation/
public/2013/0237/4.0/whole.html, 2013.
40 Alberta College of Pharmacy, What drugs can pharmacists prescribe?: https://abpharmacy.ca/what-drugs-can-pharmacists-prescribe, 2022.
41 Medscape, How did Pharmacists Become Prescribers?: https://www.medscape.co.uk/viewarticle/how-did-pharmacists-become-prescribers-2022a10016vc, April 2019.

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 11

 3. DOMAINS OF COMPETENCY IN FULL SCOPE OF PRACTICE
The competencies and scope of The domains of competency for pharmacists in providing patient care include:
practice of pharmacists are time-
sensitive, dynamic, and responsive to
emerging science and therapeutic
1 Medication supply and dispensing
trends, and the needs of the
Australian health system and society
in general. 2 Prescribing
Therefore, what may be described as
‘Full Scope of Practice’ today will not 3 Medication review
be the same as ‘Full Scope of Practice’
in the years ahead. It is for this reason
that this will be a living document,
4 Population health
updated regularly in response to
evolving needs, and documenting
the changes achieved.
5 Health conditions

6 Medicine administration

7 Ordering and interpreting laboratory tests

3.1 Medication supply and dispensing

The supply of non-prescription pharmacy medicines There are additional activities that are within a pharmacist’s
and dispensing activities are core competencies of scope of practice that they do not currently have the
a pharmacist, requiring a pharmacist’s expert clinical authorisation to perform or for which authorisation is
assessment regarding therapeutic appropriateness for and restricted. In the sub-domains below are some specific
safety of the patient. activities identified where action is required for pharmacist
to work to full scope.
The terms dispensing and supply are defined as:
Dispensing – the review of a prescription and the Medication continuance (prescription renewal)
preparation, packaging, labelling, record keeping and transfer Current Federal, state and territory laws allow for
of the prescribed medicine including counselling to a patient, pharmacists to supply some Prescription Only medicines
their agent, or another person who is responsible for the for long-term health conditions in an emergency in the
administration of the medicine to that patient42. absence of a prescription. These Emergency Supply and
Continued Dispensing arrangements provide a one-off
Supply – to give a regulated substance without a prescription
short supply of a person’s regular prescription medicine
for the treatment of a condition43.
to continue treatment until they can see an authorised

42 Pharmacy Board of Australia, Guidelines for dispensing of medicines: https://www.pharmacyboard.gov.au/Codes-Guidelines.aspx, September 2015.
43 Department of Health and Aged Care, Therapeutic Goods Administration: https://www.tga.gov.au/resources/resource/guidance/serious-shortage-medicine-substitution-
notices#:~:text=Supply%20is%20different%20to%20dispensing,does%20not%20require%20a%20prescription. 16 February 2021.

12 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

prescriber. While state and territory laws are required to are currently no pharmacist prescription renewal options
authorise both, the Continued Dispensing arrangements available to those who use hormonal contraceptives as
are a federal initiative in which the emergency supply of their regular contraceptive medication.
medicine is subsidised under the Pharmaceutical Benefits
Pharmacists have been dispensing the contraceptive pill
Scheme (PBS). From March 2020 to June 2022, as part
since it was initially marketed in Australia almost 60 years
of the COVID-19 management response, the Federal
ago. Prescription renewal (and therapeutic adaptation)
Continued Dispensing arrangements allowed pharmacists
for hormonal contraceptives (for women who have
to use their professional judgement for urgent supply
been previously assessed and prescribed a hormonal
arrangements for the whole general schedule of the PBS.
contraceptive) is already within a pharmacist’s scope
This was recognised in all jurisdictions with restrictions in
of practice and would improve affordable access to
place for Controlled Drugs. From 1 July 2022, Continued
contraception for Australian women.
Dispensing arrangements were reduced to a much
smaller list of PBS-listed medicines for the treatment of Legislative enablement for pharmacists to practise
blood pressure, diabetes, asthma and HIV. These were in to their full scope will ensure that Australians can
addition to the original 2012 Continued Dispensing list that receive timely and judicious access to their regularly
included oral contraceptives and statins for dyslipidaemia. prescribed medications, by allowing Continued
While an expansion on the arrangements from 2012, the Dispensing for the whole PBS schedule in urgent
reduced list of medicines failed to recognise the benefit situations and enabling prescription renewal from
provided by the service for patients with a wide range their pharmacist for ongoing supply, including as a
of chronic long term health conditions. It also failed to pharmaceutical benefit when eligible.
recognise the incidence of multimorbidity (2 or more Therapeutic substitution
chronic conditions at the same time), with pharmacists
Therapeutic substitution (of equivalent medications)
now only able to assist patients with urgent supply
by pharmacists is at times necessary to ensure there
arrangements of subsidised medicines for some conditions
is continuity of appropriate clinical care for patients,
but not others44.
especially in situations where there is a shortage of the
International benchmarking suggests there is opportunity for medicine(s) concerned.
increasing authorisation for prescription renewal activities.
Medicines shortages are an ongoing problem for Australians
A change in legislation is needed to enable pharmacists and a significant administrative burden for community
to renew a prescription for a prescribed medicine on an pharmacies and prescribers. Australia’s medicines shortages
ongoing basis. Medication continuance is used in the UK stem from the fact that we import over 90% of medicines
and prescription renewal is enabled across many Canadian and are at the end of an exceptionally long global supply
provinces, where doctors can authorise pharmacists to chain, making the nation vulnerable to supply disruptions46.
continue dispensing for an agreed period. This can lead Additionally, Australia represents only 2% of the global
to a more efficient use of the time and expertise of a pharmaceutical market and precedence is given to markets
pharmacist and a General Practitioner (GP), and it reduces with the highest return on investment47.
costs to patients45.
The Therapeutic Goods Administration (TGA), in response
An example where prescription renewal by pharmacists to extreme medicine shortages experienced at the onset
should be authorised is for hormonal contraceptives of COVID-19 and recognising ongoing shortages due
including oral and injectable contraceptives, and vaginal to various issues in the medicine supply chain, initially
rings. Current state and territory regulations are limited to established the Serious Shortage Substitution Notice (SSSN)
allowing Emergency Supply or Continued Dispensing of process. This allowed pharmacists to substitute specific
the OCP (oral contraceptive pills) in emergency situations, medicines without prior approval from the prescriber
with the latter limited to once every twelve months. There during critical shortages of that medicine, however, state

44 Department of Health and Aged Care, Pharmaceutical Benefits Scheme - PBS Continued Dispensing Arrangements: https://www.pbs.gov.au/info/general/continued-
dispensing#:~:text=Continued%20Dispensing%20complements%20other%20emergency%20supply%20provisions%20available,need%20to%20comply%20with%20
state%20and%20territory%20requirements. December 2022.
45 Grattan Institute submission No 21 to the Victorian Legislative Council, Letting pharmacists do more: https://www.parliament.vic.gov.au/images/stories/documents/council/
SCLSI/Community_Pharmacy/Submissions/Sub_21_Grattan_Institute_30062014.pdf, June 2014.
46 Institute for Integrated Economic Research, Australia’s Medicine Supply, February 2020.
47 Felicity Nelson, The real reasons we have drug shortages:https://medicalrepublic.com.au/real-reasons-drug-shortages/10976, September 2017.

