Stakeholders’ views on the development and adoption of health policies related to pharmacist scope of practice and the pharmacy practice environment in Australia

ABSTRACT

Background

Translating research on Pharmacy Practice Environments and Pharmacists’ Scope of Practice (PPEAPSOP) into actionable policy requires a comprehensive understanding of policy components, underpinning processes, and identifying barriers and enablers influencing policy formulation and adoption. This research examined the influences on the development and adoption of PPEAPSOP policies and whether frameworks, theories or models (FTMs) are employed to support these processes.

Method

Three focus groups and ten semi-structured interviews were conducted, adopting a qualitative design between May and September 2025. Participants were identified using the RISA tool and included pharmacists, medical practitioners, organisational, government and consumer representatives. Focus groups and interviews were recorded, transcribed and deductively thematically analysed using NVivo and a 16-item checklist.

Results

Twenty-six participants participated in focus groups (n = 16) and semi-structured interviews (n = 10). Six themes ‘Actors’, ‘Narratives’, ‘Politics’, ‘Environment’, ‘Structural and Systemic Factors’ and ‘Implications’ and twenty-five sub-themes were identified. Barriers included misalignment or opposition to PPEAPSOP policies, risks to expanded scope, structural and systemic factors and political influences. Enablers included alignment and collaboration, narratives with contextualised evidence, diffusion, innovation and future implications. Medical practitioners and government participants focused more on ‘Implications’ and ‘Risks’ compared to pharmacists and consumers, who focused more on ‘Narratives’ and ‘Evidence’. Established FTMs were underutilised by policymakers and decision makers in the development or adoption of PPEAPSOP policies.

Conclusions

The development and adoption of PPEAPSOP policies depend on alignment amongst policy actors, navigation of systemic constraints, strategic foresight of policy implications, and a narrative grounded in robust evidence, =contextualised to the policy environment. Current approaches to the development and adoption of PPEAPSOP policies highlight gaps, underscoring the need for a flexible framework for policymakers and decision makers to strengthen and accelerate policy outcomes. Exploration of a framework may align key components and support more coherent, evidence-informed approaches to targeted policy development and adoption.

Background

The pharmacy landscape and pharmacist scope of practice have been evolving globally over the last 30 years, expanding beyond the dispensary into patient-orientated clinical roles. Tsuyuki and Bond (2019) and Strand (2025). Scope of practice establishes the boundaries of professional practice and is influenced by many factors such as health policy, legislation, the context of practice, health care needs of the population, health care professionals' training, experience, expertise and demonstrated competency Care AGDoHaA (2024).

Internationally, the scope of practice changes, such as pharmacist prescribing, continue to expand and be adopted in countries including the United Kingdom, Canada, New Zealand, the United States and more recently in Australia Stewart et al. (2021), Mesbahi et al. (2025) and Woit et al. (2020). Pharmacists in these regions fulfil roles in managing minor ailments, supporting personalised medicine, conducting health screening, administering vaccinations, managing chronic disease management and promoting preventative health care Pharmacy Guild of Australia (2017). Globally, pharmacy professional groups aided by researchers have typically attempted to persuade policymakers based on clinical, humanistic and economic evidence of the value of pharmacy services; however, some frustrations emerge at inadequate policy action, where evidence exists to develop pharmacy policies and programs (Chiu et al., 2022). The barriers and enablers to policy development are multifaceted and have been studied across several health policy areas Clarke et al. (2016), Cullerton et al. (2016), Edwards et al. (2022), Green et al. (2022) and Suharlim et al. (2022).

The policy environment that influences Australian community pharmacy consists of a complex array of federal and state legislation, regulation, policies and aspirational statements by governments, statutory agencies and pharmacy organisations (Jackson et al., 2024). An analysis of the roles and use of evidence in pharmacy policy in Australia highlighted that although research-based evidence is necessary in policy making, it is often insufficiently influential to inform policy change (Chiu et al., 2022).

An Australian study of barriers and enablers for successful policy activities promoting healthy and sustainable diets found the key barriers to be the complex nature of the system, competing interests of stakeholders, pressure from industry, government silos and lack of political will (Denniss et al., 2021). Key enablers included building stakeholder relationships across disciplines, understanding the policy-making process and developing a clear and coherent solution (Denniss et al., 2021).

A recent systematic review exploring the use of frameworks, theories and models used in the development of health policies internationally, identified fifteen key components used in policy development including, research evidence, knowledge transfer, narratives, content, context, external factors, actors, personal values/beliefs, institutional factors, capacity, innovation, collaboration, politics, coalitions and diffusion (Diamandis et al., 2025). Applying these components to Pharmacy Practice Environments and Pharmacists’ Scope of Practice (PPEAPSOP) policy making and adoption has not been explored. PPEAPSOP is an acronym developed by the researchers to encompass both policies that relate to the pharmacy practice environment – such as remuneration structures or digital integration – and to pharmacists’ scope of practice, including pharmacists’ scope of practice or medicines administration. Whilst the pharmacy practice environment and pharmacist scope of practice are conceptually distinct domains, they are functionally inseparable in current policy reform. Policies governing the practice environment, particularly remuneration arrangements, operate as constraining factors on the scope of practice, underscoring a reciprocal dependency whereby each domain cannot be effectively realised in the absence of the other (Jackson et al., 2024). In principle, the scope of practice should be determined by professional competence and regulatory standards rather than by the setting in which care is delivered; however, in practice, pharmacists’ scope of practice remains closely tied to the practice environment. For example, in parts of Australia, pharmacist prescribing is currently only authorised within the community pharmacy setting, illustrating how environmental constraints continue to shape the deployment of pharmacists’ professional capabilities (Extended Practice Authority Pharmacist, 2025).

