Back to the future: the end of image-based prescribing for GPs

A person receiving a fax.
  26 April 2022  Dr Jeannie Knapp, GP and Primary Health Care Improvement GP Adviser, NWMPHN   

Editor’s note: This article has been updated to clarify that pharmacists are not legally able to dispense a faxed prescription without a verbal confirmation from the prescriber.

Image-based prescribing arrangements implemented at the start of the COVID-19 pandemic ended on 31 March 2022, except with hospital pharmacies.

Why was image-based prescribing introduced?

It was one of many measures introduced by the Australian Government in early 2020 as the pandemic changed the way we work.

GPs had always been able to prescribe verbally (by phone). However, pharmacists accepted these prescriptions with the understanding that the prescriber is legally responsible for ensuring that it would be followed up with the hard copy version. Pharmacists are not able to legally dispense a faxed prescription, although a fax helps provide the details of a prescription and may supplement a verbal order. Before the pandemic most of our scripts were given in hard copy to the patient in front of us, meaning the need for a faxed or phoned one was a rarity.

The Australian Department of Health introduced ‘image-based prescribing’ in March 2020 as an interim arrangement while electronic prescribing capabilities were being developed. This allowed the pharmacist to accept a fax or email prescription – a digital image only – for most scripts (with the exception of schedule 8 medicines), without the need for a follow up hard copy.

Electronic prescribing was subsequently introduced, allowing most scripts to be sent electronically and removing the need for practices to fax or email them – especially for telehealth consultations.

Back to business as before: phone before you prescribe

Image-based prescribing ended on 31 March 2022. So, what has changed? We’ve just gone back to ‘business as before’ – with the added option of electronic prescribing for many practices.

GPs may issue verbal instructions to a pharmacist to supply a Schedule 4 or a Schedule 8 medicine if, in the opinion of the practitioner, an emergency exists (in accordance with Regulation 25 of the Drugs, Poisons and Controlled Substances Regulations 2017.) The practitioner who issues verbal instructions must, as soon as practicable, send written confirmation (most commonly in the form of a prescription) to the pharmacist.

However, please note as per the Victorian Government’s fact sheet (.docx):

  • A pharmacist cannot supply, merely on the basis of a faxed or digital copy of a prescription (unless a specific Public Health Order indicates otherwise).
  • An image of a prescription may be requested as a means of confirming details of a prescription but the prescriber must provide verbal directions for lawful supply to occur.
  • It is the responsibility of the prescriber to ensure that an ‘owed’ prescription is provided to the pharmacist. Relying on a patient to deliver an ‘owed’ prescription to the pharmacy can be unwise.

You can avoid these requirements and save everybody time by encouraging using prescriptions (e-prescriptions) where possible.

Some issues remain, particularly for Genie users

While almost all pharmacies are accepting e-prescriptions, not all general practice software packages, most notably Genie, are capable of performing e-prescriptions. This might be an issue if there is only one pharmacy in a small town that is not capable of processing e-prescriptions. In such a situation, the practice would incur the cost of forwarding a much larger volume of hard copies.

Unfortunately, practices with software that is not compliant with e-prescriptions will be hit particularly hard with this cost. Patients can still collect the script directly from you; this might a good incentive to try an e-prescription if possible. Or practices might consider incorporating the cost of posting prescriptions into the consultation bill.

Please note: image-based prescribing has been extended for hospitals until 2023, which may be confusing for patients.

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