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 13

 and territory legislation needed to be enabled for this Pharmacists can effectively manage continuity of care,
substitution to occur48. The SSSN process has since been particularly during times of medicines shortages, if
replaced by the Serious Scarcity Substitution Instrument legislative enablement allows pharmacists to practise
(SSSI) process, whereby an SSSI (legislative instrument) to their full scope with fully enabled therapeutic
specifying substitutable medicines is made in response to a substitution.
serious scarcity being declared for a medicine. SSSI enable
Therapeutic adaptation
pharmacists to substitute medicines in accordance with the
circumstances specified in the SSSI and are automatically Therapeutic adaptation is the process of altering an
recognised across Australia without amendment to state existing prescribed medication to change/adapt dosage,
and territory legislation49. formulation or regimen, based on a determination of
clinical need.
However, the current mechanisms for pharmacists
to provide therapeutic substitution involve an overly This is another area where state and territory legislation
complicated process which does not recognise a prohibit pharmacists from exercising their clinical
pharmacist’s expertise and capabilities. This places patients judgment and positively intervening in therapy in the
at risk of harm, as pharmacists are limited in how they best interests of the patient. It may be that the pharmacist
can respond and support patients when the pharmacy believes that a capsule rather than a tablet is going to
cannot procure the specific prescribed medicine. better suit a particular patient, or that the prescribed
Additionally, therapeutic substitution via the SSSI process dosage should be adjusted, to achieve the best therapeutic
is not automatically covered by the PBS. The Department outcome for the patient but in neither case can such a
of Health and Ageing must separately authorise the decision be implemented unless the prescribing doctor
substitution under an SSSI to be eligible for subsidisation as writes a new prescription.
a pharmaceutical benefit so as not to increase patient costs A common example of where a pharmacist needs to
for their PBS medicines. Pharmacists are medicines experts, adapt the medicine dosage is in regard to prescriptions
and the straightforward dose, form and equivalency for medicine for children, in cases where the doctor has
therapeutic substitutions are within the competency of inadvertently and incorrectly prescribed a sub-therapeutic
every pharmacist in Australia to manage autonomously or supratherapeutic dose based on the weight of the child
with their patients. and the prescription needs to be amended prior to supply.
To optimise the current provisions, therapeutic substitution Often, the prescription may be brought in after-hours
should enable pharmacists to prescribe the substitution when the prescriber is unavailable, and the medicine is
of a medicine that contains chemically different active required immediately.
ingredients that are considered to be therapeutically Legislative enablement for pharmacists to practise
equivalent (when required), to ensure continuity of care in to their full scope will empower pharmacists to make
times of medication shortage or other disruptions to the therapeutic adaptations to prescribed medications,
supply of a patient’s regular medicines. to optimise therapeutic outcomes and reduce
Fully enabled therapeutic substitution by a pharmacist unnecessary hospitalisations or GP visits related
without the need to consult a prescriber should be allowed to sub/supra-therapeutic response and/or adverse
in Australia to manage medicine shortages. It is already medication events.
permitted in equivalent countries, such as the USA and
Canada without compromising safety. A medicine shortage
is not only inconvenient but can potentially have negative
health effects for patients by interrupting treatment and
affecting adherence.

48 Serious Shortage Medicine Substitution Notices | Therapeutic Goods Administration (TGA)

49 Substituting scarce medicines | Therapeutic Goods Administration (TGA)

14 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

3.2 Prescribing

The Guild defines prescribing as a patient-centred or The British Pharmacological Society has developed ten
patient-driven process involving the steps of information prescribing principles for all health care professionals
gathering, clinical decision making, communication and to follow which underpin safe and effective use of
evaluation which results in the initiation, continuation or medicines53. The ten principles are:
cessation of a medicine. The intent of prescribing is that it 1. Be clear about the reasons for prescribing
is a continuum of practice, a tool that can take on various
2. Take into account the patient’s medication history
forms.
before prescribing
There are three types of non-medical prescribing: 3. Take into account other factors that might alter the
autonomous prescribing, supervised prescribing, and via a benefits and risks of treatment
structured prescribing arrangement. These are described as:
4. Take into account the patient’s ideas, concerns, and
Autonomous prescribing – Prescribing occurs where expectations
a prescriber undertakes prescribing within their scope of 5. Select effective, safe, and cost-effective medicines
practice without the approval or supervision of another health individualised for the patient
professional. The prescriber has been educated and authorised
6. Adhere to national guidelines and local formularies
to autonomously prescribe in a specific area of clinical practice.
where appropriate
Although the prescriber may prescribe autonomously, they
7. Write unambiguous legal prescriptions using the
recognise the role of all members of the health care team and
correct documentation
ensure appropriate communication occurs between team
members and the person taking medicine.50 8. Monitor the beneficial and adverse effects of medicines
9. Communicate and document prescribing decisions and
Supervised prescribing – Prescribing occurs where a
the reasons for them
prescriber undertakes prescribing within their scope of
practice under the supervision of another authorised health 10. Prescribe within the limitations of your knowledge, skills
professional. The supervised prescriber has been educated and experience
to prescribe and has a limited authorisation to prescribe Pharmacists practising in Australia can apply these
medicines that is determined by legislation, requirements of principles when they are prescribing within their scope of
the National Board and policies of the jurisdiction, employer practice.
or health service. The prescriber and supervisor recognise
Prescribing of Schedule 4 and Schedule 8 medicines
their role in their health care team and ensure appropriate
communication occurs between team members and the In Australia, in recognition of the need to increase the
person taking medicine.51 number of prescribers for continued equity of access to
medicines, prescribing rights have already been extended
Structured prescribing arrangement – Prescribing occurs
to several non-medical professions but not to pharmacists,
where a prescriber with a limited authorisation to prescribe
even though pharmacists have the relevant competencies.
medicines by legislation, requirements of the National Board
and policies of the jurisdiction or health service prescribes Prescribing rights are available to doctors, dentists, nurse
medicines under a guideline, protocol or standing order. A practitioners, midwives, optometrists and podiatrists, with
structured prescribing arrangement should be documented all except podiatrists able to also prescribe medicines
sufficiently to describe the responsibilities of the prescriber(s) subsidised under the PBS. By international standards,
involved and the communication that occurs between pharmacists in Australia are a notable omission from the
team members and the person taking medicine. Health range of health professions with prescribing authority, and
professionals may work within more than one model of in this regard, Australia lags behind countries such as the
prescribing in their clinical practice.52 UK, USA, Canada and NZ.54