Effective translation of research into policy action necessitates a comprehensive understanding of the key components in the policy-making process and identification of barriers and enablers influencing the development and adoption of PPEAPSOP policies.

This research aims to:

1. Examine the key components and influences in the policy-making process relevant to Pharmacy Practice Environments and Pharmacists’ Scope of Practice (PPEAPSOP), including the application of frameworks, theories or models in the process.

2. Identify the barriers and enablers pertinent to the development and adoption of PPEAPSOP policies.

Method

A qualitative research design was adopted, comprising three focus groups and ten semi-structured interviews conducted over five months between May and September 2025 (Busetto et al., 2020). The interview guide was informed by a prior literature review on the policy frameworks, theories and models used in health policy making and key components identified (Diamandis et al., 2025). The interview guide was refined by the research team and followed the 11-step process described by DeJonckheere and Vaughn (2019). It explored the structure, content and influences on PPEAPSOP policy making and adoption, barriers and enablers and the use of frameworks, theories and models in policy development and decision making (Supplemental Appendix 1). Focus groups and semi-structured interviews involved policy actors at an organisation or individual level, classified by the level of involvement in the system – micro (practitioner), meso (state) or macro (federal) (van Wijk et al., 2018). Participants were recruited through purposive sampling (Ahmad & Wilkins, 2025), and included pharmacists from diverse practice settings and stakeholders engaged in PPEAPSOP policies.

Phase 1 involved three focus groups. Participants were invited to either a 90 min face-to-face or online focus group conducted by an independent facilitator and were recorded and subsequently transcribed using a professional transcription service. Focus group 1 centred on community pharmacy perspectives, focus group 2 on the scope of pharmacist practice beyond community pharmacy and focus group 3 included perspectives from non-pharmacy representatives such as government and general practice.

Phase 2 involved 10 semi-structured interviews, virtually conducted, of 60-minute duration, to capture diverse perspectives and enhance the richness of the data. The data from the focus groups and semi-structured interviews were combined in the data analysis, based on a convergence of themes, which strengthened the analysis and allowed a more robust interpretation of results (Lambert & Loiselle, 2008).

The RISA stakeholder analysis tool was used to enhance the quality and transparency of the research (Franco-Trigo et al., 2020). The RISA tool is structured into three domains, including identifying stakeholders and their stakes/interests, stakeholder differentiation/categorisation or prioritisation and methods for investigating stakeholder relationships (Franco-Trigo et al., 2020). Stakeholders were identified through the review of policy documents, contribution to policy development or adoption and the policy context and categorised according to their role, level of influence and engagement in the policy development and adoption process. The names and profiles of participants were deidentified and coded. To protect confidentiality, any identifiers contained within quotes were removed prior to the analysis.

Thematic analysis

Deductive thematic analysis (Pearson et al., 2025) was conducted using a 16-item checklist by Ahmed et al. (2025) and NVivo 14 analysis software to identify key themes and patterns (Allsop et al., 2022; Thomas & Harden, 2008). Pre-determined coding was initially undertaken based on outputs of a systematic review exploring the key components in the health policy development process (Diamandis et al., 2025) and was refined using an iterative process where new codes were derived from the data until data saturation (defined as the point where no new themes emerged) was achieved. The codes were grouped into themes and sub-themes and refined with the research team over three iterations to ensure coherence and relevance. A reflexivity journal (Braund et al., 2024) was kept, capturing and consolidating reflective thinking and discussion. Reflexivity was adopted to enhance methodological transparency and rigour by examining how the researcher’s backgrounds, experiences, values, assumptions and positioning influenced data interpretation and analysis (Olmos-Vega et al., 2022).

Ethics

The research was approved by the University of Newcastle’s Human Research Ethics Committee, Approval No. H-2025-0036. All participants were provided with information outlining the research objectives and protocol, and completed a consent form to participate in the research.

Results

Study participants

Twenty-six participants from across Australia were involved in three focus groups (n = 16) and semi-structured interviews (n = 10). Fourteen participants were pharmacists, and twelve participants were either medical practitioners (n = 3), government and organisational representatives (n = 7) or consumers (n = 2). Participants were predominantly from New South Wales (n = 17), Victoria (n = 3), Queensland (n = 3), the Australian Capital Territory (n = 2) and South Australia (n = 1). Six participants worked in regional or rural settings, and twenty worked in metropolitan settings. Pharmacists included community pharmacists (40%), prescribing pharmacists (24%), pharmacy owners (12%) and included accredited, general practice, hospital and aged care pharmacists. Non-pharmacists comprised of government department representatives (42%), state or federal politicians (17%), medical practitioners (17%) and others, including consumers and organisational policy experts.

