Nurse practitioners and midwives: doctor collaboration requirement removed
Since November 2024, nurse practitioners and endorsed midwives can bill Medicare and prescribe PBS medicines without a formal collaborative arrangement with a doctor.
Profession
Medicine
Work is moving from doctors to pharmacists, nurse practitioners and physician associates.
Reforms
Pharmacist prescribing: UTIs and state pharmacy schemes
Pharmacists can now treat urinary tract infections in every state, and Queensland and Victoria have made wider prescribing schemes permanent. NSW and Queensland made schemes permanent before their evaluations were published, and Victoria announced its decision days before publishing its evaluation summary.
Scope of Practice Review (the Cormack review)
An independent review made 18 recommendations to let primary-care professions work to their full scope. The federal government is now offering states $60m to remove barriers.
Public funding for nurse practitioner and pharmacist primary care
Under a new federal interpretation of the Canada Health Act, medically necessary care that nurse practitioners, pharmacists and midwives provide in place of a doctor is to be publicly funded. The policy took effect in April 2026, with penalties from April 2027. Ontario missed the deadline.
Pharmacist prescribing in Ontario and Nova Scotia
Ontario pharmacists now prescribe for 28 minor ailments, after 9 were added on 1 July 2026; Nova Scotia pharmacists can prescribe for conditions including hypertension and type 2 diabetes.
Health Practitioners Competence Assurance Amendment Bill
New Zealand's bill would let the Health Minister direct the health regulators on policy and let a ministerial committee overturn registration refusals. Parliament has since been dissolved for the November 2026 election.
Physician associates regulated by the Medical Council
Physician associates came under the Medical Council of New Zealand on 1 October 2026. Existing practitioners must apply by 30 November 2026.
Physician associates: expansion, regulation, and the Leng review
Planned to grow to 10,000, physician associates came under GMC regulation in 2024. After coroners' findings and an independent review, the roles are to be renamed and restricted, but not abolished.
No reforms tracked for this country yet.
Explainers & analysis
Permanent before evaluated
In Australia, pharmacy scope reforms have been made permanent before any independent evaluation was published. In the UK, physician associates were scaled up with no study of safety incidents. We think that is the strongest, evidence-based criticism of these reforms.
The case for top-of-scope reform
The strongest version of the argument for letting nurses, pharmacists and others do more, written from the reformers' own sources.
Nothing written for this country yet.
Library
Pharmacy prescribing made permanent without adequate evidence
AMA Queensland criticises the state government for making its pharmacy scope pilot permanent before an independent evaluation, calling the decision 'disappointing and dangerous'.
Why it matters: The evaluation-gap point is documented and fair. The 'dangerous' characterisation is an assertion.
BMA v General Medical Council [2026] EWCA Civ 143
The Court of Appeal dismissed the BMA's challenge to the GMC's use of the term 'medical professionals' for both doctors and physician and anaesthesia associates in Good Medical Practice. A separate judicial review by Anaesthetists United, seeking national limits on scope of practice, was dismissed by the High Court in September 2025.
Why it matters: The courts found the GMC acted lawfully on both terminology and scope of practice. In our view, change will have to come through policy, not litigation.
Physician associates and anaesthetic associates in UK: rapid systematic review of recent UK based research
Reviewed UK research on physician and anaesthetic associates published from 2015 to January 2025. Of 29 studies meeting its inclusion standard, none examined safety incidents and only one directly observed clinical competence.
Why it matters: In our view, a clear statement of the evidence gap: the authors warn that absence of evidence of safety incidents is not evidence that the roles are safe. Co-author Martin McKee was BMA president in 2022-23.
The Leng review: an independent review into physician associate and anaesthesia associate professions
An independent review found the evidence on the roles weak and based on observational data. It made 18 recommendations, including renaming the roles 'physician assistant' and 'physician assistant in anaesthesia', and requiring a named supervising doctor for each physician assistant. The government accepted all of them.
Why it matters: In our view, a template for how a government re-tightens a role after scaling it ahead of the evidence.
Susan Pollitt: Prevention of Future Deaths report
A senior coroner found that an ascitic drain, which a junior doctor had decided to place, was not clinically indicated. The physician associate who inserted it was unaware of local guidance, left it in for 21 hours and directed that it be clamped, which the coroner found was unwarranted. The report also raises the absence of a regulator at the time, title confusion, and a competency sign-off that covered only the technical skill of inserting the drain, not consent, risk factors or aftercare.
Why it matters: Its first concern was that there was then no regulator at all, so it does not show that proportionate regulation fails; its other concerns (training, supervision, the title, competency sign-off) remain relevant under regulation.
Unleashing the Potential of our Health Workforce: Scope of Practice Review
Professor Mark Cormack's review found almost all primary-care professions face barriers to full scope that are unrelated to their education and competence, and made 18 recommendations to remove them.
Why it matters: A central document in Australia's 'top of scope' agenda, now backed by a $60m incentive for states.
No library items for this country yet.