This page sets out the argument for scope-of-practice reform as its supporters make it. We think readers should understand it at its strongest.
1. Many barriers have nothing to do with competence
Australia’s Scope of Practice Review found that almost all primary-care professions face barriers to working at full scope that are “unrelated to their education (skills and knowledge) and competence” (Department of Health): funding rules, inconsistent state laws, and employment arrangements. If a nurse practitioner is trained to prescribe a medicine, a rule that stops them is, reformers argue, a cost to patients with no safety benefit.
2. Some requirements were never safety mechanisms
When Australia removed the requirement for nurse practitioners to have a collaborative arrangement with a doctor, the Department of Health said: “It’s never been, or was intended to be, a safety and quality mechanism” (Department of Health Q&A). Reformers argue that keeping rules that do not protect anyone is not caution; it is friction.
3. People are waiting
Reformers argue that long waits for GPs and mental health care are a harm in themselves, and that delayed access should be weighed against the risks of new models, not ignored.
4. Professions protect their territory
New Zealand’s Cabinet paper argues that profession-focused regulation, where each profession regulates itself, encourages “patch protection” (Cabinet paper). Harry Cayton’s British Columbia inquiry found “a lack of relentless focus on the safety of patients in many but not all of the current colleges” (Cayton report). Professional bodies have interests in who is allowed to do what, and reformers argue this can colour their warnings.
5. Courts and reviews have not stopped the roles
In England, the High Court (Anaesthetists United, 2025) accepted as rational the GMC’s view that national hard limits on scope could hold back competent physician and anaesthesia associates (judgment). The Court of Appeal (2026) separately upheld the GMC calling associates “medical professionals”. The Leng review recommended restricting the roles, not abolishing them (Leng review). Queensland’s Health Minister said pharmacies had delivered more than 1,700 services across its pilots “with no safety concerns” (Queensland Government).
Where we think the argument is weakest
The case is strongest on barriers that are unrelated to competence. It is weakest where reforms are made permanent before independent evaluation, as with pharmacist prescribing in NSW and Queensland, or scaled up with no safety studies, as with UK physician associates. “No safety concerns” during a trial is not the same as “it was shown to be safe”.