“We need to break that nexus between prescribing and dispensing because if you are involved in both,there are going to be[profit] incentives.”

The powerful Guild,a major political donor to both major parties that represents the 5800 owners of mostly small pharmacies,has ramped up its lobbying efforts in NSW and Victoria ahead of the coming state elections,meeting with health ministers and their shadows in both states.

“Residents of both states are seeing systems that are stretched,with ambulance ramping and delayed times to be able to access appropriate care,” Twomey said.

“It doesn’t make sense that in 2022,you have to make sure that you are sick when it suits the time that a private practitioner wants to work.”

Twomey said the Guild wanted to have “a mature conversation about evidence-based care” and was not interested in a turf war with the AMA.

“Why is it that women in other highly developed countries in Canada in the United Kingdom can receive contraception from their local community pharmacy,whereas in Australia,they have to wait four days to be able to get an appointment?” Twomey said.

He pointed to online “instant script” services run by doctors and delivered through apps where patients can get prescriptions via email or SMS “without even having a conversation with a health care professional”.

“We’re saying you can access one of the 6000 community pharmacies in Australia,and actually physically see someone and talk to someone.”

The AMA is not totally opposed to pharmacists who can prescribe medicines;the association has backed a regional Victorian trial where pharmacists deliver follow-up care after patients see a GP,checking if the dose is working for the patient,and what Robson called “occasional repeat prescribing”.

“There is no doubt a health workforce shortage,” Robson said. “It’s really important that people work at the top of the scope of practice,but not do it in a silo.”

He argued more pharmacists should be employed within GP practices and be funded through Medicare to deliver “team-based care” along with a practice nurse.

The Victorian government has introduced changes that will enable pharmacists to offer a wider range of vaccines,following consultation with the Guild and other stakeholders.

“Pharmacies are an important part of our primary healthcare system – we will continue to engage with them,GPs and other healthcare providers on how they can best support the system and increase access to critical medications for all Victorians,” a government spokesperson said.