I offer the following advice to NHS GPs. Under the terms of the GMS contract, and for PMS contractors subject to the same terms, they have until 31 March 2011 to terminate their use of "expensive" telephone numbers.
The precise terms of clause 29A of the contract specify:
"having regard to the arrangement as a whole, persons will not pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number"
The only type of telephone number that meets these conditions is a "Geographic Rate" number, i.e. one beginning 01/02/03.
The truth is really that simple. Geographic Rate numbers are the cheapest. ALL 0844 and 0845 numbers are more expensive and therefore cannot be used.
BT subscribers incur a penalty charge for calling geographic numbers outside the terms of their Call Plan or package. For weekday daytime calls, this may be greater than the currently regulated rates which BT has to charge for calls to 0844 and 0845 numbers.
This is however of little relevance. Because the terms apply to the "arrangement as a whole", unless a practice can show that all of its patients would fall into this very particular category, both now and for the life of its use of the number, then a 0844 or 0845 number cannot be used.
To put it another way, calls to all 0844 and 0845 numbers are invariably more expensive than calls to geographic numbers for those who call from:
|•||All Virgin Media Landlines|
|•||All Mobile Telephones (Contract and PAYG)|
|•||All Public Payphones|
It may be possible that a practice could show that no patient could call from any of these, because none of them were available in the area covered by the surgery. In any such case where a 0844 number was used it would also be necessary to demonstrate that no patient called under the terms of a BT Call Plan.
Practices should also note that Ofcom proposes to remove the special regulations that currently apply only to BT, causing the perverse effect which relates to BT subscribers who call outside the terms of their selected Call Plan.
I urge anyone who may have been led to believe otherwise to verify my comments by referring to the relevant published tariffs (see links below).
Regrettably, the Department of Health has somehow come to the false conclusion that there are 084 numbers which are not more expensive, in general terms. I am aware that the BMA and others have suggested specific examples of such numbers - without adding the qualification that this only applies to BT subscribers who call outside the terms of their selected Call Plan, and thereby to all 084 numbers.
They have failed to respond to my request to cite a single example that avoids the need for this most significant qualification, which effectively excludes most NHS GPs, because they offer a universal service to all NHS patients. I repeat that request, with an earnest assurance that I will revise these remarks if any should come to light.
Systems that require non-geographic numbers
Some surgeries use telephone systems that require use of the additional features available on non-geographic numbers. In their submissions to the Department of Health consultation on this topic in 2008/9, both the BMA and Network Europe Group Ltd argued that patients should meet the costs of these features by paying higher call charges.
These arguments were rejected by the Department of Health in its statement following the consultation, as it stipulated that no call should cost more than the cost of a geographic call.
03 numbers are charged at "Geographic Rate", by regulation and in practice, costing no more than the cost of a call to a 01/02 number. This applies to all types of telephone service, including the terms of packages where these apply to 01/02 numbers. They do however provide exactly the same features as other non-geographic numbers, and therefore support systems that rely on exchange-based features.
Any surgery that has chosen to take advantage of these features could satisfy the terms of their NHS contract, and their duty to NHS patients, by using a 03 number.
Changing to 03
The effort of changing to 03 is eased by the availability of a simple migration path.
For every 0844 and 0845 number, the equivalent 0344 / 0345 number is reserved for continuing service from the same telephone service provider.
All network telephone service providers (including Cable & Wireless and Talk Talk) are known to permit customers to migrate from 0844/5 to 0344/5 within the term of their contract. Agents of these companies, with whom surgeries are most likely to have dealt, should be ready to honestly report the policies of their principals.
Those who are committed to long term arrangements with system providers may find that migration to the equivalent 0344/5 number is the easiest way of retaining their existing system.
It must however be noted that such a change will cause the subsidy of the costs of the additional facilities and perhaps other system expenses, which is currently being provided by patients, to be lost. The practice will be left having to meet the cost of the system for which it contracted out of its own resources.
As independent contractors to the NHS, GPs rightly take pride in being able to manage their own affairs.
Those who foolishly took advice about the cost of telephone calls from those with no professed competence in such matters may feel aggrieved, at their own foolishness. Those who followed false advice from those who may be expected to demonstrate relevant competence may have a grievance that is worth pursuing.
Returning to a Geographic number
Some practices presently using 0844/5 numbers do so only for the financial benefits available (at the expense of patients), as they make no use of the additional features of non-geographic numbers. Many would argue that the cost of these features is not justified for those with call volumes below those of a sizeable call centre.
Returning, or moving afresh, to a geographic number may cause 0844 or 0845 users to suffer the loss of (improper) residual income, but they would avoid the additional expense of features which they are not using.
I understand that there are some companies who can construct highly competitive deals to deliver no more than what the Surgery actually needs and thereby giving an overall saving, even if early termination charges are incurred from the existing provider.
The principles of the NHS
My personal interest in this matter is purely out of concern for the principles of the NHS. Patients incur third party costs in accessing NHS services, e.g. the bus or taxi fare to the GP surgery or the cost of a normal (geographic rate) telephone call. For a NHS provider to add their own charge to help cover the costs of their provision of NHS services is to contradict the principles of the NHS.
This applies to the 084 numbers used by NHS Direct and some hospitals and PCTs, to some hospital car park charges and shop concession arrangements. The Hospedia fiasco is an unmitigated disaster for which there is no easy solution.
I have no down on GPs; indeed I look to them as a body to help preserve the NHS as most of the profession now demonstrates a total commitment to its principles. However ...
... those who continue to use 0844/5 numbers past 31 March will be in breach of their contracts. None of the listed exclusions can be shown to apply - the truth about the cost of calling and option of migration to 03 settles that point. I hope that nobody will waste their money on the foolish notion of a call back system to protect patients from incurring improper charges. The necessary systems are prohibitively expensive for so small an application.
More importantly, those who continue to use 0844/5 numbers, as well as the PCT that commissions their services, will be in breach of the terms of the Health Act 2010. This requires NHS bodies and their contractors to have regard to the rights under the NHS Constitution, which include access to NHS services without payment, except where sanctioned by parliament. Patients will have the opportunity to seek redress under these provisions, whereas only the, now largely impotent, PCTs may enforce the terms of the GMS contract.
I will be delighted to offer any help I can to any NHS GP who wishes to come back into the NHS, whilst it still remains.
It is "our NHS"; the present government is only its temporary custodian for no longer than the life of the current parliament. As a part owner, I will continue to fight to defend it.
To verify the comments made above, one may wish to refer to the following published information.