I remember when my law firm got a state-of-the-art telex machine [for sending text] in 1986. Only a few months later, we got our first fax machine, which made the telex machine redundant. By 1993, we were using email. l don’t think I’ve received a fax since 2011.
I believe the general public would share the surprise expressed by health secretary Matt Hancock, when he discovered that fax machines were still being used in the UK. Indeed, he subsequently signed regulations requiring NHS trusts to stop using the machines after March.
In addition, the 2020 GP contract requires GPs to have an “online presence” to promote their services. Under a dispensing update rolling out this year, GPs can give a token with a barcode to a patient who has not nominated a pharmacy for electronic prescriptions, so that the patient can take it to any pharmacy.
Some GPs already promote services through apps. I’m aware of instances where these apps direct patients to a participating pharmacy, so I took a closer look at what the GP general medical services contract for 2018-19 says about electronic prescriptions and found this clause:
“The contractor [the GP practice] must:
“(a) not seek to persuade a patient or a patient's authorised person to nominate a dispenser recommended by the prescriber or the contractor; and
“(b) if asked by the patient or the patient's authorised person to recommend a chemist whom the patient or the patient's authorised person might nominate as the patient’s dispenser, provide the patient or, as the case may be, the patient's authorised person with the list given to the contractor by [NHS England] of all chemists in the area who provide an electronic prescription service.”
In other words, NHS doctors aren’t allowed to persuade patients to nominate a particular pharmacy. If they do, they will be in breach of their contracts.
Community pharmacies are already under severe financial pressure, and prescription direction may be the last straw that breaks the back of some struggling pharmacies. Right now, the focus of healthcare administrators is understandably elsewhere, but when the COVID-19 crisis has passed, NHS England needs to take action to enforce its contracts with GPs.
The healthcare system can survive without fax machines. It can’t survive without community pharmacies.
David Reissner is chair of the Pharmacy Law and Ethics Association