Pharmacists could receive public funding to dress wounds, deliver vaccinations and give weight loss advice under a $19 billion deal between the Abbott government and the powerful Pharmacy Guild.
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Under the five-year agreement, announced by Health Minister Sussan Ley on Monday, patients could pay $1 less per script from July under a change the government hopes will promote greater competition among pharmacists.
It will be up to pharmacists to decide whether to offer the $1 discount, and pharmacists that do offer the discount would have to absorb its cost.
The government expects the optional discount, which is opposed by the Pharmacy Guild, to save taxpayers about $360 million over the life of the agreement, due to fewer patients qualifying for free medicines under the Pharmaceutical Benefits Scheme safety net.
The discount, which would reduce the concessional patient contribution to $5.10 a script and the general patient contribution to $36.70 a script, is at odds with legislation before the Parliament to increase patient contributions for concessional patients by 80 cents a script and for general patients by $5 a script.
The increase to patient contributions, worth more than $1 billion over four years, remains government policy but is unlikely to pass the Senate.
Most of the $19 billion provided under the deal will be paid to pharmacists for dispensing Pharmaceutical Benefits Scheme drugs, but $1.2 billion will fund trials in which pharmacists would perform work currently undertaken by doctors and nurses.
This could include vaccinations, wound care and the management of chronic conditions such as arthritis. Pharmacists have previously proposed offering checks for weight, blood pressure, blood sugar and cholesterol.
Ms Ley said the funding recognised "the increasingly important role pharmacists play in a patient's 'medical team' of health professionals" and demonstrated the government's commitment to delivering greater integration between health services.
The Medical Services Advisory Committee - the independent expert body which evaluates medical treatments - would assess and approve proposals for new services.
"There is an opportunity for pharmacists to step into the primary care space, but we are doing this carefully and in an evidence-based way," Ms Ley said.
The announcement drew an angry response from doctors, with Royal Australian College of General Practitioners president Frank Jones accusing the government of bowing to pressure from the pharmacy sector.
Dr Jones said while the government had frozen the Medicare rebates paid to doctors, it was rewarding pharmacists with extra funding, despite a lack of evidence of the benefits of existing pharmacy programs.
Australian Medical Association vice-president Stephen Parnis questioned the value of pharmacists playing a greater role in primary care and expressed concern such changes would lead to "fragmentation".
"Pharmacists are not medically trained to provide medical services, nor are they indemnified to do so," he said.
Pharmacy Guild national president George Tambassis said it would consult and collaborate with doctors on its proposals for new services.
"The AMA are our friends. We work together," Mr Tambassis said.
Stephen Duckett, the director of the health program at the Grattan Institute who has argued for pharmacists to be allowed to provide vaccinations, issue repeat prescriptions and help manage chronic conditions, said the move was positive.
"Pharmacists are highly skilled professionals and ... I welcome proposals to give them greater roles, provided that it doesn't undermine general practice in any way," he said.
In a blow to competition, rules which restrict new pharmacies opening near existing pharmacies or in supermarkets will be extended until 2020.
However these rules and other pharmacy regulation and remuneration arrangements will be reviewed over the next two years, with any changes to be incorporated into the next five-year agreement.
Consumers Health Forum chief executive Leanne Wells said this review was "a welcome break from the previous practice of both sides of politics to treat these anti-competitive aspects as no-go areas."