Six themes, with 25 sub-themes, were identified as influences in the development and adoption of PPEAPSOP policies (Figure 1).

Figure 1.

Themes and sub-themes of the development and adoption of pharmacy environment and pharmacists’ scope of practice policies.* *Detailed thematic structure and supporting quotations are provided in Supplemental Appendix 2.

Thematic findings

Theme 1: actors

The role of actors in PPEAPSOP policy making and adoption was the most prevalent influence identified. Most participants discussed the need for alignment, acceptance, appetite and collaboration from various stakeholders as well as the role of leadership, coalitions and personal values affecting policy-making and adoption. Ensuring alignment with structural and institutional factors was seen to be critical for making policy recommendations both evidence-based and practical, while supporting governance frameworks and enabling successful adoption. Likewise, alignment among policy actors and with the policy issue itself appeared essential to maintaining coherence and legitimacy.

Stakeholder buy-in …  how do you convince other stakeholders, … not only just the funder, but other players in that system, that what you're proposing, actually could have a positive impact on the final outcome? (Participant S05 – Pharmacist)

So, what makes health policy challenging is if people don't agree. Broadly, that there's a problem. (Participant S03 – Consumer)

When you don't have good alignment between the policy problem you're trying to solve and the policy solution that's being proposed … that makes it very, very difficult to progress anything. (Participant S09 – Government)

Acceptance of PPEAPSOP policies by policy actors was integral to the credibility and collaborative development of a policy, necessitating broad consultation and sustained engagement to ensure actors are collectively invested in the policy trajectory. The perceived lack of legitimacy of the source of the policy, as well as active opposition, was seen to constitute a critical barrier to policy progress. Appetite for a policy among government, the public and practitioners creates an enabling environment for policy development and adoption. In addition, appetite from the practitioners directly impacted by the policy change was seen as important for developing policy and ensuring future capability and capacity for expanded scope.

The source of the idea can influence how successful or unsuccessful a policy is. … when you have to actually lobby to get that up … there can be a lot of barriers to get through, and you need to get a lot more support and prove your point more extensively. (Participant FAB22 – Pharmacist)

If the people that you're making the policy for don't want it or can't engage with it, then that impacts adoption. (Participant S09 – Government)

There is a willingness now to hear from lots of different stakeholder groups about what possible solutions there might be, and a willingness to put political will behind that … (Participant S09 – Government)

Robust intra-and interprofessional collaboration, underpinned by effective communication and strong professional relationships, appeared to enable positive policy dynamics, fostering shared understanding and coordinated action.

Make a health policy favourable and feel like we're all working together and being heard and compromising so that we're all getting the best outcome. It comes back to again, good communication. (Participant S06 – Medical Practitioner)

It’s all health professionals, not just pharmacists, but everyone working collaboratively to their top of scope to benefit the consumer. (Participant FA14 – Pharmacist)

Leadership and establishing policy champions were thought to enable momentum for favourable health policy development and adoption. Vocal dominance and perceived authority were seen to create an imbalance of power in the policy-making and adoption process, and therefore perceived as a barrier by pharmacists and medical practitioners. In addition, the role of coalitions including medical groups and pharmacy groups in influencing health policy making and adoption was highlighted, with coalitions seen to exert a stronger influence in the adoption phase either in favour for or against a particular policy.

Every policy needs a leader, and every issue needs a champion. (Participant S08 – Government)

You can have the most evidence informed policy … but if there's one person in a position of power, then they're not going to like … get through to the keeper. (Participant S05 – Pharmacist)

There was a strong perception amongst participants that personal values, inherent bias and individual experiences significantly shape the trajectory of policy making and adoption. Notably, actors in key decision-making roles were often perceived as being unaware of the extent to which their own beliefs shaped the development and adoption of pharmacy and pharmacist scope of practice policies.

There’s a bias that exists in terms of what data is used and not. (Participant FA16 – Pharmacist)

Because [individual] doesn’t want to see pharmacists expand – their opinion, or their policy, is to slow everything down. (Participant FA14 – Pharmacist)

Theme 2: narratives

The importance of narratives in setting the scene for policy-making and adoption was a consistent theme across all stakeholders, noting the value of having clear objectives and framing the narrative for different audiences. Narratives were considered to comprise adequate content, context and evidence so that knowledge is transferred effectively to specific audiences.

Narratives that enabled PPEAPSOP policy-making and adoption, which focused on addressing specific needs or creating equity, access, value or a positive impact for the community, were thought to be more successful.

