Layer 1

GP pharmacist: My community colleagues must finally ditch fax machines

"It should not still be an integral piece of equipment in seemingly every community pharmacy"

Community pharmacies would benefit more from reconsidering their approach to NHSmail and fax machines than installing fibre optic internet, the GP Pharmacist argues

I’ve nicknamed my work computer Not Responding because of the ridiculous number of times the message pops up and my work momentarily fades into background as it attempts to reconnect to the network. So, ostensibly, it’s good news that health secretary Matt Hancock has announced plans to upgrade every hospital, GP practice and community care service to high-speed fibre optic broadband.

Apparently community pharmacies will benefit too. According to the Department of Health and Social Care, the upgrade will allow GPs and pharmacists to transfer data “quicker than ever before”. This assumes that communications are currently impeded by the system and not the users.

My experience suggests that speed of communication and patient care could be vastly improved if pharmacies would embrace what is already available to them – for example, having an NHSmail account that they actually use and check regularly, and fully utilising the functionality of the electronic prescription service (EPS).

I have mentioned in other blogs how important having close links with local pharmacies is for patient care. However, it does astonish me how many local pharmacies don’t have a working NHSmail account, which means I can’t share important patient information such as changes to medication via what is a very simple and straightforward system.

I also find it incredible that we get NHS Urgent Medicine Supply Advanced Service (NUMSAS) notifications from pharmacies from non-secure email accounts, when having an NHSmail account is supposed to be a pre-requisite for using the service.

GP surgeries and pharmacies are both integral to increasing uptake of EPS and electronic repeat dispensing, which would not only benefit patient care, but improve efficiency in the system.

Upscaling my practice’s repeat dispensing has been hindered by a lack of training in my local pharmacies, who seem reluctant to take on the challenge. The manager of one pharmacy actually told me that they didn’t think the staff would cope if large numbers of patients went over to electronic repeat dispensing.

Finish with fax

A bold move forward would be to do away, once and for all, with the fax machine. While it is worthy of a special place in the Royal Pharmaceutical Society’s museum, it should not still be an integral piece of equipment in seemingly every community pharmacy, many GP surgeries, hospital clinics and out-of-hours centres.

Healthcare’s sentimental attachment to such an outdated piece of equipment encourages bad processes and thwarts technological progression. My surgery got rid of the fax machine a few years ago, but we still get frantic phone calls chasing urgent prescriptions that have apparently been requested by fax. The request won’t have come to us, so who knows where that patient’s personal data has ended up?

It will take more than super-fast fibre optic broadband to ensure that data transfer is “quicker than ever before” and patient care truly reaps the benefits. No matter how fancy the system is, it is the competence of its users that will ultimately define how efficient it is.

The GP Pharmacist is a former community pharmacist working in a general practice

26 Comments

A.S. Singh, Community pharmacist

Actually a fax machine is mostly for YOU at the surgery as you've forgotten to give poor old Mrs Smith her BP meds and in a hurry fax over the Green Rx praying for a miracle that the pharmacy will sort it out

Tired Manager, Community pharmacist

Electronic Repeat Dispensing is a good concept but in practice it is abysmal due to the standard surgery madness/incompetence. Some items on 28 days, some 30, some 56, some not authorised as repeat dispensing = complete random chaos as they all drop down at different times. As one customer once said to me with a twinkle in her eye “wasn’t it easier when we just brought in our prescriptions straight from the doctors”

Leon The Apothecary, Student

Not Responding error messages have very little to do with internet speeds unfortunately, they are typically caused by your hardware failing to keep up with the demands being exerted on them and would be better improved by upgrading parts such as your CPU for processing tasks such as databases, RAM for handling multiple applications and switching to a solid state hard drive for improved loading times.

Stephen Hay, Locum pharmacist

Funny that anytime we query where an electronic prescription is, and we say that there's nothing on the Eps tracker the GP receptions don't have a clue what we're on about. And anytime we try and send them documents via email, they ask for us to fax it. Round my end its the surgeries that are behind the times with the technology.

Leon The Apothecary, Student

From my travels, it is very clearly apparent that not all areas are at the same level. I've been in pharmacies where they are calling to find out where prescriptions are every few minutes taking up huge chunks of the day; when I showed them how to use the EPS tracker and SCR records, I was treated like I was dealing with black forbidden magic and we were back in the 1750s.

On the flip side, I know those, both in pharmacy and GP surgery, who are really up to date with technology; and it does streamline processes significantly.

There's a clear inconsistency between areas in the uptake of technology, implementation, and training. 

Phil Goddard, Community pharmacist

Take away the fax machine? Why not take my pen as well while you are at it, its even more old fashioned.

Leon The Apothecary, Student

It is a bit archaic that we mark every single label with a pen. Even a tiny step of confirming per page is correct with a single signature would be a good direction.

Community Pharmacist, Community pharmacist

Try signing the top of each script instead,Section on pharmacy address printing area allocated to D = dispensed by , CA = clinical assesesment (for ACT accuracy check scripts) AC = accuracy check (pharmacist or ACT).Abbreviations printed on top corner of script as it is endorsed.The Dispenser,ACT,Pharmacist initial the space on the endorsement to show who dispensed,clinically checked and accuracy checked that prescription.Better than mindlessly initialling each label which detracts from checking the item.Superintendent will need to authorise the change and amend SOP obviously.Time saved...huge !!

anti-depressed Pharmacist, Manager

You could send patient data to the wrong email address too so don't use that as a valid reason to drop the fax.

 

I can see sending patient repeat request via nhs email being useful as it leaves a trail, no more gp receptionist denying they did not receive the fax or having to call the surgery after sending the fax to confirm they have received it.

