The Next Rung

Australia is moving toward a national standard for advanced practice paramedics, complete with independent prescribing. Here is where things stand, who is worried, and what it could mean for the profession's career ladder.

Every November, more than 28,000 registered paramedics across Australia go through the same small ritual. They log into the Ahpra portal, check their 30 hours of CPD are accounted for, confirm their recency of practice and renew before the 30 November deadline.¹ It is administrative, necessary and rarely exciting.

This year there is a bigger story sitting behind the renewal reminder. In its October newsletter, the Paramedicine Board of Australia confirmed it remains committed to regulating advanced practice paramedics, and said it will seek public feedback on proposed guidelines and supporting materials in the coming months.¹ That one sentence signals the next stage of what is arguably the most significant regulatory shift for the profession since national registration began in December 2018.¹⁶ If it proceeds, experienced paramedics with the right postgraduate qualifications would carry an endorsement on their registration recognising advanced practice and, for the first time in Australia, would be able to independently prescribe scheduled medicines.

How the profession got here

The idea did not arrive overnight. In May 2024 the Australasian College of Paramedicine welcomed a decision by Health Ministers, meeting in Brisbane, to work with the Board on establishing area of practice endorsements for advanced practice paramedics in critical care and community paramedicine.² College CEO John Bruning described the move as recognition of the postgraduate education and clinical experience that paramedics in those roles already bring to the job.

Less than a year later the Board put a model on the table. Under the proposal released for consultation in April 2025, endorsed advanced practice paramedics would provide advanced critical care and advanced primary care, and would be able to independently prescribe scheduled medicines.³ Paramedics in Australia currently have no independent prescribing rights. The Board argued that changing this would improve access to care, especially in rural and remote communities, and noted that Health Ministers had signalled interest in enabling independent prescribing outside ambulance services.³

Board Chair Professor Stephen Gough was careful with his framing. The reform, he said, was "not about changing the role of paramedics" but about building on what already exists in a safe and sustainable way.³

The bar would not be low. Applicants would need additional education and training and would have to meet length of service requirements.³ Published submissions describe the consultation model in more detail, including three years of full time practice (5,000 hours) in a direct patient care role within the previous decade, a Board approved qualification, a period of supervised practice, and an extra 10 hours of CPD each year relating to scheduled medicines.⁴

Quietly, the pieces are moving

Consultation closed on 20 June 2025. The Board says it has since developed a revised version of the proposal after considering all the feedback it received.⁵ In October 2025, Ahpra called for applications to a new Advanced Practice Paramedicine Expert Reference Committee, set up to advise the Board and Ahpra on matters relating to advanced practice paramedics.⁶

Then, in December 2025, came a step that attracted far less attention than it deserved. The Board announced it had approved professional capabilities describing safe and competent advanced paramedic practice and independent prescribing of scheduled medicines, and went looking for an external party to develop an evidence guide to support them.⁷ Those capabilities will be used by education providers to design curricula and applied by the Board in its regulatory work.⁷ Put simply, the yardstick that future advanced practice programs will be measured against now exists.

The next visible milestone is the guidelines consultation flagged in October.¹ For any paramedic with a view on how supervision, prescribing and endorsement should work in practice, that will be the moment to speak up.

Victoria went first

While the national framework has been taking shape, Victoria has been running its own version. In February 2025 the Victorian Parliament passed legislation creating the Paramedic Practitioner role, making it the first Australian jurisdiction with dedicated laws to support it.⁸ The program was funded through $20 million in the 2023/24 state budget, which also covered a free master's degree at Monash University for Ambulance Victoria paramedics with more than five years of experience.⁸

The role is aimed squarely at the conditions that so often end in an emergency department visit: urinary catheter care, wound care and closure, minor infections, dislocations and fractures.⁸ Amendments to Victoria's Drugs, Poisons and Controlled Substances Act 1981 cleared the way for Paramedic Practitioners to prescribe and administer scheduled medicines and treat patients where they are.⁹ According to Ambulance Victoria, the first cohort completed clinical placements across nine health services, a second cohort of 26 started study in February 2025, and the first graduates are due to be deployed to regional Victoria in 2026.⁹

There is a detail here that prospective students should not skim past. Monash states plainly that completing its Master of Paramedic Practitioner and gaining professional endorsement are related but separate processes, and that the course has yet to be assessed for accreditation by the Paramedicine Accreditation Committee.¹⁰ Graduates will still need to satisfy whatever registration, supervised practice and endorsement requirements the Board has in place when they apply.¹⁰ For anyone weighing up years of postgraduate study, that distinction matters a great deal.