In terms of developing [PPEAPSOP] policies it's been a combination of multiple triggers. It's been influenced by consumer needs in terms of access to timely services and it's been driven by the impact of the lack GPs in being able to provide the services. (Participant S04 – Government)

Logical reasoning is really important, explaining things in a clear and appropriate way, and to different audiences to medical groups that's going to be evidence, that's going to be data …  and providing reassurance to governments … to the Australian population, the framing will be different again. (Participant S02 – Pharmacist)

Evidence was perceived as an important part of the policy narrative, with government reporting to require further substantiation of existing evidence before advancing policy formation or adoption, in contrast to pharmacists and consumers who believed there was sufficient evidence in the narrative to progress PPEAPSOP policies. Testing evidence in the context of different geographical, cultural and socioeconomic conditions to ensure relevance and feasibility and providing the right context between state and federal systems was stated as enabling policy making and adoption. However, evidence alone was regarded as insufficient in driving policy adoption, and gaps were observed in the translation of evidence into evidence-based decision-making in relation to PPEAPSOP policies.

There has been evidence and different trials … international development of scope of practice that has been ignored … The way that scope of practice is developed … there has been a desire to start from scratch rather than to bring in any models or evidence or data externally. (Participant FA16 – Pharmacist)

I think it's time has come and there's lots of evidence to show from the trial, from the international evidence that people have better access to care, safe access to care and are getting the care they need when they need it. (Participant S03 – Consumer organisational)

Knowledge transfer was identified as a mechanism for shaping policy narratives, particularly around practitioner capability and developing credible and relevant policies. A persistent lack of knowledge transfer was noted as fragmenting understanding and diminishing confidence in PPEAPSOP policy-making and adoption.

There’s this fundamental lack of understanding of one, how pharmacists are trained, how they interact with patients on a day-to-day basis, the referral pathways back through to the rest of the healthcare system and how it can be best leveraged as well. (Participant FA16 – Pharmacist)

Theme 3: structural and systemic factors

Structural and systemic factors were identified as barriers to policy-making and adoption, consisting of institutional limitations and limited capacity within government and the workforce undergoing transformation. Institutional factors impeding policy-making and adoption were predominantly identified by government actors and included insufficient resources and funding by government departments, as well as jurisdictional constraints embedded in legislation and regulation and structural complexities in how healthcare is delivered, accessed and financed across healthcare settings.

We get asked to do a lot of policy change, but the team that I work with is tiny, and we’ve got a lot of asks on the plate. So sometimes it’s just resourcing and capacity … (Participant FC25 – Government)

The State vs Federal, different agendas and different pools of money. That makes it tricky. (Participant FA15 – Pharmacist)

Additional barriers included limitations to infrastructure for practitioners and a lack of access to digital technology. Capacity limitations, including conflicting priorities, proof of capability and practitioner capacity, were identified as barriers to effective PPEAPSOP policy formation and adoption by pharmacists and government, exacerbated in regional and remote areas.

There seems to be a … lack of appreciation in terms of the volume of patients that you have to see to make it feasible … the way that you have to change the nature of the businesses, the infrastructure that’s required. (Participant FA16 – Pharmacist)

The real challenge is to get critical mass and to structure our workflows to make sure that when someone comes in with a UTI, we don't go, oh sorry, we're too busy with scripts. (Participant S02 – Pharmacist)

Theme 4: politics

Political influence and networks were identified as enabling mechanisms, shaping decision-making with an imperative to mitigate political loss and secure political advantage. Alignment of prevailing political agendas, coupled with public support and acceptance, underpinned by strong political will, was identified as a key enabler of PPEAPSOP policy-making and adoption.

Where progress has been made, there is often because there is political will, to not just listen to one stakeholder voice. (Participant S09 – Government)

Advocacy and political influence can be significant in some of these spaces. There are some things that have broad appeal but are not politically safe enough for decision makers to agree to. (Participant S02 – Pharmacist)

If it's on the minister's agenda and obviously if it's a situation where you've managed to secure an election promise those things are always prioritised very highly. (Participant S10 – Consumer)

Theme 5: implications

PPEAPSOP policies that considered equity and integration, allowing for continuous evaluation and iterative improvement, were enablers to policy development and adoption. Negative implications, such as perceived risks or cascading interdependencies, were identified as significant barriers to policy development and adoption. Government representatives, medical practitioners and consumers emphasised risks related to scope of practice policies, particularly in relation to patient safety, safe practice and the potential for adverse outcomes.

Additionally, professional risks in terms of managing conflicts of interest, addressing skills gaps, maintaining professional competence and jurisdictional consistency were all identified as barriers that need to be overcome to enable the development and adoption of PPEAPSOP policies.

For me, the primary things are safety, safety for the patient, safety for the doctor, you know, how do we make it safe. (Participant S06 – Medical Practitioner)

I think what makes it favourable at a national level is … Australians believe that every citizen should be able to access healthcare, and they see it almost as a right and that it should be something that they can access affordably and when they need it. (Participant S07 – Government)

My next concern is going to be around the training and the knowledge gaps. (Participant FC26 – Medical Practitioner)&&&

Conversely, participants emphasised the importance of PPEAPSOP policy success, particularly regarding future implementation, funding, scalability, viability and outcomes as an enabler of policy development and adoption. The main success outcomes identified by participants were centred around equity, access and better health outcomes, backed with sustainable funding models.