50 Health Workforce Australia, Health Professionals Prescribing Pathway (HPPP) Project (2013): https://www.aims.org.au/documents/item/400
51 Health Workforce Australia, Health Professionals Prescribing Pathway (HPPP) Project (2013): https://www.aims.org.au/documents/item/400
52 Health Workforce Australia, Health Professionals Prescribing Pathway (HPPP) Project (2013): https://www.aims.org.au/documents/item/400
53 British Pharmacological Society, Ten Principles of Good Prescribing: https://www.bps.ac.uk/education-engagement/teaching-pharmacology/ten-principles-of-good-
prescribing, Accessed March 2023.
54 Pharmacy Board Commissioned Report 9 December 2015 Pharmacist Prescribing in Australia by Lisa Nissen et al of QUT

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 15

 The Queensland University of Technology’s (QUT) submission pressure medicine) and return to their GP for review and
to the 2018 Queensland Inquiry referred to the ASPRINH to adjust dose, add, or change to a new medicine to
Project (Cardiff L et al, 2017) led by QUT which found that manage therapeutic response or an adverse reaction. This
pharmacists are well aligned to the National Prescribing is time consuming and costly for patients and the health
Competencies and that universities prepare students well for system, and it could efficiently be managed by community
roles in medicines management and for models of prescribing pharmacists after diagnosis. Prescribing medicines is within
practice with the existing training curriculum. the scope of practice of pharmacists and included as a
competency in the Competency Standards.
However, prescribing is not currently included in legislation
describing a pharmacist’s role; there is only reference to the Legislative enablement to allow pharmacists to
supply of Schedule 2 and Schedule 3 medicines, and the supply prescribe is needed to realise the potential patient
activity is not considered prescribing, even though, in order benefits and health system savings resulting from
to effectively and safely supply an appropriate therapeutic pharmacists prescribing within their individual
intervention in the community pharmacy, the pharmacist scope for acute conditions, chronic conditions and
undertakes a process that reflects the components of the preventive health measures.
prescribing process; i.e., information gathering, clinical decision
Enabling funding mechanisms for community
making, communication and evaluation.55
pharmacy services that are equivalent to services
There are several practical examples where pharmacist provided by other healthcare professionals will provide
prescribing would enable better patient access to care, effective, equitable access to services for patients.
increase health system efficiency and reduce unnecessary
Deprescribing
hospitalisations, if there was enabling legislation in place to
allow pharmacists to prescribe. These include: Prescribing medicines is within the scope of practice of
pharmacists, therefore so too is the ability to deprescribe
• Effectively and appropriately managing acute pain
medicines. The World Health Organisation’s Guide to
conditions (such as dental pain) through judicious
Good Prescribing includes a step to ‘Monitor (and stop?)
prescribing of moderate-strong pain medication for
the treatment’, where it recommends using treatment
immediate, short-term relief while patients are waiting
monitoring to determine whether a treatment has been
for a dental appointment.
successful or whether additional action is needed56.
• Prescribing an appropriate respiratory preventer Treatment monitoring is already within the scope of
medication consistent with an asthma or Chronic practice of a pharmacist; and using clinical knowledge and
Obstructive Pulmonary Disease (COPD) management professional judgement, a pharmacist has the competency
plan for patients experiencing worsening asthma or to deprescribe medicines and refer the patient for further
COPD symptoms, without needing to delay optimal review where appropriate.
symptom management while waiting to see their GP.
Currently, pharmacists determine the therapeutic need
• Providing timely access to preventative health measures
of a patient when considering whether to recommend a
through pharmacist prescribing of both pre- and
non-prescription medicine or whether it may no longer be
post-exposure prophylaxis for HIV (PrEP and PEP), while
required. However, current legislation restricts the ability of
also providing appropriate community access to HIV
a pharmacist to deprescribe a Prescription Only Medicine
screening and sexual health referrals when required.
or Controlled Drug where there is no longer a therapeutic
• Prescribing medicines for diagnosed chronic health need for the medicine or due to adverse effects. As an
conditions (e.g. hypertension, diabetes, dyslipidaemia) example, pharmacists could trial cessation of long-term
consistent with the current therapeutic guidelines. proton pump inhibitors and monitor and assess patient
A pharmacist is the best placed health professional to outcomes for permanent cessation.
effectively manage the up-and-down titration of newly Legislative enablement to allow pharmacists to
prescribed medicines (e.g. antihypertensives, respiratory deprescribe within their individual scope for acute
medicines) to ensure patients are appropriately stabilised conditions, chronic conditions and for preventive
on an optimal medicine dosage based on clinical effect health measures would enable pharmacists to
and medication tolerance. Under current arrangements, contribute to reducing polypharmacy, thereby
patients must trial a prescribed medicine (e.g. blood- providing patient and economic benefits.

55 Pharmacy Board Commissioned Report 9 December 2015 Pharmacist Prescribing in Australia by Lisa Nissen et al of QUT
56 World Health Organisation, Guide to Good Prescribing – A practical manual.

