Practitioner title protection and the “unnecessarily complex” process to make reforms around issues like drug prescribing are among longstanding issues potentially holding back the ophthalmic sector, and have been highlighted in the government’s final scope-of-practice report.
The landmark ‘Unleashing the Potential of our Health Workforce’ review was headed by Professor Mark Cormack and covered health professions working outside of hospital settings, including optometrists and orthoptists.
Findings from the year-long review were released on 5 November 2025 and found virtually all the nation’s health professions are held back by restrictions and barriers unrelated to their skills, training and experience.
“Inconsistencies across states and territories make it harder for patients to get the care they need, and for health practitioners to move to where they’re needed,” federal health minister Mr Mark Butler said.
“Healthcare activity that one state enables and supports, another state may block or restrict.”
The review produced 18 recommendations in three broad areas: workforce design, development, education and planning; legislation and regulation; and funding and payment policy.
Barriers to optometry oral prescribing
Optometry Australia, which has been pushing hard for scope expansion, highlighted the issue of oral medications prescribing. It’s something optometrists in New Zealand, Canada, UK and other countries are authorised to do, but not here.
“For optometrists, when it comes to prescribing oral medications for the purpose of the practice of optometry, it is not state and territory drugs and poisons laws that are holding back change,” the organisation said.
“Rather, it is the need to secure a decision that allows therapeutically-endorsed optometrists to prescribe oral medications for the purpose of the practice of optometry. This decision is made by health ministers, based on advice from Ahpra, following a thorough deliberative process by the Optometry Board of Australia, which includes public consultation and consultation with the relevant professions.”
Optometry Australia CEO, Ms Skye Cappuccio, said the body had long advocated for a system that recognised and supported optometrists’ full scope-of-practice, including the development of collaborative care models alongside ophthalmologists.
“It’s important and useful that the review highlights the barriers to health practitioners – including optometrists – employing their full scope-of-practice for the benefit of patients and communities. We eagerly await the government’s response to recommendations directed at removing key barriers,” she said.
In the report, Prof Cormack said progressing evidence-based, significant scope reforms, such as prescribing, have proven to be “an unnecessarily complex process requiring decades of work across professions, regulators, Australian, state and territory governments and officials”.
“Such progress has involved ad-hoc investigative processes, one-off reviews and complex intergovernmental mechanisms to settle the case for change and sensible reform.”
As such, he recommended forming an independent agency that supports innovation and reform, stating “primary care workforce innovation and reform were identified as requiring more systematic assessment and support”.
New funding models
In discussing the report publicly, Prof Cormack mentioned: “If there’s not a payment available for a healthcare worker to work at their full scope of practice … they won’t do it.”
The review recommended a new blended payment to enable access to multidisciplinary health care delivered by health professionals working to their full scope in primary care.
Optometry Australia said this aligned with its Strategic Plan 2024-27, which identified the need for funding systems that empower optometrists to work to their full and evolving scope-of-practice.
“Current Medicare item fees don’t cover the true cost of optometric clinical care. Optometry Australia is committed to exploring funding models and advocating for those which hold promise for optometry, optometrists and community eye health,” Cappuccio said.
Limitations of title protection
“Rigidity” in the health system brought about by title protection was a major focus.
It’s something Orthoptics Australia noted in its submission. The organisation said risk-based regulatory approaches were likely to be more appropriate than current approaches that rely on the National Law – to the exclusion of self-regulated practitioners – in enabling all health professions to work to their full scope.
“This is likely to be particularly important where there is overlapping scope-of-practice, skills and capabilities (e.g. orthoptics, ophthalmology, optometry) to enable all health professionals with necessary capabilities to perform these activities,” Orthoptics Australia said.
“It will be essential that all health professions are included where relevant, beyond those registered with NRAS (National Registration and Accreditation Scheme).”
In the report, Prof Cormack called for a more balanced approach to regulating scope-of-practice, which does not rely solely on title protection, in future legislation and regulation that would address the high degree of rigidity within the legislative and regulatory environment.
“Consumers stand to benefit from increased access to common types of primary care which are enabled to be delivered by a potentially broader range of health professionals,” the report said.
On the topic of self-regulated professions, of which orthoptists are, the review recommended the Health Ministers’ Meeting (HMM) agree to strengthen and standardise the regulatory model for those currently operating outside of the NRAS.
Evidence strongly points to self-regulated professions being precluded from performing activities for which they are competent in, and which are within scope. It said this recommendation would “ensure improved access to care delivered by self-regulated health professions”.
“It is also likely to result in greater public confidence in the scope-of-practice of self-regulated professions by introducing greater transparency and certainty through the chosen mechanism.”
Review validates frustrations of health workforce
Butler, the health minister, said review found that removing many of the existing barriers would make it easier for Australians to get high quality care, when and where they need it, without waiting weeks for an appointment.
This is particularly the case in regional and remote areas, where a health professional may be available and yet the regulatory and legislative settings may not authorise or enable them to provide care that is within their scope, he said.
Fewer needless barriers would mean health teams work better together across disciplines and health professionals have greater job satisfaction, making it more likely they stay in the workforce for longer.
“This review validates the frustrations of so many of our incredible health professionals: the health system does not enable and support them to consistently deliver the care that is within their skills, training and experience,” Butler said.
“Many of the recommendations will require collaboration between the Commonwealth and state and territory governments, as well as consultation with peak professional organisations, Ahpra, patient groups, and the sector more broadly. I look forward to these discussions.”
The full final report and recommendations can be found here.
More reading
A hard pill to swallow: oral medication prescribing rights for optometrists
Orthoptics Awareness Week 2024: Unleashing the potential of orthoptists
Caution urged for Australian optometrists considering cosmetic scope expansion