What does extended scope look like, and then the next step on from that then is how does Medicare funding, particularly in primary care, follow? (Participant S01 – Government)

I think it's time has come and there's lots of evidence to show …  that people have better access to care, safe access to care and are getting the care they need when they need it. (Participant S03 – Consumer)

Participants noted that complex PPEAPSOP policies were a barrier to policy development, particularly if they impacted patient availability of the proposed service and other professional roles. A tendency towards risk aversion and minimising change, driven by fear of negative consequences, was observed, namely from government participants.

We know that not all pharmacies are providing this service, so, initially that's a bit of a downside for the consumer because they have to identify which pharmacy will provide that service. (Participant S06 – Medical Practitioner)

The potential disadvantages is the pharmacy availability to actually provide these services, the potential distraction of pharmacy from providing their core service. (Participant S04 – Government)

We've got to be careful, cause if we're not careful, we wind up like Canada where they've got like a motorhome that goes from town to town offering to write [name] prescriptions for people. (Participant S01 – Government)

Integration within the health system, encompassing funding structures, legislative frameworks, communication channels and access to shared systems utilised by other health professionals, was identified as a critical enabler to PPEAPSOP policy development and adoption.

We’re evolving our clinical role, and the integration piece hasn't really caught up … the priorities are not only about evolving scope, but how do we evolve integration of pharmacists into the health system? (Participant S09 – Government)

I think it's important across Australia … legislation and regulations are harmonised, so everyone's … working at the same standards and regulation across Australia. (Participant S03 – Consumer)

You shouldn't have to pay in one state and not pay in other states and in a way which integrates into the local health system … one of the problems we have in scope of practice is that we're still evolving the role of pharmacists, but … we don't have access to the same health systems in terms of identifying patient issues. (Participant S05 – Pharmacist)

Agility and capacity for responsiveness, with the need for flexibility and continuous evaluation and iterative improvement were framed as an enabler to PPEAPSOP policy progress.

The continuous monitoring to an evaluation to make sure that your policy intent is being realised and there's no adverse impacts. (Participant S04 – Government)

Policy needs to be more dynamic. As someone who just works on the ground, it just gets really annoying that they put all this effort in and then it’s just – it gets outdated so quickly as well. (Participant FB19 – Government)

Future strategy planning appeared essential to enabling scope of practice policy reform, which was lacking in both the government and pharmacy sectors, according to some policy actors. Future thinking and consideration of applicability to other sectors were seen to enable policy development and adoption.

The lack of long-term strategic directional vision within the departments and the sectors quite typically, both federally and from a state level … We should be looking at the long-term consequences if nothing is done or policy is not developed further, and there should be far-reaching strategies that the whole of sector is bought into. (Participant FA11 – Policy Expert)

Theme 6. environment

External factors, such as social determinants of health, were noted as environmental factors that impacted policy making and adoption. Innovation was considered an enabler of PPEAPSOP policy development and a key consideration in the adoption process. Technology advancements were seen to foster an innovative culture, enabling pharmacists to expand their scope of professional practice and undertake broader and more impactful roles.

That intersection with … . things like housing, education, employment, all of those other non-health-related things that have tangible health impacts. (Participant S09 – Government)

Technology has substantially advanced …  primary healthcare practitioners should be able to have access to electronic medical records, digital records … across the country. (Participant FC24 – Government)

Diffusion also functioned as an enabler to informing policy making and enabling adoption, with international learnings and jurisdictional pressure providing momentum for PPEAPSOP policy reform.

It’s been a combination of multiple triggers. You've had the influence from the government, but then that's been influenced by other jurisdictional policies and direction. (Participant S04 – Government)

We have initially relied fairly heavily on overseas examples to say that this is something that happens and that is safe. Without overseas examples … this probably would have been a lot harder to get off the ground … (Participant S02 – Pharmacist)

Application of policy frameworks, theories or models

Across pharmacists, medical practitioners, government and policy officials, there appeared to be a lack of recognition of the use of policy frameworks, theories and models in the policy-making process, some noting a subconscious application of frameworks, theories and models in practice.

Ignorant to know what those frameworks, theories and models are. (Participant S06 – Medical Practitioner)

I don't consciously see particular models used in policy development, that's not to say they don't exist, but it's really quite inconsistent. (Participant S02 – Pharmacist)

Just common sense, right? I don’t think I’ve ever seen a framework or theory applied to policy evolution … well, it may have been … I wouldn’t been aware of it. (Participant S05 – Pharmacist)

I don’t bother with them anymore, if that makes sense. (Participant S01 – Government)

I don’t operate in an academic environment or through frameworks and models. I look at problems and I look at them needing to be solved. (Participant S08 – Government)

I’ve certainly seen people use programme logics … I suppose. Have I seen them applied in a very pure way, maybe not. (Participant S10 – Consumer)

Participants were unable to name any specific policy frameworks, theories or models that they had encountered in the policy development or adoption process.