16 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

3.3 Medication review

Medication management review Eligibility criteria for Federal funded HMR and RMMR
Medication management reviews involve the review of programs require pharmacists to be an ‘accredited
a patient’s medicines to assure quality use of medicines. pharmacist’58 – an additional training and accreditation
Pharmacists consult with patients to ensure safe and process.
appropriate use of their medicines and to identify and Pharmacy degree programs now include a substantial
address any medicine-related problems. Noting that every component in their curriculum of the necessary
pharmacist uses their clinical expertise and experience knowledge, skills and competencies to undertake
to perform a general medicine-assessment at the time of comprehensive medication management reviews,
dispensing or enrolling/updating dose administration aids indicating that the additional training is not required for
(DAA) for patients (e.g. assessing potential interactions, recent graduates. Additional education would only be
dosage or adherence issues), in-pharmacy medicines required where a pharmacist has identified gaps in their
reviews, home medicines reviews (HMRs) and residential competency to complete a HMR or RMMR.
medication management reviews (RMMRs) are types of
This is an example of how, as the profession evolves to
more comprehensive medication management reviews
meet the needs of the health system and society, so should
performed by pharmacists.
the relevant authorisations, reducing the barriers to all
Patients are particularly vulnerable at any point of pharmacists working to their full scope of practice.
transfer between care providers, such as entry to or post-
Pharmacists have the necessary medicines knowledge,
discharge from hospitals, residential or respite facilities.
skills and resources to undertake and remain competent
A reconciliation and review of a person’s medicine at the
to complete a medicine review such as a HMR or RMMR.
time of transition of care is an area where community
However, program requirements restrict providers
pharmacists can play a valuable role, particularly for
to accredited pharmacists, therefore limiting many
patients at high-risk of readmission or with complex
pharmacists from working to their full scope of practice
medicine-related needs. This was recognised in the final
and limiting patient access to medicine review services.
report of the Royal Commission into Aged Care Quality
and Safety which recommended medicine reviews by a Removing requirements for additional accreditation
pharmacist on entry to a residential facility57. The transition for medication management services would enable
between hospital and community or residential care pharmacists to work to full scope of practice and
is particularly problematic, and it is essential that there ensure patients are able to access these medication
is effective communication between the hospital and management services without delay.
primary care providers, including community pharmacy, on
discharge.

57 Aged Care Royal Commission Final Report: Recommendations; Recommendation 64

58 Medication Management Programs – Pharmacy Programs Administrator (ppaonline.com.au); January 2023

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 17

 3.4 Population health

Community pharmacy offers a highly accessible network of Screening

primary health care delivering quality advice and services, Community pharmacies provide health screening services
and as such is poised for effective and agile preventive for acute conditions, chronic conditions and preventive
health activities. Pharmacies exist in well dispersed and health including chronic obstructive pulmonary disease
accessible locations, and often operate over extended (COPD), sleep apnoea, diabetes risk, cardiovascular risk,
hours, seven days a week in urban, rural and remote areas. anaemia, cholesterol and sexually transmitted infections.
Services that community pharmacy offers that contribute Some community pharmacies provide influenza-screening
to the health outcomes of their community include, but services using point-of-care devices59 in addition to
are not limited to: providing similar in-store and supervised outreach
services during the COVID-19 pandemic. Pharmacists
• provision of up-to-date and locally relevant information
perform screening using screening tools (questionnaire
on other health care and support services and resources.
or device) and provide education and referral for patients
• participation in community health, preventive health and at risk where appropriate. Health screening in community
other public health services. pharmacy is an important measure in identifying patients
• distribution of public health information and educational who potentially require intervention for a health condition
materials. they may be unaware they have. This could be enhanced
• health promotion activities and group education by ensuring that screening services offered by all health
programs. providers can be readily uploaded to a shared patient
• screening and risk assessments record with means of notifying the patient’s GP or other
members of their health care team.
• harm minimisation programs such as needle and syringe
programs and opioid replacement therapy. Health screening services are recognised within the
scope of practice for pharmacists, with the main barrier
Preventive health
to pharmacists working to full scope again being lack of
Pharmacists already conduct preventive health programs funding mechanisms for these services as a coordinated
that contribute to the health system action of preventive program, meaning vulnerable and target populations are
health. Such programs include immunisation programs required to self-fund access to these services. This is in
(discussed specifically under section 3.5.1), smoking stark contrast to government funded screening programs
cessation programs, weight management programs, delivered through other health providers where patient
harm minimisation programs and general health checks. costs are subsidised, particularly for vulnerable and target
However, as with all professional services beyond populations.
dispensing and medication management, current self-
funding arrangements for all patients seeking preventive
health services through community pharmacy limit access
for vulnerable populations, and the wider population
where the service is not viable due to self-funding as a
limiting factor.
Where there are funded programs available at the state
level, such as harm minimisation, there is significant
variability between available remuneration and patient
access criteria, including quotas and patient co-payments.
This affects both the level of community pharmacy
participation and the extent to which patients can be
supported by their preferred community pharmacy.

59 Rapid tests for the diagnosis of influenza – Australian Prescriber (nps.org.au)

18 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

3.5 Health conditions

Community pharmacists provide a range of services Pharmacist management of everyday health conditions is
which extend well beyond the provision of prescription an under-recognised activity that adds significant value to
medicines and, as such, pharmacies are often the first the health system. Research conducted by Orima in 2022
contact point of the primary health care system for many showed that all pharmacies surveyed reported providing
people. Sometimes these services can be provided without patient consultation on common conditions daily, with
the need for an appointment where they may not be time- over half of pharmacies surveyed reporting over 20 such
consuming and when the pharmacy is suitably staffed. consultations occurring daily, and 65% of these patients
indicating they would otherwise have attended their
Services that community pharmacy offer for everyday
local Emergency Department or GP60. Pharmacists can
health conditions and chronic health conditions include,
assess and triage these common conditions, and either
but are not limited to:
treat patients within their scope, or refer them to another
• assessment, treatment, and provision of information health professional. This assessment, triaging and referral
about medicines and health conditions. process can help to reduce the burden on emergency
• referral to and collaboration with a GP or Hospital departments, and allow GPs to focus on more complex and
Emergency Services; and chronic conditions.
• referral to and collaboration with other appropriate The main barrier to provision of these services is a lack
health professionals where required; e.g. community of adequate funding mechanisms that recognise the
health nurses, mental health services, physiotherapists, role pharmacists play in delivering primary healthcare
drug and alcohol rehabilitation facilities etc. services for patients. In fact, a pharmacist may spend
• monitoring of health conditions and biomarkers such as time assessing and advising a patient and not receive any
blood pressure, blood glucose levels, INR and cholesterol remuneration for their time as they may have determined
levels. that a treatment option is not required, or that referral
Everyday health conditions is necessary. The Orima research indicates that unpaid
pharmacy consultations last on average between 5 and 10
The management of everyday health conditions is a
minutes, which is a significant use of pharmacist time.
core component of pharmacy practice. Pharmacists
provide management, both pharmacological and non- Community pharmacies must be remunerated for
pharmacological, for common conditions including service consultations, including recognition of the
wounds, pain (e.g. migraine, dental pain, arthritic pain), time differential that can be involved according to
urinary tract infections, acne, constipation, diarrhoea, a patient’s needs. Pharmacist health and medicine
hay fever, common colds, head lice, mouth ulcers, consultations can be used to manage less complex
gastro-oesophageal reflux, vaginal thrush and tinea. everyday health conditions as well as to triage and
For the management of everyday health conditions refer situations requiring more expert oversight.
pharmacists across all jurisdictions can recommend and Such an arrangement would cost-effectively re-
supply medicines that are unscheduled, schedule 2 and distribute the workload to enable GPs and emergency
schedule 3 medicines. Pharmacists can also provide patient departments to prioritise and manage the more
education and advice on lifestyle modifications. complex and/or serious conditions.

