The prescribing debate must start with patient safety

As governments across Australia continue to expand pharmacy prescribing rights, policymakers should pause and carefully consider the patient safety implications. Accessibility is an important goal – and one Avant supports – however, high-quality care and patient safety must be paramount. 

Prescribing is not simply the act of writing a script. It involves assessment, diagnosis, clinical judgement, ongoing monitoring and, at times, the decision not to prescribe at all. Our claims data shows why that matters.

What the data tells us

Avant recently completed the most detailed analysis yet of where prescribing can go wrong and the consequences for patients. 

Our new Prescribing and Patient Safety report found one in five patients involved in prescribing-related claims and regulatory complaints experienced a major injury. Schedule 8 medicines featured in 36 per cent of cases (almost 1,000 claims), with opioids the leading category. Medicines used to treat mental health and neurological conditions such as depression and schizophrenia were the most common Schedule 4 medicines involved. 

The analysis reviewed more than 16,000 claims and regulatory complaints closed between July 2020 and June 2025 and identified more than 2,600 claims and complaints involving medication-related issues. 

Sometimes safe prescribing means saying no

One of the most important findings is that safe prescribing does not always mean providing a prescription.  

We’ve seen many claims arise from decisions to reduce, decline or cease medication, yet in most of these cases practitioners were found to have met the required standard of care. Sometimes safe prescribing means saying no. 

Prescribing requires accurate diagnosis, clinical assessment, an understanding of competing causes of symptoms, and careful consideration of risks, benefits and alternatives. These are skills developed through years of medical education, supervised training and clinical practice. 

From our perspective as an insurer, the greater the complexity, uncertainty and potential consequences of error, the higher the threshold should be for expanding prescribing. 

This is not about opposing pharmacists or diminishing the important role they play in healthcare. Pharmacists are medicines experts and are often the final safety check in the prescribing process. The question is whether prescribing reforms adequately recognise that safe prescribing depends not only on knowledge of medicines, but also on assessment, diagnosis and ongoing clinical management of the patient. 

Getting the safeguards right

We welcome the decision of State, Territory and Federal Health Ministers last month to develop a National Decision-Making Framework but believe it must put patient safety ahead of further scope expansion. Avant has proposed eight recommendations to inform its development. 

Schedule 8 medicines and other drugs of dependence require the strongest safeguards and should remain outside autonomous community pharmacy prescribing.  

“Where there is a reasonable likelihood that safe use of a medicine depends on assessment and diagnosis by a doctor, that medicine should not be available for autonomous pharmacy prescribing.”  

Avant is also calling for all pharmacist consultations to include comprehensive clinical documentation, separate from dispensing records, in line with Ahpra’s shared code of conduct. 

Like pharmacists, we support improving accessibility. However, improving access should never be at the expense of quality and safe patient care. Underestimating the complexity of prescribing or the importance of getting the diagnosis right will put patients in harm’s way.