Pharmacy insights

Banning fax machines in NHS. Hurray!

It may come to your surprise, but first experimental fax machine was invented and patented by Alexander Bain in 1842 who used paper sensitive to electricity to transmit information at distance with success. A modern fax machine became commercialised in 1960s when Xeron Corporation introduced ‘modern’ type of fax machine.

Ban on purchasing new fax machines by NHS was announced in December 2018 by Health and Social Care Secretary, Matt Hancock. Additionally, an order is in place to phase out use of fax machines in NHS by April 2020. The Telegraph reported that more than 8000 fax machines are still used in NHS hospital trusts and NHS is world’s biggest fax machine buyer due to ‘stubborn’ resistance to new technology.

The above number does not include high street pharmacies, who use fax machines on daily basis for all sorts of data communication between pharmacies and other healthcare provides including surges, hospitals and other online providers who issue private prescriptions.

What are the uses of fax machines in pharmacies?

The most common reason for fax machine use in high street pharmacies is to receive prescriptions. Even though faxed prescription is not legally valid it is a common practice to dispense one should it be faxed over.

Some pharmacies use fax machines to send patient’s request for repeated medication to surgeries.

Downfalls of fax machines?

  • Faxed prescriptions are not legally valid

Supply of medication on faxed prescription can only be processes as emergency supply. This also means that original prescription needs to be posted to the pharmacy.

  • Readability issues due to poor quality
  • Fraud

Almost anyone can send fax from anywhere as long as they have fax machine and access to a landline. In the past NHS issued safety alerts with warnings about fraudulent prescriptions being sent to pharmacies (private and NHS). Because physical prescription is not present it may be difficult to assess its authenticity. Additionally, the whole process can be supported with different fraudulent phone calls and misleading contact information on the actual prescription. With regards to private prescriptions two-way authorization process (for example entering verification code on the website) creates safety net.

  • Breaches of information governance

In February this year NHS England was contacted by a hotel group which mistakenly received a number of faxes (dispensing tokens/electronic prescriptions, certificates and requests) from GP surgeries and pharmacies because of similar numbers being used in the healthcare system.

  • Reliability issues

How many times have you seen a pharmacy personnel trying endlessly to send something over the fax?

How can we replace fax machines?

  • Electronic Prescription service

Electronic prescription service (EPS) is the best option for fax replacements (excluding private prescriptions). With Phase 4 being rolled out, EPS will become the default for prescribing, dispensing and reimbursement of prescriptions in primary care in England. Currently, around 64% of all prescriptions are processed as EPS. With EPS Phase 4 being rolled out nationwide this share is expected to increase to 95%. Paper prescriptions will only be used in special circumstances (NHS Digital, 2019).

This service became even more beneficial with recent roll out of controlled drugs in EPS.

  • NHS email

Utilising NHS email to replace fax communication is another option. Having shared NHS email is a Gateway criteria for Quality Payments Scheme. ‘Secure email’ can be used to send requests to GP surgeries for example. Generally it is thought that sending sensitive information over fax is more secure that using email. The greater advantage of email comes from reliability, speed and reproductivity. For example you can prepare a template for patients medication request. The speed advantage is even greater in hospital settings where lengthy documents and discharge letters often need to be transmitted.

  • NUMSAS

NHS urgent Medicine Supply (Advanced service) is a pilot scheme which currently runs till 31st of March 2019. This scheme is designed for patients who are referred to the pharmacy from NHS 111 service. This service allows patients to obtain their medication and can be useful during out of hours times. Information about supply of patient’s medication is sent via PharmOutcomes website. The advantage of this service is that all NHS exemption apply to supply of medication. If patient is exempt from paying, they will use their exemption when collecting their medication. Pharmacies are paid for the cost of supply and consultation fee.

Perhaps the biggest challenge comes in changing people’s attitude towards new way of communicating whether is a receptionist, dispenser or pharmacist who used a fax machine for last 30 years.

Although this ban applies to NHS organisations one would expect decrease in use of fax machines in community pharmacies and hopefully complete ‘natural’ phase out of this technology.

References:

NHS Digital (2019). Electronic Presciption Serivice – Phase 4. Available at: https://digital.nhs.uk/services/electronic-prescription-service/phase-4 Accessed on 15/03/2019

I am a community pharmacist working in UK. I blog about drugs, health and pharmacy.

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