Not everyone is convinced

The proposal has drawn genuine opposition. The College of Intensive Care Medicine told the Board in June 2025 that it remained opposed to the model in its then current form.⁴ Its objections centred on patient safety. CICM argued that a master's degree and a relatively short period of supervised practice could not substitute for the vocational training of intensive care specialists, and it did not support endorsement for the full range of scheduled medicines, Schedule 8 drugs in particular.⁴

The college also questioned whether advanced practice paramedics would actually end up where they are most needed. It cited College of Paramedicine workforce survey data showing 69 per cent of Australian paramedics work in the two most urbanised Modified Monash categories, and suggested a model in which advanced practice paramedics work under medical supervision instead.⁴

Other submissions asked for clarity rather than a rethink. The National Health Practitioner Ombudsman urged the Board to spell out whether supervision after endorsement would be required for every advanced practice paramedic and, if so, the minimum requirements.¹¹ Palliative Care Australia supported regulation outright, while calling for reforms so that advanced practice paramedics can access advance care directives and electronic medical records.¹²

These are serious points, and the revised proposal and its guidelines will need to answer them convincingly. Supervision, the limits of prescribing and the question of where these clinicians will really work look set to dominate the next round of debate.

A well trodden path elsewhere

Australia is not venturing into unknown territory. In the United Kingdom, an amendment to the Human Medicines Regulations that took effect on 1 April 2018 allowed advanced paramedic practitioners to train as independent prescribers.¹³ By February 2020, 430 UK paramedics held the qualification and were registered as independent prescribers with the Health and Care Professions Council.¹⁴ Across the Tasman, as Code Chronicles reported in June, New Zealand has moved to give suitably qualified paramedics authority to prescribe from a specified list of medicines.¹⁵

The Australian model has its own shape, with two endorsement areas and a single national standard sitting on top of state based roles like Victoria's. The direction of travel, though, is consistent across comparable health systems.

What it means on the road

For most paramedics, nothing changes this month. Renewal still closes on 30 November, the CPD standard still asks for 30 hours a year including at least eight hours in an interactive setting with other practitioners, and late fees still apply after the deadline.¹

For those thinking about the next ten years of their career, though, a few things are worth doing now. A well kept CPD portfolio that records advanced assessment, pharmacology and supervised experience is likely to carry real weight once endorsement pathways open. Anyone looking at a postgraduate program should ask the provider directly how it maps to the Board's approved capabilities and where it stands on accreditation. And when the guidelines consultation opens, it will be a rare chance for working clinicians to shape how supervision and prescribing operate day to day, instead of leaving those decisions entirely to others.

For a long time the career ladder in Australian paramedicine has looked broadly the same: graduate, qualified paramedic, then intensive care or a specialist role, with extended care models that vary from one state to the next. A national advanced practice endorsement would add a rung that is recognised in every jurisdiction and written into registration itself. How sturdy that rung proves to be will depend on the detail still to come.

References

1. Paramedicine Board of Australia. Newsletter, Issue 17, October 2026.
2. Australasian College of Paramedicine. We're being heard: Health Ministers recognise advanced practice paramedic roles. 2 May 2024.
3. Ahpra. New paramedic model to boost access to healthcare. 23 April 2025.
4. College of Intensive Care Medicine of Australia and New Zealand. Submission: Proposal to regulate advanced practice paramedics. 20 June 2025.
5. Paramedicine Board of Australia. Past consultations: Proposal to regulate advanced practice paramedics.
6. Ahpra. Call for applications: Advanced Practice Paramedicine Expert Reference Committee. 8 October 2025.
7. Paramedicine Board of Australia. Expression of interest: Evidence guide for advanced practice paramedic and independent prescribing capabilities. 12 December 2025.
8. Premier of Victoria. Australia's first Paramedic Practitioner laws pass Parliament. 6 February 2025.
9. Ambulance Victoria. Annual Report 2024/25: Our people.
10. Monash University. Master of Paramedic Practitioner.
11. National Health Practitioner Ombudsman. Submission to the Paramedicine Board of Australia on the proposal to regulate advanced practice paramedics. 2 June 2025.
12. Palliative Care Australia. Workforce policy priorities: Regulation of advanced practice paramedics.
13. The Pharmaceutical Journal. Paramedics can now become independent prescribers. April 2018.
14. Journal of Paramedic Practice. Paramedic prescribing: implementation in practice.
15. Paramedic Shop, Code Chronicles. Writing Their Own Scripts: New Zealand Moves to Give Paramedics Prescribing Authority. June 2026.
16. Paramedicine Board of Australia. Professional standards.

Code Chronicles is published by Paramedic Shop on the 15th of each month. This article is general information only and does not constitute legal, regulatory or career advice. Paramedics should refer to the Paramedicine Board of Australia for current registration requirements.