 

But why must there be only one method of commutation? What happens when the internet goes down like it has many times before, should we go home? Who is going to pay for the scanners? Or the extra computer needed for the extra workload this will incur?

 

Leon The Apothecary, Student

I mean...you should be making an audit trail anyway as good practice and a number of the PMRs actually do this for you anyway even if you don't know how to access it. I've managed to address a number of queries on a regular basis by having that in place.

It wouldn't be that difficult to create a macro or to streamline the electronic sending of requests either by email or digital faxing; this is already existing software technology.

You make a good point that technology needs a backup plan because it can and will have outage moments; even a simple mobile broadband modem as secondary access to the internet addresses your example as a basic and easily implemented safeguard.

And of course, we can always go back to pen and paper if everything starts breaking down!

Kawsar Kamal, Community pharmacist

Sending a million pictures of repeat slips to your GP surgery would probably break the person at reception.

I can just see Margret going over the edge trying to sort through a bunch of pictures.

Leon The Apothecary, Student

You are showing yourself up a bit there. Why would anyone send pictures? Have you never heard of Print to File?

Interleukin -2, Community pharmacist

Sorry Bill Gates or whatever your name is, I haven't heard of print to file, do you mind educating us?

Richard Binns, Primary care pharmacist

or the patient could just register online and order their own meds, rather than paying your staff to run round operating a 1960s piece of technology for no apparent financial gain

Alexander The Great, Community pharmacist

Totally useless if its electronic repeat dispensing.
 

Paul Dishman, Pharmaceutical Adviser

Hmm, someone sitting behind a desk handing out advice to front-line staff. If a fax is useful, then its none of your business.

 

Leon The Apothecary, Student

It's also a soon-to-be-banned piece of equipment so it's good advice to get modern in good time before you are forced to.

Paul Dishman, Pharmaceutical Adviser

I'd like to see anyone try to actually ban a private business using a fax machine.

Alexander The Great, Community pharmacist

Oh, and this patient confidentiality codswallop... yes it can get faxed to the incorrect number, but i'll be you ANY money that your receptionists give the wrong prescription to the wrong patient MORE. And just a food for thought, when you have to "duplicate" a prescription, where do you think its gone?? Me thinks its been given to the wrong patient!

Alexander The Great, Community pharmacist

Dear Dr, When was the last time you worked in a pharmacy??? Do you realise how short staffed we are? Do you know how busy we've become. It is FAR QUICKER and more efficient to us, to fax a repeat request, rather than log on to a computer that is CONSTANTLY been used to type up prescriptions, and type out the patient, name address, DOB, each item, strength and quantity.

 

I dont know if you have implemented, electronic repeat dispensing? This has shifted A LOT of your staff's work over to us. Each time we do a download we get hundreds of scripts come through (using our toner which we dont get reimbursed for), it takes HOURS of my staff time to fold and sort out prescriptions - into ones we've order, into deliveries, into scripts that have just appeared out of the blue.

Then we have to spend an hour every evening to submit scripts to claim for payment and check all exemptions - which we are not getting paid for.

So the argument, yes, it is old fashioned, but hey it works and it saves me A LOT of time and inconvenience.

I would fight to keep fax machines, but like most top-down decisions, we dont get a say, and my view doesnt matter.

Leon The Apothecary, Student

Unpopular opinion coming up, and I suggest this with the greatest respect, perhaps you slow to send a request via email because you might simply not be good at it? Takes me about 30-40 seconds to take a request from a telephone call into an electronic format and a further 20 seconds to send it, and I could half that time if I setup software.

The slowdown from old systems clashing with new. And that's what we are seeing with hub and spoke models when a new system completely replaces an old system, then it could be reasonably compared, and in my opinion, it would be the far better option to leave the fax machine back in the 1980s where they belong.
 

Alexander The Great, Community pharmacist

Takes me 2 secs to tick boxes the patient needs. Takes me less than 1 sec to send a fax (pre-stored numbers on fax machines). Thats 3 secs. You've just spent 1 min to do a job I did in 3 secs. I'm 20 times more efficient than you.

Richard Binns, Primary care pharmacist

I agree staff are overworked in pharmacies, how about directing patients to register online with their surgeries and order their own meds via NHS app. Take this unecessary workload away from the pharmacies and the need to waste staffing hours on this task.

Community Pharmacist, Community pharmacist

Electronic scripts ....the best buck pass that GP's have pulled off ever....Where were PSNC when we had this palmed off onto us including time,consumable costs etc etc....All at a buffet lunch I strongly suspect...

Caroline Jones, Locum pharmacist

You tell her alexander the great. It is this patronising pen pusher that needs educating methinks not her overworked, understaffed, cash strapped  professional colleagues. If this is an example of the mis informed drivel being peddled in GP surgeries by this tier, then it goes a long way to explaining the deterioration of attitude I have observed by receptionists and doctors surrounding RDS and script queries in the last 2 years. A sharp reality check needed here esp surrounding NUMSAS which is often used late at night, weekends and bank holidays when NHS email systems are often down or undergoing upgrades. Perhaps like the GP surgeries  this princess 'supports' , they don't work unsocial hours either.  Defo reset and re-educate buttons need pushing here.

Leon The Apothecary, Student

Caroline Jones, the professional part of you is really coming out in your reply. One should remember as a locum the bulk of your work contracts will be with clients who are struggling with pressures, both staffing, time, and operational - such as nature is of our work. Respectfully, you must take this into consideration of your own self-bias.

Although I do agree that NUMAS needs another rethink - there are several issues from the system that needs to be addressed. I can add to your stories by sharing times when controlled drugs have come through, spelling mistakes so bad where we couldn't recognise what was meant, and medicines just not suitable.

Job of the week

Pharmacy Dispenser
Feltham, London (Greater)
£20,000