The Accessibility Trap: When “Accessibility” Becomes Medical Negligence
Dr Stefanie Hammond - 7th March 2026
Jacinta Allan announced yesterday that from July 1 the contraceptive pill will be available in Victorian pharmacies without a prescription.
The combined oral contraceptive pill (OCP), vaginal rings and Depo-Provera injections will join hormone replacement therapy and treatment for “uncomplicated” UTIs to be available direct from a pharmacist without “the hassle” of a doctor’s appointment.
For some context – Pfizer has recently been under fire for failing to warn women of the five-to-six-fold higher risk of meningiomas (brain tumours) if they use Depo-Provera for more than 12 months. There are mass class actions taking place across the world including Australia where the Women with Disabilities Australia group have highlighted significant concerns about the routine use of this form of contraception in women with disabilities – including under false pretences such as saying it is a flu-shot.
There is growing body of evidence linking hormonal contraception to vascular risk in women of reproductive age. Most notably the SECRETO study in 2025 which showed a threefold increase in the risk of ischaemic stroke “with no identifiable cause” in young women using hormonal contraception aged 18 to 49 even after adjusting for co-morbidities.
Another significant study is the 2025 Danish Registry Study which looked at over 2 million women aged 15-49 years living in Denmark between 1996 and 2021 with no known risk factors for heart attack or stroke. This study challenges older guidelines which suggested that progesterone-only contraception was “neutral” for cardiovascular disease risk. It showed an increased risk of ischaemic stroke and heart attack associated with both combined and progesterone only hormonal contraceptives – a 60% increased risk of stroke for the progesterone only pill, and a double risk for the progesterone only implant, though the authors note this requires further investigation due to smaller sample sizes.
It also challenges the notion that non-oral routes of administration are safer with a 3.8 relative risk increase in heart attack associated with the vaginal ring. The only one not associated with increased risk was the levonorgestrel-releasing intrauterine device.
It is also worth noting that there was not a time dependent variation in risk – meaning that your risk for stroke and heart attack doesn’t change if you take the pill for 3 months or 3 decades.
I want to highlight that stroke and heart attack are arterial clot risks, and that the commonly accepted “increased risk of clots” refers to venous clots which are called venous thromboembolism (VTE) and include deep vein thrombosus (DVT) and potentially life-threatening pulmonary embolus (PE). Again, the IUD doesn’t increase this risk, but the other forms of hormonal contraception do.
Concerningly the newer OCPs marketed as “better for skin” such as Yaz and Yasmin increase the relative risk 6-8 fold with a higher propensity for PE. In comparison the progesterone only contraceptives such as the mini-pill and Slinda do not increase the risk of venous clots. It is also important to note that these increased risks escalate significantly if there is a pre-existing risk factors for VTE – for example a 12 to 24-fold increased risk if you have a BMI>30.
In comparison to arterial clots, venous clots DO have a time-dependent variation in risk with the highest risk of venous clots being in the first 3-6 months of starting or restarting an estrogen containing contraceptive. This, combined with the risk of hormone induced hypertension or deranged lipids (increased bad cholesterol and decreased good cholesterol), is why most GPs will review their patient within the 6 months following initiation of any hormonal contraception, and will insist on seeing you face-to-face to do a proper assessment including a repeat blood pressure check. I haven’t even attempted to cover the various other considerations including comorbidities, medication interactions and family history but you can get a feel for these by having a read through the 138 page UKMEC guidelines.
These risks highlight why the Australian Therapeutic Goods Administration (TGA) re-affirmed in early 2026 that oral contraceptives must remain as Schedule 4 medications (prescription-only) because only an authorised medical prescriber can safely navigate the complex and evolving risks associated with these medications.
This also doesn’t take into account that most GPs use these “just a script” appointments as an opportunity to review other cardiovascular risk factors, sexual health and domestic violence screening.
Which brings me back to the disaster of the pharmacist UTI prescribing trial. The “success” of pharmacist prescribing across Australia is a façade. Have a read through the Victorian government’s assessment of the pharmacist prescribing pilot and you will note that success is determined by patient satisfaction and “access to care”. There is no actual assessment of health outcomes.
You will also notice how they assess safety based on the quality of the guidelines and that complications were measured by looking at the number of patients who lodged complaints independently during the 12 month pilot program (i.e. they had to seek out formal pathways to complain outside of the pilot) which relies on patients to actually realise they have had a bad outcome within that time-frame – unlikely in cases of missed STD causing infertility or missed urogenital cancers.