60 Orima, 2022. Framework for Change Survey of Guild Members, unpublished.

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 19

 Chronic health conditions The role that pharmacists can play in the management
Chronic health conditions are long-lasting conditions of chronic conditions is evolving, and this is reflected in
which might be preventable or delayed through lifestyle pharmacists becoming credentialed diabetes educators,
measures, and which can be managed on an ongoing certified asthma educators and mental health first aiders.
basis to control or prevent worsening of symptoms These roles are restricted to pharmacists who have
and avoid hospitalisation or excessive health care. They completed additional training in these specific areas,
include conditions such as diabetes, COPD, cardiovascular despite recent pharmacy graduates having many of the
disease, mental health conditions, epilepsy, glaucoma, competencies required for these roles. Multimorbidity
Parkinson’s Disease and asthma. Pharmacists contribute brings a greater risk of polypharmacy and as discussed
to the management of chronic health conditions by way previously, pharmacists can provide medicine review and
of ongoing treatment monitoring, therapeutic medicine adherence services to assist people with understanding
monitoring, education, lifestyle interventions and advice. and managing their medicines and addressing medicine-
related problems.
The Australian Institute of Health and Welfare found that
chronic conditions are becoming increasingly common, Greater recognition of the role that pharmacists can
with many patients experiencing multimorbidity (2 or play in the management of chronic health conditions
more chronic conditions at the same time)61. will allow pharmacists to practice to full scope and
provide patients with chronic conditions better access
to healthcare services.

61 Australian Institute of Health and Welfare, Chronic disease overview, Updated 10 November 2020. https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/
chronic-disease/overview

20 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

3.6 Medicine administration

Pharmacists support patients in the administration of all The geographical spread of pharmacies throughout
their medicines by ensuring appropriate counselling and Australia, combined with their convenience and extended
advice, or provision of devices that assist effective use, such hours of operation, assists in increasing vaccination
as spacers for asthma. rates. The administration of vaccines by pharmacists
complements the work of traditional immunisers. This
Pharmacists can support patients further especially for
increased choice and the convenience of being able to
vaccine and non-vaccine injections if given the authority
walk in and be immunised opportunistically means that a
through legislative amendments, which will have benefits
greater number of at-risk patients, particularly older adults,
to the patient and the health system.
can access the service, including those who might not
However, while pharmacists are trained to administer otherwise have been vaccinated, for example in the case of
medications by injection, legislation currently restricts the annual influenza vaccine.64
pharmacists to administering a limited range of injectable
Despite community pharmacy demonstrating a willingness
medicines determined at a state or territory level with
and capability to administer vaccines, pharmacists are
significant variability between jurisdictions.
only able to administer a limited range of vaccines with
Vaccines significant variation between the states and territories
Pharmacists have only been involved in the supply and as to which vaccines pharmacists can administer and
dispensing of vaccines or hosting a nurse immuniser whether or not as part of the NIP65; The National Centre
vaccination service in the pharmacy until more recently for Immunisation Research and Surveillance maintains a
where pharmacists have broadened this role to become resource that details these variations.
immunisers in their own right (vaccine administrators) as Where pharmacists can administer NIP vaccines, while
well as educators and facilitators.62 the Federal Government covers the cost of the vaccine,
Prior to 2014, community pharmacists in Australia were not there is no service remuneration at either Federal or state
authorised to administer influenza vaccinations, however or territory level for the community pharmacy, requiring
since then, community pharmacies are now contributing costs to be paid by the patient. This service inequity is not
to public health and herd immunity by vaccinating acceptable given that NIP patients are the most vulnerable
millions of Australians, including as part of the National community members, many being on aged care or
Immunisation Program (NIP) for some vaccinations. disability pensions.
Community pharmacies are becoming a preferred choice Legislative enablement in all states and territories for
of vaccination provider for many Australians. pharmacists to practise to their full scope will ensure
Pharmacists can develop the competency to administer that pharmacists are able to deliver all vaccinations
vaccinations either as part of their pre-registration to meet preventative care requirements for patients,
pharmacy education or through pharmacist-specific following the guidelines set out in the Australian
accredited training programs and thus establish and deliver Immunisation Handbook66.
vaccinations in community pharmacy to patients of all
different age groups.63

62 Poudel A, Lau ETL, Campbell C, Nissen LM. Unleashing Our Potential- Pharmacists’ Role in Vaccination and Public Health. Sr Care Pharm. 2020 Sep 1;35(9):372-378. https://
pubmed.ncbi.nlm.nih.gov/32807260/
63 Ibid
64 Poudel A, Lau ETL, Campbell C, Nissen LM. Unleashing Our Potential- Pharmacists’ Role in Vaccination and Public Health. Sr Care Pharm. 2020 Sep 1;35(9):372-378. https://
pubmed.ncbi.nlm.nih.gov/32807260/
65 Vaccination from community pharmacy | NCIRS
66 Australian Immunisation Handbook – https://immunisationhandbook.health.gov.au/