Discussion

This study sought to examine the key components and influences shaping policy development and adoption of PPEAPSOP policies, including the application of frameworks, theories and models and barriers and enablers affecting these processes. The findings indicate that effective policy development and adoption in this context are dependent on alignment and leadership amongst policy actors, navigating systemic constraints and anticipation of policy implications. Additionally, the findings emphasise the need for a clear and credible policy narrative, supported by robust evidence and informed by a nuanced understanding of the policy context. The application of frameworks, theories and models in the development and adoption of PPEAPSOP policies was limited.

Previous international studies have largely examined stakeholder perspectives on discrete elements of PPEAPSOP (Dahri et al., 2024; Jebara et al., 2018) or barriers and enablers associated with implementing non-medical prescribing and expanded scope of practice (Edwards et al., 2022; Graham-Clarke et al., 2022; Rouleau et al., 2024). In contrast, this study addresses a gap in understanding by exploring how PPEAPSOP policies are formulated and the broader factors that shape their development and adoption.

‘Actors’ appeared to be the most prevalent influence identified by all participants. A lack of alignment, acceptance, appetite or collaboration amongst actors impacted by a policy was considered a significant barrier in the development and adoption of PPEAPSOP policies. Alignment was multifactorial – considering not only alignment of actors, but more importantly, alignment of the policy objective with the policy issue and across institutional structures and systems. Relationships with actors, including experts and intermediaries, have been previously identified as crucial in the Australian health policy development context (Ingram et al., 2024; Lilly et al., 2023). However, this study emphasises the need for deeper engagement amongst policy actors and at the earliest stages of policy inception to generate legitimacy and credibility for PPEAPSOP policies.

Personal values, beliefs and inherent bias emerged as significant barriers to advancement in policy making and adoption, with participants citing the influence of powerful decision makers obstructing progress and departmental staff highlighting the impact of ministerial announcements in shaping and constraining the trajectories of PPEAPSOP policies. Inherent bias also extended to the perceived legitimacy of the policy source – with pharmacist-led policies often seen as lacking validity when compared to those originating from within government departments or initiated by other health care providers (Liverani et al., 2013; Schippers et al., 2025) and further solutions are needed to enhance the process so that it is applied with minimal bias to maximise policy outcomes.

Conversely, acceptance and appetite for PPEAPSOP policies by government, practitioners and consumers enable policy development and adoption, enhancing the future capability and capacity for expanded scope and the sustainability of the policy within the health system. Previous studies have also highlighted the importance of policies perceived as acceptable by stakeholders, as they are more likely to be congruent with government agendas, implemented effectively and sustained over time (Haby et al., 2025; Sharp et al., 2020).

Consistent with findings from a systematic review on collaborative policymaking (Cairney & Toomey, 2024) this research underscores the need for early, cross-sector collaboration across government departments and levels as policy problems transcend traditional boundaries. Equally critical is co-design with consumers, stakeholders and external organisations to gather diverse insights and build momentum for policy change (Cairney & Toomey, 2024).

Narratives were identified as influential to the development and adoption of PPEAPSOP policies and are well-documented as a tool for influencing health policy change (Bandelow et al., 2025; Fadlallah et al., 2019; Lilly et al., 2023). Integral to the policy narrative was ensuring the right context was applied in the policy development process. Narratives that focused on addressing a specific need or solving a problem supported by evidence and knowledge transfer from other geographical regions enabled PPEAPSOP policy-making and adoption. Whilst evidence was considered important, in isolation, it was deemed inadequate to influence policy making or adoption. This is consistent with broader health policy research showing that whilst evidence is more likely to support policy action, it may not always be used to inform policy (Lilly et al., 2023). Where government representatives and medical practitioners raised risks to PPEAPSOP and a lack of substantial evidence, pharmacists and consumers focused on the benefits and beliefs that there was substantive evidence for the development and adoption of pharmacy policies. This is also reflected in a systematic review of stakeholder perspectives of pharmacist prescribing, where patients and pharmacists viewed prescribing as a natural progression to improve access to healthcare and leverage pharmacist expertise supported by evidence (Jebara et al., 2018). This contrasts with, medical practitioners and government, who remained cautious, citing gaps in diagnostic skills, additional training and system access to prevent care fragmentation (Jebara et al., 2018). Establishing a shared, evidence-informed understanding of pharmacists’ clinical competencies and scope of practice, combined with a co-design of training, governance and system integration, is essential to overcoming policy inertia.

Structural and systemic factors were often seen as barriers to the development and adoption of PPEAPSOP policies. Barriers included jurisdictional constraints embedded in legislation and regulations between state and federal counterparts, which create misalignment across systems governing health care delivery, communication and funding. The implications of these structural and systemic factors are far-reaching, leading to inequitable health care – affecting patients’ access to health care, the cost of care and the consistency of health care delivery across regions. Furthermore, these jurisdictional discrepancies produce professional disparities as practitioners operate under different legislative conditions, are permitted varying levels of scope of practice, which not only limits what practitioners can deliver, but also contributes to uneven workforce capability and fragmentation across the health system.

