The view from the hill

Guild national president Trent Twomey talks about his fight against postcode healthcare, his views on the 7CPA, pharmacy’s  COVID vaccination future and professional services expansion  

AJP: Are you pleased to be finally back at APP?

Kos [Sclavos] and I had been holding our collective breaths with glitches in a few states in the leadup, but it’s great to be here. It’s been a great vibe.

It’s important for people to help get over the sense of loneliness and isolation I know a lot of our members have had, staying in their dispensaries, of staying open when our medical colleagues were often closed, and connect in person.

But just being able to have a beer with someone. You just can’t undervalue that!

As a Guild leader, I’d imagine zoom fatigue became an issue during 2020?

There certainly was some fatigue. Although something like negotiating the seventh community pharmacy agreement you couldn’t do through teams, there was a lot of face to face and travel to Canberra, which just meant more time away from home.

We tried to stay in contact as best we could with weekly zoom meetings and such, but nothing really beats face to face.

This is your first APP as Guild national president. How does it feel?

Thank you. Look I really do miss George [Tambassis], and Terry Battalis and a few of the others that are no longer on the team.

But I’ve got an outstanding new national council with some amazing women and men that have put their hands up to represent their colleagues     

Do you look on this as a new era for the Guild, with a newer demographic mix?

I think it’s a continuation of the good work that’s been happening. I mean two thirds of the council have been there for quite a long time. I’m now going into my fourth national council term – I’ve been there over a decade.

My senior vice-president Nick Panayaris is going into his eleventh year, and people like John Dowling have had nineteen years’ worth of experience.

I think there’s a great balance of new faces and of experience there, which is good.  


Your last couple of years have been heavily involved with the 7CPA. Was there a sense of relief when this was signed and produced a generally positive outcome for community pharmacy?

Last year was all about uncertainty and fear, wasn’t it? And to have something like the seventh community pharmacy agreement signed, and which gave us stability, predictability, bankability to be able to hire staff, train staff, sign leases, invest in new shop fittings, is an absolute relief to the membership.

I’m very proud of the 7CPA. It’s given us a stable platform in a very uncertain time.

What is the thing that you celebrate most in the agreement?    

I suppose there are several things that are wins. It’s not about something being a win for the Guild and a loss for the government. The whole agreement is a win for patients, a win for taxpayers and a win for community pharmacy owners.

One thing that is a standout, that we were able to co-design with the Department of Health, is the remuneration adjustment mechanism – RAM. This is something that not only gives certainty to the sector, it gives certainty to central agencies over the cost of the Pharmaceutical Benefits Scheme going forward. So it gives certainty to both sides.  

Were there any disappointments?

I think it puts us in a good foundation for the negotiations of the Eighth agreement. As soon as you’ve signed one, you immediately start negotiating the next agreement.

This is about making sure that an important piece of health architecture – the PBS – is still fit for purpose, is still right for revenue, delivering good clinical outcomes as well as good value for taxpayers.

There’s a few things that the Commonwealth and the Guild are in alignment about, and are going to continue to work on in the background, and these are alluded to in the agreement, and that is about returning the principle of universal access to PBS medicines.

So, at the moment we have a thing called postcode healthcare where you pay a bit more for things if you live in the bush, relative to those who live in the cities. So lowering the cost of medications to ensure it’s the same cost, no matter where you live, is something that we will continue to work on.

What about the PBS co-pay discount?   

This is part of that universal access right. The vast majority of prescriptions are still charged at full price, and we want everyone to have access to the discount, not just those living in major metropolitan centres to get the discount. Every Aussie deserves a discount. There shouldn’t be a differential in price depending on where you live.

Part of the work the commonwealth will be doing, in partnership with the Guild, about reducing out of pocket expenses for consumers will be not about just reducing the general and concessional co-payment but ensuring there is no differential.   

One thing our readers highlighted as a disappointment in the agreement was the lack of new funding for clinical interventions

There were no cutbacks to HMR and RMMR funding, the money went up. Clinical interventions did cease. That is a fact.

Of course we want to see community pharmacies providing more services other than the traditional professional services. We want them to do more medication use reviews, more vaccinations, not just in pharmacy, but in people’s homes, in nursing homes.

So, what we’re doing is a two-pronged approach. We’re working with state and territory governments to remove those regulatory barriers that are preventing pharmacists from practicing to their full scope for administering vaccinations to more people against more diseases.

But we’re also in the midst of negotiations with the Commonwealth about the finer points of their response to the Royal Commission into aged care.

So, watch this space, let’s see what happens over the next six months. But the Guild is very supportive of pharmacies acting as a primary health care hub providing more services.

Let’s talk about vaccinations. Obviously as a Queenslander you’d be pleased with the announcement that Queensland would lead the way with COVID vaccinations in pharmacy. But what did you make overall of the comments by the health Minister during his presentation?

Firstly, we are in a very privileged position in Australia. We’re an island nation with a low population density and a decentralized population.

Those gifts, those blessings that geography brings give us more time to roll out our COVID-19 vaccinations. Now, it’s been accused of being more of a ‘stroll-out’ than a roll-out so far, to quote our Victorian President…..

But pharmacies are included in the national vaccination roll-out strategy. Of course we would have preferred pharmacies to have been activated before mass vaccination centres.

It makes no sense to have big hubs in football stadiums in major metropolitan areas when you have 4000 community pharmacies that have done the training, been assessed by the commonwealth government as being eligible sites, but they’re not being engaged.        

We’re looking beyond the roll-out of 2020. The virus will be with us for many, many years. It will continue to morph. We will need to have an annual booster. I think we’ll see by the end of the calendar year that all pharmacies that wish to participate will be participating and they will be access points from 2022 for the annual booster for all Australians.    

Part two of the interview will be in our Thursday newsletter 

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