Guild president resorts to name-calling

Speaking at a student conference this week, Professor Trent Twomey also rubbished the idea of pharmacists and GPs working together.

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Some among us hoped that 2023 would usher in a new era of cross-profession respect and co-operation between pharmacy and general practice.

That hope lasted a solid 18 days – right up until the Australian Journal of Pharmacy reported on Pharmacy Guild of Australia president Professor Trent Twomey’s address to the National Australian Pharmacy Students’ Association Congress in Canberra.

In his speech, he referred to GPs as “twits” and likened the idea of doctors supervising pharmacist-led prescribing to “a plumber needing to look over the shoulder of an electrician before they put in your air conditioner”.

The “twits” comment was made in the context of GP clinics not having to be owned by a doctor, which Professor Twomey said had opened the door for commercialisation of the sector. He implied that this was a major reason for the current state of general practice and the healthcare system as a whole. Famously, community pharmacies can only be owned by pharmacists under the rolling federal Community Pharmacy Agreements in place since the 90s.

Professor Twomey said pharmacist prescribing should be autonomous and done in a community pharmacy setting, rather than the supervised model backed by the RACGP and AMA. He also rubbished structured prescribing arrangements, whereby pharmacists would only be able to prescribe medicines under certain guidelines and protocols.

“[Doctors] only want you to be able to prescribe if it’s within their preferred building and as long as there’s another medical practitioner making sure that smart enough to be able to do it,” the Guild president said.

“It’s bloody insulting.

“We do not support, at the Pharmacy Guild of Australia, being able to only prescribe if someone else is looking over my shoulder.”

According to Professor Twomey’s vision, pharmacists should be allowed to dispense, review, prescribe and administer “all medicines for all people”.

The Guild confirmed with The Medical Republic that Professor Twomey stood by his comments.

He was not available for interview.

To say that GPs were not impressed with Professor Twomey’s comments is an understatement.

“If he is keen to do all the work of a general practitioner, then I would invite [Professor Twomey] to train as a general practitioner,” RACGP vice president Dr Bruce Willett said.

“I think these comments are so destructive that I would call on Professor Twomey to really consider his position and whether or not he can continue to add value towards the building of a better healthcare system in this country.”

The fact that the Pharmacy Guild specifically represents pharmacists who own pharmacies adds another layer to Professor Twomey’s insistence that community pharmacy should be the only setting where pharmacists prescribe.

“Pharmacists essentially have a monopoly on where [other] pharmacists can go to work, which means that currently working pharmacists are held hostage to the near monopoly of the Guild,” Dr Willett told TMR.

The one part where Professor Twomey did hit the nail on the head, although not in the way he intended, was the plumber analogy, according to Dr Willett.

“Electricians should do what electricians do and plumbers should do what plumbers do,” he said.

College president Dr Nicole Higgins described Professor Twomey’s speech as “nothing short of astonishing” and said it should “send a shiver down the spine of politicians everywhere”.

“Let’s just pause for a moment and consider what he is suggesting here, which is pharmacists acting as quasi-GPs without any supervision treating myriad complex health conditions and prescribing the most serious of medications, including those with the potential to cause severe side effects or lead to dependence,” she said.

Meanwhile, Pharmaceutical Society of Australia national president Dr Fei Sim, speaking to a webinar audience earlier this week, said the success of community pharmacy vaccination programs showed pharmacists were competent to prescribe Schedule 4 medications.

Currently, state and territory authorities allow pharmacists to administer injections like the MMR, dTpa, covid-19 and influenza vaccines, even if the vaccinations themselves are prescription-only medicines.

“In my mind that is a form of prescribing, because the definition of prescribing means clinician would have to gather information and make an informed clinical decision to initiate a therapy – in this case … when it comes to vaccination [pharmacists absolutely] do that,” Dr Sim told the International Pharmaceutical Federation on Wednesday.

“[It] is a really good way for pharmacists to demonstrate that we can actually do it safely and that really helps set the precedent for all the other work when it comes to prescribing for minor ailment conditions, urinary tract infections, [or] for hypertension down the track.”