Doctors ‘declare war’ on the Pharmacy Guild

GPs are outraged over a Guild leader column blasting “five-minute medicine” – but he says as long as doctors hold themselves above everyone else the system will be fragmented

The Pharmacy Guild is under fire from doctors after its NSW branch president David Heffernan took aim at “five-minute medicine” in his recent column, arguing that pharmacists should be able to practise in the full minor ailment space to help ease the strain on general practice and emergency rooms.

“There are a litany of minor ailments that could be addressed immediately by a community pharmacist – if the law permitted,” wrote Mr Heffernan.

“Gone are the days where a GP would turn up on your doorstep in their dressing gown and doctor’s bag.

“You will find in the corporate GP practices, business models that appear to encourage five-minute medicine – turnstile operations which encourage patients to come in for short visits and often.

“More and more, healthier patients with low morbidity conditions fill GP time slots. Healthier and wealthier patients are financially more attractive to business models that put profits before patients (a GP practising five-minute medicine can earn over $400 an hour in a bulk billing practice).

“This phenomenon, called ‘cream skimming’, is where financially more attractive – wealthier/healthier patients with low morbidity conditions – are given preference over high morbidity patients.

“The unfortunate side effect is when GP books are filled with ‘easier’ clients, the poorer and more in need of health care are marginalised, forced into the public system of emergency wards.”

Mr Heffernan added that while the AMA calls for more funding, “this would be a disaster for an already struggling MBS budget as it will do nothing to address the issue of cream-skimming. Instead, increased funding to GPs will only incentivise five-minute medicine and blow out an already out of control GP and hospital spend.

“A solution is there for our legislators where community pharmacy stands ready to ease the strain on a burgeoning health spend and free up appointment times for GPs and emergency rooms.”

GP blowback

After Mr Heffernan’s comments were picked up by a doctor’s publication, GPs have lashed back. Here are a selection of the responses:

“We need to declare war on the Pharmacy Guild whose members are selling unproven naturopathic and homeopathic products over the counter. Who has the biggest rort when my local pharmacist tell my patients to get me put down Regulation 24 on all their scripts especially toward the end of the calendar year so that the patients do not pay the gap and the pharmacist pockets the profit. Mr Heffernan brings it on.”

“Enough is enough, whoever think they can do a better job than Doctors let them come and replace us. I feel sorry for these people who never managed to get to medical school and trying to show us as bad carers for our patients.”

“Vitriolic hyperbole. Pharmacists have their own turnstile, and as the patient walks out with their bucket of ‘complementary medicine’ and other such snake oil – the pharmacist dips into their vulnerable wallet. Sure the corporates have a lot to answer for, but so does the churn of the pharmacy supermarket. Sour grapes indeed – makes for fancy snake oil. Allowing pharmacists in to manage the “minor ailment” space is like getting the fox to watch the chickens. Let Woolworths, Coles and Aldi dispense.”

“Such a self-serving article. Many a consult presenting as a ‘minor ailment’ has led to a serious diagnosis because as caring holistic practitioners we listen to the patient. Pharmacists clearly want to practise ‘turnstile’ pharmacy and ‘cream skin[sic]’.”

“Yo Heffernan, You wanna practice medicine and be entitled to all the privileges – be a sport, compete and enrol into Medicine. When you have your MBBS/MD and FRACGP/FACRRM – then you can have a say in General Practice. I’ll wait for you at the finish line, if you make it… :-)”

“If only…… He’s completely out of touch with what bulk billing corporate GPs actually do! I find his comments insulting. Especially since I have just finished a surgery where 50% of my consultations (as usual) took more than 20 minutes.”

“Try not to generalise that all GPs do are 5-minute consults and tend to avoid the more complicated patients by catering to those with ‘low morbidity conditions’. The conditions you have mentioned may be as simple as what you think but do not necessarily follow. Your Guild has bad eggs as well, just like in any other professions. Let’s not make it your group against ours. Don’t flame it any further. Why can’t we work together?”

“Never have I read such a blatant push to further denigrate the value of the general petitioner than this article and to the person making all these assertions and putting it bluntly allegations of rorting Medicare, he should go and f*ck himself. Show me an ethical community pharmacist and I will show you shop full of useless stuff to sell to a naïve population because they are promoting themselves as not only pharmacists but as pseudo-doctors!”

“Lool…a simple headache could be a brain tumour, a simple UTI like presentation could be bladder cancer, a simple skin lesion could be a melanoma or other skin cancer………..there is no simple thing in medicine unless you have passed through a medical school. This is a call for disaster.”

Mr Heffernan told AJP: “The commentary is not very productive and glances past the actual issues of some of these emerging business models that marginalise the sicker and healthier people into the hospital system.

“Now by no means was I indicating that the behaviour of a few represent the whole mob, however if collectively health providers and the industry have their head in the sand, ignoring some of these issues, then it’s the patients who lose out.”

He highlighted that Health Care Homes have been set up to specifically address the issue of “cream skimming” he was talking about.

“Health Care Homes are concepts that help the poorer and the sicker and bring equity of access back to the health system, it’s what pharmacists and doctors should be aiming to work collaboratively together on,” he told AJP.