They also determined that treatment was in line with standard care because in an evaluation survey completed 8-21 days post treatment 13% of respondents reported that their symptoms didn’t resolve. The report presents this as aligning with treatment failure rates internationally of 12-17% and surmise that this represents that pharmacist prescribing is no less effective or safe than in usual care settings. They even have the nerve to suggest that because women made up 84% of all pilot patients, that they are improving health equity and benefiting women. Again - neither of these statements are actually based on any health information or outcomes of the participants.
Even the statement “symptoms didn’t resolve” is misleading. They obviously wouldn’t resolve if the cause of their symptoms wasn’t a UTI in the first place. The assessment that the failure rates are the same relies on the flawed assumption that a pharmacist can diagnose an “uncomplicated UTI”. It is also worth noting that they have no capacity to send off urine cultures to confirm the patient ever even had an infection. So they may feel confident in their ability but have no actual evidence to back that up.
In the absence of actually helpful information regarding safety and patient health outcomes, the Australian Medical Association reached out to GPs to ask what was happening on the ground in the wake of this and the results were horrifying. Whilst the guideline for pharmacist UTI prescribing is actually quite good, the reality reflected in poor patient outcomes suggests they were simply not followed.
At least three men were identified as having complications as well as multiple pregnant women being given antibiotics that are unsafe in the first trimester which is most alarming since the guidelines start with excluding both men and pregnant women. Missed complications included life-threatening ectopic pregnancy, pyelonephritis, urosepsis, STDs and cancer. There was no pathway for doctors to report these complications to those running the trial, and the only way to provide feedback was to report the individual pharmacist to the health ombudsman (an independent authority) in the hope that this would flag as a concern with the program and not an issue with the individual pharmacist, and be passed on to those in charge of the scheme within the relevant government department.
This complete disregard for guidelines shows that pharmacist prescribing models can absolutely not rely on pharmacists following treatment algorithms. There is also no apparent mechanism for making sure that they do follow these guidelines, particularly as they only have to keep a note of the name of the medication and the indication for prescribing for 2 years. They also only have to document a single blood pressure reading from any time in the last 12 months, from any source.
In contrast GPs are required to maintain detailed clinical notes for 7 adult years (i.e. 7 years past the age of 18 for children), and it is an expectation that they would be reassessing risk factors and tracking blood pressure changes over time. There are many cases of doctors being reprimanded for failing to identify contraindications for hormonal contraception, failing to adequately consent patients who use it, failing to appropriately monitor in a way consistent with the standard of their peers (i.e. checking blood pressure prior to every OCP script) and failing to complete thorough documentation.
Similarly, doctors are not legally allowed to own a pharmacy due to the potential for conflict of interest in profiting from medications that they prescribe. Doctors have been reprimanded for referring patients to a pharmacy that they had a financial interest in (i.e. dividends from pharmacy profits), making a profit from anything sold directly to the patient (i.e. doctors can only sell a medication at cost only directly to a patient in a clinic setting to streamline care), and more notably the recent crackdown on doctors profiting from telehealth services where doctors were being paid per script or held shares in the telehealth company that owned the pharmacy that dispensed the weight loss medications and medical marijuana that the telehealth company “specialised” in.
It is a criminal offence for a doctor to own a pharmacy, not to mention the obvious breach in medical code of conduct. If a doctor is found to have even a “beneficial interest” (like a family trust) in a pharmacy, they face massive fines and immediate investigation for professional misconduct. In contrast, the Labor government is actively funding pharmacy corporations in establishing a model of care that is not just unethical but quite literally illegal for a doctor to do the same. Not to mention the kick in the guts that is the $18 million funding in the 2025-2026 Victorian government budget that was put towards covering the cost of these pharmacy consults (approx. $20-30 per visit), so they appear free to the consumer.
Let me repeat that – the Labor government is paying pharmacists directly for consultations with patients, to prescribe them medication that they then profit from selling to them. Something that as a GP I would risk my medical license for, and potentially face literal jail time under the Health Practitioner Regulation National Law and the Pharmacy Regulation Act 2010 (Vic).
It would appear that the government no longer cares about the risks associated with vertical integration of healthcare systems in Australia once you donate over half a million dollars to the political parties involved.
Similarly, if I was to decide that I personally wanted to ignore the legal classification of a drug by the TGA, I would almost certainly lose my medical registration for professional misconduct and breach of state and commonwealth law. However, with the power of the pen, Jenny Atta can bypass these laws by granting secretary approval to do so.
The Labor government calls seeing your GP a “hassle”. Doctors call it basic healthcare. It baffles the mind that state government who is responsible for funding the struggling Victorian hospital system is actively eroding the role of the GP. GPs are the medical professional with the best “bang for buck” across the board for both acute “urgent care” type presentations, and longitudinal population level health outcomes.