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 21

 Other injectable medicines (non-vaccine) Travel medicine
Pharmacists having completed first aid training and Australians undertaking international travel have
attained certification can administer adrenaline in the always needed to consider their travel health risks and
event of an anaphylactic reaction. Whilst this type of acute requirements. Some countries mandate that travellers have
care is permitted, administration of injectable medicines for to be immunised against specific conditions. Travellers
other health conditions is almost non-existent. also need to be cautious of infectious diseases such as
malaria or travellers’ diarrhoea. As Australians’ travel levels
The ability of pharmacists to administer non-vaccine
continue to increase through the pandemic recovery,
medicines, requiring the same injection techniques that
some restrictions are still in place across various countries,
pharmacists are trained and competent in, are currently
and travel health measures continue to exist to keep
not enabled through legislation. Medicines such as Vitamin
travellers safe on their journey and to keep Australia safe
B12 injections, depot medroxyprogesterone as a long-
upon their return. Community pharmacies are ideally
acting contraceptive or the osteoporosis medication Prolia®
placed to provide travel health services with vaccines (see
(Denosumab) injections are not able to be administered
section 3.5.1) and other travel medicines. However, there
to patients by a pharmacist when requested, or when they
are restrictions with regard to the travel medicines that a
are due. This latter example has posed concerns during the
pharmacist can supply without requiring a prescription.
pandemic, while GP surgeries have been closed, as it has
left many patients deferring their 6-monthly dose of this In the current global climate, the ability for a
medication, impacting its therapeutic efficacy. comprehensive travel health service to be provided
through community pharmacy would provide Australians
Additionally, enabling pharmacists to administer non-
with an alternative, affordable option to receive travel
vaccine medicines, such as injectable buprenorphine
medicines and tailored travel heath advice to support their
to a patient for the treatment of opioid dependence,
safe travel overseas.
would provide increased patient access to these
services at a location and time that is convenient to the Legislative enablement for pharmacists to practise to
patient. Authorised pharmacists in Victoria67 have been their full scope would ensure that a comprehensive
administering depot buprenorphine since 2020 and while travel medicines service could be delivered through
other states are in the process of making changes, it has community pharmacy, to prescribe and administer
not been a consistent implementation process. Given the appropriate travel health vaccines to patients as well
lack of service providers for opioid replacement therapy as provide preventative health travel medicines such
(ORT) programs, enabling pharmacists to monitor and as antimalarials for chemoprophylaxis and antibiotics
prescribe ORT would enhance patient access and assist in for travellers’ diarrhoea.
addressing this significant community problem.
Legislative enablement for pharmacists to work to full
scope of practice would ensure that patients who are
prescribed injectable non-vaccine medicines could
have these administered in a community pharmacy at
a time and location that is convenient for the patient.

67 Victorian Pharmacist-Administered Vaccination Program Guidelines (health.vic.gov.au)

22 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

3.7 Ordering and interpreting laboratory tests

Ordering and interpreting laboratory tests Pharmacists in equivalent overseas countries are already
Not all pharmacists in Australia are able to order laboratory authorised to order and interpret laboratory tests, with US
tests (relevant to pharmacist care) on behalf of a patient, pharmacists accessing and/or ordering laboratory tests
despite having the clinical knowledge and competencies dependently within collaborative practice agreements,
to undertake this role and despite this role being within and pharmacists in Canada able to access and/or order
their scope of practice. Therapeutic drug monitoring laboratory tests depending on the province in which
(TDM) is the “interpreting and monitoring of measured they practice. The United Kingdom allows for laboratory
drug concentrations in body fluids to optimise medicine testing to be performed by independent prescribing
efficacy and minimise toxicity. TDM applies to the disciplines pharmacists or dependently by supplementary prescribing
of pharmacology, pharmacokinetics, pathology and clinical pharmacists70, and New Zealand pharmacist prescribers
medicine”68 can independently order laboratory tests.71

If authorised to take on this function, pharmacists would be Legislation enabling pharmacists in all jurisdictions
able to ascertain whether further medical treatment should to order and interpret laboratory tests would ensure
be sought or whether pharmacist care interventions would patients could access testing and receive appropriate
be appropriate for the patient’s clinical need, thus saving treatment with minimal delay.
time and expediting appropriate treatment/management Point of care and diagnostic testing
approaches. Additionally, further TDM or other pathology
Pharmacists are able to provide point of care testing
testing could be ordered and interpreted as part of a
and diagnostic testing, within the scope of practice of
medicine review, such as those funded under the Seventh
pharmacists, for many acute and chronic health conditions;
Community Pharmacy Agreement (7CPA)69.
including blood glucose testing, HbA1c testing, INR testing,
In jurisdictions within Australia where legislation enables cholesterol testing, blood pressure testing, pulmonary
pharmacists to order laboratory tests for patients, the function testing, anaemia testing and genetic testing.
major barrier to this occurring is patient cost due to
Section 3.4.2 highlighted how some pharmacists provide
lack of appropriate remuneration and subsidisation for
point-of-care testing for communicable conditions such
pharmacists providing the consultation. As pharmacist-
as influenza or COVID-19. Pharmacies are also involved in
ordered laboratory tests are not subsidised, patients must
facilitating diagnostic testing and screening services for
cover both pathology costs and pharmacy service costs.
health conditions including bone density testing, hearing
Appropriate funding for a standardised service through
testing, bowel cancer screening, sleep apnoea screening
a government funded program would lead to increased
and COPD screening.
patient access where appropriate.
The main barrier to pharmacists working to full scope
in this area of practice is the same as that for ordering
and interpreting laboratory tests – inadequate access to
funding for a standardised program to make these services
affordable for patients.

68 National Competency Standards Framework for Pharmacists in Australia

69 Medication Management Programs - Pharmacy Programs Administrator (ppaonline.com.au)
70 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739653/
71 https://pharmacycouncil.org.nz/public/pharmacist-scopes-of-practice/

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 23

 4. THE VISION
Some significant advancements towards pharmacists in
Australia working to full scope have been achieved, and
the implementation of pharmacist full scope of practice
pilots in several jurisdictions is progressing. However, the
journey to pharmacists working to full scope is ongoing,
with the future vision being for pharmacists to prescribing
independently as autonomous prescribers.

4.1 Current state of play

The table below documents the current state of play across
Australia in relation to conditions and services identified
as areas of opportunity to utilise pharmacists working
to full scope. It highlights government announcements
about scope of practice, preparation being done for
implementation, phased implementation (including pilots),
and services that have become permanent practice.