“I said on the record many times that in the real world, pharmacists and doctors work well together and have a symbiotic relationship that is both mutually respective and has the patients’ interest at the forefront.

“I’m not having a go at doctors vs pharmacists but this is a patient-centred argument.”

However he added: “When we’re talking fragmentation or continuance of care, it will always be reliant on the collaborative and mutual respect of pharmacists and GPs. As long as doctors hold themselves above everyone else the system will be fragmented.”

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  1. luis trapaga

    In what is described as a stoush between doctors and pharmacists, its naturopaths and homeopaths that get it in the neck! There was one rational reply amongst the vitriole:
    “Try not to generalise that all GPs do are 5-minute consults and tend to avoid the more complicated patients by catering to those with ‘low morbidity conditions’. The conditions you have mentioned may be as simple as what you think but do not necessarily follow. Your Guild has bad eggs as well, just like in any other professions. Let’s not make it your group against ours. Don’t flame it any further. Why can’t we work together?”
    I don’t know the author, but I applaud the sentiment.

  2. matthew

    SIGH this power struggle between pharmacists and doctors is actually so detrimental to healthcare, there is absolute arrogance from both sides, doctors do not value pharamcists , we pharmacists just think its all a money gran from doctors, i would love for healthcare to be what its supposed to be, respect between both professions, its all about the dollar and its honestly ripping healthcare apart for the neeedy so sad

  3. In discussions I have had with Doctor Clients, Colleagues and friends there is a general consensus that there is a battle looming between Doctors (GPs) and Pharmacists. Such provocations from David Heffernan are both very inaccurate and unhelpful. His purpose was to put the case for Pharmacist being able to treat minor ailments (yet to be fully defined) and of course acquire prescribing rights. Sad part is, in such a scenario we (Pharmacists) would only discount the hell out of the service provided. Why? To compete with each other to attract the more affluent who wish to bypass the GP or Hospital ED waiting times. So what exactly is that then? Loop back to what David was critiscising what he believes is the current landscape in GP world for the answer.
    Fortunately when reading the comments to his article by Doctors in Oz Doctor, there exists many good Doctor Pharmacist relations that were put forward by way of examples and perhaps we should be mining that goldfield and expanding our business plan (and a Business Plan is all David is proposing after all) to encompass and support that very vital part of what we are professionally obliged to be – a gate keeper on behalf of the patient who has an ongoing mutually respectful relationship with the prescriber.
    A good Pharmacist already knows how to treat effectively a huge number of minor ailments and will always make sure that the patient follows up with their GP should symptoms persist or remain unabated. Any rural placed Pharmacist really understands this role because often on a Saturday afternoon or Sunday/Public Holiday – you’re it! Perhaps we should have considered this argument before we allowed all of those recent changes to S3/S2 medications which after decades were taken away from our guardianship.

    • Philip Smith

      The future for both professions is going to be interesting. With advances in robotics, pharmacies main source of income can be automated (the productivity commission has hinted at it).

      With AI advancing will GPs need as much training when a computer can read over 100k articles in under 7 seconds on your symptoms and give the most likely diagnosis, with those better at patient communication vs memory of conditions will better serve patients.

      Pharmacist may step into GP shoes and GP become specialists who are referred to in this future.

      Time will tell.

  4. GlassCeiling

    Perhaps the article should be titled – ” Response to Pharmacist representing Pharmacy Guild of NSW ‘ declaring war ‘ on Doctors.

    David needs to learn that you win friends with honey and not vinegar and his views are his own.

    Evidenced based approaches to our work will succeed in time and with further education. Minor ailments are a retrospective diagnosis.

  5. Amanda R

    Pharmacists have had it too good for too long. They have a protected industry that props up captial value of their (essentially) retailing businesses. Not only ownership is highly restricted but also location. The best retailing locations are often dominated by the big boys in the industry via circumventative proxy-ownership structures. 99% of ordinary pharmacists will NEVER have a shot at owning a top drawer store; pharmacies that do come up advertised for sale are generally crumbs off the table. The best ones are sold behind closed doors to those in the know (I’ll save that for another time).
    Good on doctors for sticking to the pharmacists. It’s well deserved. Enough encroaching on GP’s territory – I think that the pharmacists should stop this turf war with GPs immediately – they can only get away with their protectionary benefits for so long and should be EXTREMELY grateful. My advice: lay low.
    Pharmacy owners may not fully appreciate it, but they have been incredibly fortunate.

  6. Red Pill

    GPs vs PGA.
    I said PGA will come out of this one bloodied but winning like always.

  7. Ex-Pharmacist

    Have a listen to David Heffernan when he had a chat with Chris Brooker last year.
    Makes ‘interesting’ listening & will give readers an insight into where his comments have come from.

  8. John Wilks

    Mr Heffernan’s comments are intemperate, ill-advised, politically immature, offensive, indelicate, undiplomatic, uncivil and rude. They contribute nothing but envy and bile to the relationship. When you want people to trust and respect you the first action is not to spit in their face.

  9. Lee Ho

    PGA will always win. How much did you AMA donate to the politicians?
    We pharmacists were ranke no.13 in Australia in term of money donated to politicians. No politicians will listen to stingy doctors.

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