A lack of capacity and potentially capability was seen as a barrier to policy progress, with the need for a critical mass to be developed to ensure the policy delivered on its objectives in creating greater access to care. Australia’s health system has long grappled with complex governance, funding and provision of health care (Angeles et al., 2023), with regulatory constraints, inconsistent funding and a lack of resources and capacity frequently cited as barriers to policy action (Lilly et al., 2023; Liverani et al., 2013). Future reorganisation of the health system, considering these structural and institutional tensions, such as integrating and coordinating services and aligning funding across states and state-federal jurisdictions, is essential to sustainable PPEAPSOP policy reform.

Digital advances were seen as an enabler to overcoming some of the structural and systemic factors, as well as building confidence in government and medical practitioners in the capability of the pharmacy workforce to deliver on expanded scope. In addition to interjurisdictional coordination and enhanced resource allocation, modernisation of regulatory frameworks and investment in digital health infrastructure are needed to support integrated pharmacist scope of practice service delivery. Digital ecosystems enhance real-time communication, accessibility and care coordination (Mwogosi & Mambile, 2025) integrating technology into clinical workflows and providing infrastructure that supports integration and collaboration amongst healthcare providers. Integration across systems and sectors is critical to achieving coherence and maximising policy effectiveness. Consideration of regulatory frameworks and practice standards, and the need for proactive changes, is integral to ensuring workforce readiness and enabling future capacity.

Consistent with previous studies (Lilly et al., 2023), politics was seen as both a barrier and an enabler to the development and adoption of PPEAPSOP policies, depending on the policy actor. Power and influence of individuals, and hierarchies across government levels, all contributed to the complexity of political influence in developing and adopting PPEAPSOP policies. Participants underscored the multifaceted nature of politics as a critical determinant of policy processes, highlighting the paradigms and strategic considerations in the development and adoption of PPEAPSOP policies.

The political influence of pharmacy coalitions in enabling policy progress with government ministers was highlighted across stakeholders, as was the role of medical practitioner coalitions in stalling policy progress with polarising narratives. Government and public support were both enablers for policy development and adoption, whereas mitigating political risk and a lack of political will by the government acted as barriers.

A comprehensive review of proposed policy and future considerations, such as anticipating risks, enabling conditions, success measures and cascading interdependencies, is essential to influencing policy change. The implications of PPEAPSOP policies were typically seen as a barrier to policy development and adoption, particularly if they were not considered in the policy proposal. The implications identified as barriers, highlighted by government and medical practitioners, centred around risk and included patient safety, adding complexity to care delivery and managing conflicts of interest by separating the prescribing and supply function. A lack of integration of pharmacists in primary care, as well as state-federal systems integration impacting care coordination and remuneration, were barriers to policy making and adoption. The implications that enabled PPEAPSOP policy development and adoption included the potential impact on improving care access and equity across the population, coupled with the viability and scalability of the policy change being favourable and achievable. Equity in health care in terms of access to health care providers, medicines and cost, was a key consumer consideration for future policy success, identified consistently across Australia and internationally (Ellis et al., 2021; Mesbahi et al., 2025; Phillips et al., 2023).

Transparency around a future strategy and vision, and sharing this openly with all policy actors, was seen as an enabler to PPEAPSOP policy change to establish a shared understanding of goals and success. The need for monitoring and evaluation to inform policy revisions and future policy development has been emphasised in prior research (Lane et al., 2020). Future planning should incorporate a comprehensive assessment of risks, success factors and potential cascading impacts, which should be embedded from the policy-making phase. Effective strategies should prioritise implementation fidelity, anticipated outcomes and mechanisms for continuous improvement while fostering agility and long-term sustainability.

The external environment to the immediate health policy environment was considered an important influence on PPEAPSOP policy change. Whilst the pandemic accelerated policy change across several health care areas (Capano et al., 2022; Golden, 2023; Haun, 2025), this is typically followed by prolonged periods of political policy equilibrium, highlighting a potential environmental barrier to PPEAPSOP policy making and adoption. Other environmental barriers include socioeconomic influences, poor timing and competing priorities of policy actors, particularly the government. Osypuk et al. emphasised the importance of policy-makers designing future policies to evaluate health outcomes using validated health measures targeting more broadly across the socioeconomic spectrum (Osypuk et al., 2014).

Innovation and diffusion were seen as enablers to PPEAPSOP policy development and adoption, with the diffusion of international learnings and from other jurisdictions providing evidence and momentum towards the proposed policy solution. Policy diffusion is known to be anchored in the recognition that policy adoption is inherently interdependent and rarely occurs as a result of internal factors alone, and occurs through five key mechanisms: learning, emulation, coercion, competition and social contagion (Fundytus et al., 2023). In this study, diffusion processes in relation to PPEAPSOP policies have occurred at an international and national level through a range of these mechanisms and will continue to be integral in the development and adoption of future PPEAPSOP policies. Besides digital enablement, innovative models of PPEAPSOP should also be considered. Looking ahead, policy-makers should innovate and proactively lead future policy rather than reactively look to solve problems, to progress PPEAPSOP policies.