Condition​ ACT​ NSW​ QLD​ NT​ WA​ SA​ VIC​ TAS​

Acute cellulitis​
Acute nausea and vomiting​
Acute wound management​
Allergic and non-allergic rhinitis​
Asthma and exercise induced bronchoconstriction​
Atopic dermatitis​
COPD​
Depression and anxiety​
Dyslipidaemia​
ENT infections ​
Gastro-oesophageal reflux ​
Herpes Zoster (shingles)​
Hormonal contraception
Hypertension​
Impetigo​
Influenza testing, diagnosis and treatment​
Mild to moderate acne​
Minor skin conditions
Musculoskeletal pain and inflammation​
Oral health screening and fluoride application​
Other injectable medicines (non-vaccine)
Psoriasis​
Smoking cessation​
Travel medicines​
Type 2 diabetes​
Uncomplicated urinary tract infections​
Vaccination (NIP and non-NIP)​
Weight management for obesity​
Govt Announcement/interest Preparation Phased Implementation Permanent Practice

24 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

4.2 The journey to prescribing
The future vision is for pharmacists practising in Australia
to be enabled to prescribe independently as autonomous
prescribers. It is important to distinguish between
autonomous prescribing and structured prescribing, which
is the type of pharmacist prescribing being implemented
through the full scope of practice pilots, where pharmacists
will prescribe in accordance with the treatment protocols
of the Therapeutic Guidelines.
Incorrectly defining or using interchangeable terms such as
dispensing, supply and prescribing, and not distinguishing
between different types of prescribing, is doing an injustice
to our current workforce, our future pharmacists and their
professional practice, and confuses the public.
There are many benefits to pharmacists having the ability
to independently prescribe. In the United Kingdom,
pharmacist independent prescribing was introduced in
2006, with research reporting benefits including decreased
workloads for general practitioners, increased patient
safety, improved job satisfaction for pharmacists, improved
patient relationships, and enhanced cost savings.72
Using the checklist for change will help identify and
address changes that need to be made to enable
pharmacist to independently prescribe as autonomous
prescribers.

72 General practice pharmacists in England: Integration, mediation and professional dynamics - ScienceDirect

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 25

 and interpret laboratory tests, would ensure patients could
access testing and receive appropriate treatment with
minimal delay.
Pharmacy is also involved in facilitating diagnostic testing and
Enabling pharmacists’ access to appropriate funding screening services for health conditions including bone density
mechanisms for services that are equivalent to Government testing, hearing testing, bowel cancer screening, sleep apnoea
funded services provided by other healthcare professionals is
5. CHECKLIST FOR CHANGE
required to ensure equitable access to services for patients.
screening and COPD screening.

The main barrier to pharmacists working to full scope in this

3.6.2 Point
In order of care andto
for pharmacists Diagnostic
work to fulltesting
scope of area of practice is the same as that for ordering and interpreting
practice, now laboratory tests – inadequate access to funding.
Pharmacists are and
able into the future,
to provide the
point of following
care are key
testing and
considerations that will need to be worked through
diagnostic testing, within the scope of practice of pharmacists,on Enabling pharmacists’ access to appropriate funding
each
for occasion
many acute andto provide evidence
chronic health and assurance
conditions; including for
blood mechanisms for services that are equivalent to Government
glucose testing, that
governments INR testing, cholesterol
pharmacists testing, blood
are indeed pressure
competent and funded services provided by other healthcare professionals is
testing, pulmonary function testing, anaemia testing
accountable to undertake the task and therefore should be and required to ensure equitable access to services for patients.
genetic
afforded testing.
the appropriate authority.

4. CHECKLIST FOR CHANGE

In order for pharmacists to work to full scope of practice, now and into the future, the following are key considerations that will need to
be worked through on each occasion to provide evidence and assurance for governments that pharmacists are indeed competent and
accountable to undertake the task and therefore should be afforded the appropriate authority.

• Are the competencies required to perform the task included in the Competency Standards?
Competency
• Are the competencies covered in university programs, ITPs, or existing training for pharmacists?

• Is training required for all pharmacists (new skill), OR

Training • Is training required for pharmacists that need to ‘retrofit’ a competency that is now in the degree programs?
• Does training need to be developed, and accredited?

• Is an additional qualification required? For example, vaccination certificate, CDE

Qualification or • Is a professional endorsement required by the Pharmacy Board, as required by AHMAC?
Endorsment
For example, autonomous presecribing

Funding • What is the proposed funding mechanism - private, government funded?

Mechanism • What are the eligibility requirements for government funding?

Professional
Standards / • Do professional practice guidelines, or standards need to be developed?
Guidelines

• What are the legislative or regulatory changes required?

Legislative • What is the relevant legislation/regulation that needs amending?
Authority • Is there a precedent in another jurisdictions

14 Scope of Practice of Community Pharmacists

26 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

6. GLOSSARY
Accountability Responsibility of a heath professional, such as a pharmacist, to uphold professional standards of practice

Acute conditions Conditions which usually have a sudden onset

Administer a medicine To give a patient a single treatment of the dose of a medicine by the prescribed route e.g. injection of a
vaccine

Ahpra Australian Health Practitioner Regulation Agency

APC Australian Pharmacy Council

Authority Legislative authority to undertake practice components

Chronic conditions Conditions which are long-lasting and/or ongoing

Competency Standards See National Competency Standards Framework for Pharmacists in Australia 2016

Continued Dispensing Continued Dispensing is the one-off emergency supply of a prescription medicine in the absence of a
versus Prescription prescription to ensure continuity of therapy whereas Prescription Renewal is the ongoing authorisation
Renewal for dispensing a prescription medicine for a chronic condition

Controlled drugs Substances listed in Schedule 8 of the Poisons Standard

COPD Chronic Obstructive Pulmonary Disease

CPD Continuing Professional Development

CVR Combined Hormonal Vaginal Ring

Dispense To supply a medication on prescription

Drug versus medicine or Australian Federal, state and territory regulations use the terms poisons and drugs, with drugs being
medication defined as a poison for therapeutic use (e.g. Poisons Standard). For this document, the term medicine or
medication is preferentially used being the formulated form of a drug intended for therapeutic effect in
humans or animals.

Drug Schedules in See Medicine Schedules in Australia

Australia

Drug Schedules in other The Drug Schedules for the comparator OECD countries (Appendix 1) do not directly match the
countries scheduling in Australia, however there are broad similarities in medications provided ‘over-the-counter’
by pharmacists, on prescription only and classified as controlled (or narcotic) drugs.