Primary care works best when it is allowed to function as intended. Countries like Norway know the value of continuity of care and fund primary care well. They spend less on national health expenditure and have better health outcomes for their population. Meanwhile the Australian government continue to fragment care and allow Private Health corporations such as Bupa and Medibank to buy up large portions of the market. This is important because both Bupa and Medibank have a strategic alliance with TerryWhite Chemmart rewarding customers with incentives to encourage them to bypass their local independent pharmacist.
It is interesting to note that Prof Zoe Wainer – the new inaugural Director-General of the Australian Centre for Disease Control (CDC) – led the division responsible for the Community Pharmacist Statewide Pilot (now Chemist Care Now) in her previous role as the Deputy Secretary for Community and Public Health in the Victorian Department of Health. Prior to that she held two high-ranking roles within Bupa as Head of Public Health & Medical Director and Director of Clinical Governance. During her tenure Bupa significantly strengthened their alliance with TerryWhite Chemmart by integrating pharmacy services directly into Bupa’s member benefits.
Prof Wainer has background in cardiothoracic surgery and thoracic surgical oncology, and holds an honorary PhD and a Master of Public Health from the University of Melbourne. She known for championing women’s health and from what I’ve read it appears that it is her belief that allowing pharmacist prescribing for the pill is aligned with that value.
I would suggest that it is in fact undermining equity for women’s health by suggesting that it is appropriate for such a complicated area of health be managed by pharmacists who simply don’t have the appropriate qualification to do so. The focus needs to be on funding GP with a goal of quick and affordable access for all Australians. Men won’t even agree to bare the brunt of the side effects of a hormonal contraception. I can’t imagine that they would accept the increased associated health risks that women do every day, or being told that despite these increased risks that they didn’t need to see a doctor to make sure it was actually safe or medically appropriate for them to continue these medications.
I would also suggest that from the outside this all looks a bit suspicious for a planned undermining of General Practice and a strong move towards vertical healthcare in Australia. In particular:
The State Government 2025/2026 budget cuts to the Community and Public Health division with the subsequent redundancies beginning this month (after many employees took voluntary redundancy packages over the last few months already). This is the team responsible for overseeing the Victorian implementation of the National Immunisation Programme and supporting GP clinics to do so. They are now set to drop below 2016 FTE levels of staffing.
The outsourcing of immunisation programs to pharmacies and the shift to pharmacy prescribing and administration of vaccinations outside of the program.
The strengthening of alliances between private medical insurance and pharmaceutical corporations within Australia.
These same private medical insurance corporations buying up a large portion of the GP clinics in Australia. Medibank is now the second largest corporate operator in General Practice with 168 clinics and Bupa announced a plan to build a network of 130 clinics.
The shift towards Medicare clinic bonuses rather than incentives to individual GPs
The escalation in pharmacist prescribing – including the Department of Health utilising a Secretary Approval to bypass the law that is in place to keep Victoria in compliance with the TGA. Noting that the TGA – our peak regulatory body for medicine in Australia – recommended only recently that it is in the best interest of women’s health to keep hormonal contraception as requiring a doctor’s prescription and remain as a S4 medication.
The same person who has been integral in driving these changes – initially at Bupa, and then through the Department of Health, has just become the lead for our centre of disease control.
The line that I hear over and over again from government departments and these corporations is some variation of “oh we would just love to have enough GPs, oh we would love to have affordable and accessible primary care, but we can’t do it overnight and in the absence of quick meaningful change we are just doing our best to support the healthcare system”.
The thing is – I have been hearing that for years now and it is pretty clear that the amount of money being poured into band-aid solutions that fragment and undermine primary care, could have already made meaningful change for GPs and the general population.
Hell, it would make a bigger difference to the health of our population to have put the $18 million poured into “pharmacy consults” into housing solutions for our increasing homeless population despite the literal tens of thousands of empty homes sitting bare in Melbourne alone (and increased by 16% last year). This issue has been a focus of Jordan van den Lamb – known as “purplepingers” on tiktok – who has announced he will be running as the candidate for the Victorian Socialists’ in the November Victorian State Election.
So, if the goal isn’t actually sustainable, accessible and high-quality healthcare for the Australian population, and the goal isn’t improving health outcomes by addressing the social determinants of health such as a very clearly manufactured housing crisis... I can’t help but think the goal is actually vertical integration of healthcare systems within Australia, taking advantage of a sicker population who has to work a full-time job just to afford to live in a tent with their family, and gradually shifting to a point where we are indistinguishable from the American healthcare system we all love to hate.
The future is rapidly approaching: Less access to more expensive and lower quality healthcare, and more cost to the government in healthcare expenditure which gets passed on to the average Australian in taxes while the billionaires continue to increase their profits.
This isn’t about women’s health. This isn’t about equity. This is about the rich getting richer at the expense of the health of the Australian people.