Finally, this study highlights a lack of application of frameworks, theories and models in the development of PPEAPSOP policies, by policy makers and decision makers, consistent with other studies exploring their use in the health policy process (Diamandis et al., 2025; Lilly et al., 2023). Although Australian pharmacy policy research has demonstrated the value of applying frameworks, theories and models to highlight structural constraints, stakeholder dominance and incremental reform (Jackson et al., 2023), established frameworks, theories and models are not proactively applied to policy development. Future PPEAPSOP policies should draw on the application of these tools to support more systematic policy development and adoption. This emphasises the need for a flexible framework to support policy making and adoption by governments, funders and decision makers as well as to support organisations in their quest for policy change on key health priorities.

Strengths and limitations

A key strength of our study was the use of semi-structured interviews in addition to focus groups, to validate focus group findings and gain a deeper understanding of PPEAPSOP policies across system levels and jurisdictions.

The focus groups and semi-structured interviews included a broad range of pharmacy, medical, consumer and government stakeholders across federal and state jurisdictions; however, the predominance of participants from NSW may have given more prominence to barriers and enablers of PPEAPSOP policies specific to this geographical location. Pharmacist representation was also predominantly community pharmacy-based, which provided limited opportunity to cover the expanded scope of practice across other pharmacy settings comprehensively. This may have limited the visibility of alternative barriers and enablers encountered in other jurisdictions or practice contexts, where regulatory arrangements or policy processes may differ.

Whilst pharmacists from rural settings and practice environments outside community pharmacy (including general practice, aged care, hospital and consultant pharmacists) were included in the research, their potential underrepresentation may be reflected in the perspectives captured, and this should be considered when interpreting study findings.

Data analysis and coding were performed by one researcher and may be dependent on the individual skills and personal bias of the researcher. To navigate this, a reflexivity journal and iterative process were undertaken by the research team to review and develop themes to maintain validity.

Implications

This study adds important evidence on the key components and influences in the policy process, providing greater depth to the barriers and enablers pertinent to the development and adoption of PPEAPSOP policies. This study also highlights the lack of application of established frameworks, theories and models in the policy-making and adoption process for PPEAPSOP policies by both policy-makers and decision-makers.

Although this research examined the expanded scope of pharmacists and pharmacy environments in Australia, the findings may have broader relevance. They may inform the development and adoption of PPEAPSOP policies internationally, as well as the scope of practice reforms affecting other allied health care providers. This relevance is likely where similar policy dynamics, stakeholder relationships and institutional constraints shape practice environments and reform processes. In addition, the findings may offer insights relevant to other health systems and jurisdictions with differing regulatory structures where comparable processes and constraints influence practice environment and scope of practice policy change.

Considering the future implications is fundamental to enabling sustainable PPEAPSOP policy change. This requires deliberate attention at the initial policy development phase to implementation strategies, scalability and viability to ensure the reforms are practical and adaptable across diverse contexts. Anticipating challenges and opportunities in PPEAPSOP policy making and adoption allows for proactive planning to support positive outcomes, mitigate unintended consequences and may foster more policy-relevant research. Embedding mechanisms for continuous evaluation and iterative improvement of PPEAPSOP policies further strengthen responsiveness and adaptability and enhance the likelihood for successful adoption and long-term impact. A flexible framework for PPEAPSOP policy makers and decision makers, such as the government, would enhance PPEAPSOP policy development and adoption by tackling the drivers and barriers to the policy change.

Study recommendations

A more structured and intentional approach to the development and adoption of PPEAPSOP policy is required to ensure policy reform is practical, efficient and sustainable. Alignment amongst policy actors and leadership will enable navigation of structural and institutional constraints, supported by strategic foresight that anticipates policy implications. A coherent narrative grounded in robust evidence and contextual understanding, considering the policy environment, alongside digital technologies that support integration, is essential to driving policy change. The use of a cohesive framework by policy-makers and decision-makers may further strengthen and accelerate policy outcomes.

Conclusion

This study demonstrates that beyond the influence of political and environmental landscapes, PPEAPSOP policy-making and adoption are more likely to succeed where there is alignment and leadership among policy actors regarding the proposed policy solution, effective navigation of structural and systemic constraints and strategic foresight that anticipates future implications of the policy. This process should be anchored in a coherent policy narrative informed by robust evidence, substantive content and contextual understanding. This study further reveals the gaps in the approaches currently applied by policy makers and decision makers during the development and adoption of PPEAPSOP policies, highlighting the potential for a flexible, cohesive framework that supports more integrated, multi-dimensional and evidence-informed practices to enhance the development of targeted policies and strengthen policy outcomes. Future research should draw on the literature on health policy making and adoption, as well as established frameworks, theories and models to inform a cohesive framework that facilitates efficient and sustainable development and adoption of practice environment and scope of practice policies across diverse international health systems.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20523211.2026.2670703.