Extended Practice A certified document published by the Department stating circumstances in which, and conditions
Authority under which, a person who may act under the protocol may use a stated controlled or restricted drug or
poison for stated purposes (Queensland)

Emergency Supply Limited supply of restricted drug (S4 medication), to a patient who does not have a script, but who has
an urgent need for that medication (See continued dispensing)

ENT infections Ear nose and throat infections

FIP International Pharmaceutical Federation (Federation Internationale Pharmaceutique)

Generic/Biosimilar Substitution by pharmacist of a bioequivalent medicine for the prescribed medicine, where the patient
Substitution has provided consent

HPPP Health Professionals Prescribing Pathway (published Health Workforce Australia in 2013)

IHC Injectable Hormonal Contraception

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 27

 Immunisation program An immunisation program carried out by the department, local government or Hospital and Health
Service; a certified program

Laboratory tests A procedure in which a sample of blood, urine, other bodily fluid or tissues, is examined to get
information about a person’s health. E.g. INR test to monitor blood thinning medicines/ anticoagulants

MBS Medical Benefits Scheme

Medication adherence Patient compliance with prescribed medicine regimen

Medication adherence Pharmacist intervention to ensure there is patient compliance with medicine regimen
counselling/management

Medication continuance See Continued dispensing

Medication Management Review of a patient’s medicine regimen by a pharmacist to ensure that each medication is appropriate
Review for the patient, effective for the medical condition, safe given the comorbidities and other medications
being taken and able to be taken by the patient as intended

Medicine Schedules in • Schedule 2 of the Poisons Standard: Pharmacy Medicine – Substances, the safe use of which may
Australia require advice from a pharmacist and which should be available from a pharmacy or, where a
pharmacy service is not available, from a licensed person
• Schedule 3 of the Poisons Standard: Pharmacist Only Medicine – Substances, the safe use of which
requires professional advice but which should be available to the public from a pharmacist without a
prescription.
• Schedule 4 of the Poisons Standard: Prescription Only Medicine – Substances, the use or supply of
which should be by or on the order of persons permitted by State or Territory legislation to prescribe
and should be available from a pharmacist on prescription.
• Schedule 8 of the Poisons Standard: Controlled Drug – Substances which should be available for
use but require restriction of manufacture, supply, distribution, possession and use to reduce abuse,
misuse and physical or psychological dependence.

National Competency A framework describing the knowledge, skills and attributes that are central to pharmacists performing
Standards Framework for effectively to an acceptable standard in contemporary professional practice in Australia
Pharmacists in Australia
2016

NIP National Immunisation Program

Non-vaccine Injectable Medicines, other than vaccines, that are administered by injection. E.g. Denosumab (Prolia) to treat
medications osteoporosis

NPS National Prescribing Service

Nurse A registered nurse or enrolled nurse

Nurse practitioner A registered nurse whose registration is endorsed under the Heath Practitioner Regulation National Law
as being qualified to practise as a nurse practitioner

OCP Oral Contraceptive Pill

ORT Opioid Replacement Therapy

OTC Over the counter medicines, such as Schedule 2 and Schedule 3 medicines, sold in pharmacies without
a prescription

PBA Pharmacy Board of Australia

PBS Pharmaceutical Benefits Scheme

PCF Prescribing Competency Framework: NPS Medicine Wise Competencies required to prescribe medicines;
2nd edition April 2021

28 Scope of Practice of Community Pharmacists in Australia The Pharmacy Guild of Australia

 Point of care testing A form of testing in which the analysis is performed outside of a laboratory setting e.g. Blood Glucose
(BG) levels via a glucometer (testing device)

Prescribe Make a written direction (other than a purchase order or written instruction) authorising a dispenser to
dispense a stated controlled or restricted medicine or poison

Prescriber A person who is endorsed by regulation to prescribe a controlled or restricted medicine

Prescribing • A patient-centred or patient-driven process involving the steps of information gathering, clinical
decision making, communication and evaluation which results in the initiation, continuation or
cessation of a medicine
• Autonomous Prescribing - the prescriber acts with independent accountability, without the
supervision of another heath professional (but still in collaboration with other health professionals)
• Collaborative prescribing – the prescriber is supervised by, or acts collaboratively with, another
authorised heath professional
• Structural Prescribing - the prescriber has limited authorisation to prescribe medicines under a
guideline, protocol or standing order

Prescription A prescriber’s direction (other than a purchase order or written instruction) to dispense a stated
controlled or restricted medicine for an identified patient, with details of medicine form, quantity and
dosage and whether supply can be repeated

QCPP Quality Care Pharmacy Program – quality assurance program for community pharmacies

QPIP Queensland Pharmacist Immunisation Pilot

QUM Quality Use of Medicines

Registered nurse A person registered under the Health Practitioner Regulation National Law to practise in the nursing
profession

Registered pharmacist A person registered under the Health Practitioner Regulation National Law to practise in the pharmacy
profession

Repeat prescription A prescription on which there is a direction to repeat the supply of a stated controlled or restricted
medicine for a specified number of times

Restricted medicines Schedule 4 substances

Scope of pharmacy Those professional activities that a pharmacist is educated, competent and authorised to perform, and
practice for which they are accountable

Supply To issue one or more doses of a medicine as treatment for a diagnosed condition for a patient

TGA Therapeutic Goods Administration

Therapeutic Substitution Issue to a patient of an equivalent prescribed medication at the same dosage to ensure continuity of
care (for example, during medicine shortages)

Therapeutic Adaptation Change or adaptation of prescribed medicine dosage, formulation, regimen, based on determination of
clinical need and in response to control of patient’s condition or experience of adverse effects

Travel medicine Medicines and/or vaccines required to prevent or manage health problems for international travellers

UTI Urinary tract infection, also known as cystitis

Vaccine A biological preparation that provides active acquired immunity to an infectious disease. A restricted
medicine that is identified as a vaccine in the current Poisons Standard

Vaccine preventable Diseases that can be prevented by vaccine, such as influenza, measles, whooping cough
conditions

The Pharmacy Guild of Australia Scope of Practice of Community Pharmacists in Australia 29

The Pharmacy Guild of Australia
Level 2, 15 National Circuit, Barton, ACT 2600
PO Box 310, Fyshwick, ACT 2609
Telephone: 13GUILD (13 484 53)
Email: [email protected]
guild.org.au