Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025

Senator ANTIC (South Australia) (18:34): I rise to speak against the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025 and I seek to set out some of the reasons for that. The bill speaks in the language of aiming to improve access to medicines, particularly in rural and regional Australia, to remove the pressure that's on the health workforce and, most notably, to allow registered nurses to work the full scope of their practice.

These, of course, are legitimate policy goals for consideration, and they do deserve consideration, but the key question really is whether or not the proposed safeguards are sufficient to protect patients, nurses and collaborating practitioners from the risks, and I think there are quite a number of risks in what's being proposed here. It's important that improved access to prescribing shouldn't be confused with improving health care itself.

Many times in health care the actual act of prescribing is the end point of the diagnostic process. Of course, we know that nurses and nurse practitioners are highly skilled professionals, but they're not doctors; they're not trained medical professionals. Often times the training that the nurse will have will be focused on the care of the patient and all the other important stuff.

There is, I see, a foreseeable risk that treatment might be even initiated before an underlying diagnosis has been adequately explored or excluded. The bill also raises questions about medication safety, including adverse drug reactions, interactions and prescribing cascades, particularly in elderly patients, many of whom will have very complex chronic disease.

As I've been speaking to people in the industry, they've described to me the risk of fragmented care, which is where assessment, diagnosis and prescribing and ongoing management are shared across multiple practitioners where no single clinician can assume overall responsibility for the patient's care. Finally, the one that was so egregiously overlooked during the COVID period is the issue of informed consent.

That really does require a particular degree of consideration here. Many patients are unlikely to understand the substantial differences in training and diagnostic expertise and the scope of practice between the nurse and the medical practitioner. Patients really should be able to make an informed decision about who's providing that care and the nature of the clinical decision-making involved.

The bill also heavily relies on prescribing agreements, endorsement standards and conditions of approval and regulatory oversight, but we should consider whether these are genuine clinical safeguards or primarily administrative safeguards. A safeguard ultimately is only effective in the prescription if it changes behaviour and reduces risk in practice. The existence of prescribing agreements doesn't necessarily measure and ensure meaningful supervision, clinical oversight or accountability.

So my question is: will the proposed governance arrangements provide real-world protection or just be in the business of creating documentary compliance? As you can see, there are a range of issues that arise as a result of this bill. One that really hasn't been properly covered is the risks to the nursing profession itself.

With the responsibility of prescribing what can be up to schedule 8 drugs, the reform in this bill may actually expose nurses to increasing complaints, to litigation, to regulatory scrutiny and to professional liability. So the issue is not really whether the nurses are capable and whether they're able to do this job. Rather, it's a question of whether or not workforce shortages are being addressed by transferring responsibilities which were traditionally borne by medical professionals and trained practitioners, without equivalent safeguards and support structures.

The nursing profession, of course, has an enormously high level of public trust. Arguably, it may be said in some circumstances the nurses are even more trusted than the doctors themselves. But any expansion of prescribing authority has got to be accompanied by clear accountability, sound governance and ongoing evaluation.

Finally, this does overlay the cloud of overprescription. We know that pharmaceutical companies love nothing more than getting their products into the hands of willing recipients. For those reasons—and many, many others—I simply won't be supporting this bill today.