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Monday, 14 September 2009


After reviewing the full material and some of the reactions, I have:

A sense of déjà vu

On 24 February 2005, The Department of Health announced:


The only special service numbers the NHS will be able to use in future are freephone numbers or those that offer patients a guaranteed low rate call, such as '0845' or '0844' numbers.

Neither “0800” (from mobiles), “0845” nor “0844” numbers have ever offered patients a guaranteed low rate call, since the introduction of competition in the provision of telephone services. There was no such guarantee then, there is none today and there can be none in the future, unless existing competition law is changed. There is no regulation of the charges for calling these numbers (other than of the per minute element of some of rates charged by BT).

On 14 September 2009, The Department of Health announced:


It has however shown that it still does not know how this may be achieved:

The Department does not intend to ban the 084 number range; rather, it intends to amend legislation and issue supporting guidance to the NHS to ensure that patients contacting the NHS do not pay more than the equivalent cost of a call to a geographic number, regardless of the number they call.”

It is the telephone companies we use to call the NHS who set the charge rate for calling particular types of number. They normally charge a premium for 084 numbers because a defined premium is paid on to the “terminating” telephone company; this is known as “revenue sharing”. The premium may be used to discount the cost of the facilities provided or passed on directly to the user of the number.

If the Department of Health wants all telephone companies to fund this premium through package fees or premium charges on non-inclusive calls to ordinary numbers (like BT does), then it needs to talk to them. It will fall foul of EU competition law if it tries to fix rates by legislation. There is no point in asking, or trying to compel, individual Hospitals and GPs to fix retail telephone call charges from each of over 200 providers, whilst protecting their source of subsidy; their work is in providing NHS healthcare, funded exclusively by taxation.

Dr Richard Vautrey, deputy chairman of the British Medical Association’s GPs committee, is quoted as saying:

we’re pleased that the phone companies who supply these lines to practices have agreed to ensure that their tariffs are in line with local charges”.

Dr Vautrey’s practice (like most GPs with revenue sharing numbers) is supplied by the business-to-business division of Talk Talk (Opal Telecom). Residential Talk Talk customers pay over 32p for a five minute call to the 0844 477xxxx number, from which the practice earns money to subsidise the cost of its phone system. Talk Talk customers enjoy free local calls and pay for inclusive calls to 0845 numbers through increased package charges, in line with BT. Neither Dr Vautrey nor Talk Talk have any control over what the other 200 telephone operators charge, or which of these his patients use.

Dr Vautrey goes on to say that:

the GPC would like to see more phone companies include 084 numbers in the comprehensive call packages they offer customers

He seems to be unaware of the fact that no landline or mobile telephone company includes 0844 numbers (as used by most practices that benefit from revenue sharing) in a comprehensive call package.

Some have been misled by the announcement to believe that:

Patients will still dial numbers starting 084 to get through to their surgery but will only pay for the cost of a local call.”

Even Dr Vautrey appears to believe this complete nonsense:

Combining the benefits of 084 numbers with an assurance that they won’t cost more than a local phone call is the best solution for patients and practices.”

This seems to suggest that the BMA thinks that the Department of Health has done the fix, whereas the Department of Health thinks that GPs will be able to do it.

In its response to the consultation, the Department of Health places great emphasis on the benefits of non-geographic numbers. These are equally available on 03 and 08 numbers.

Ofcom is quoted as saying:

We recently introduced 03 numbers, where calls are charged at standard national rates as an alternative to more expensive 08 numbers, and we are encouraging public bodies to use them.”

I am quoted as saying:

The government has failed to realise that the only way to ensure people only pay a normal charge is by prohibiting numbers that might charge more, the only way to do it is to prohibit 084 numbers."

I could not have put it better.

The government got this wrong in 2005 and is showing every sign of having repeated, rather than corrected, its mistake (perhaps by again taking poor advice from an interested party).

I want the Minister to be able to deliver his reassurance, as this is essential to re-affirm the principles of the NHS. He has failed to indicate how this may be achieved.

1 comment:

  1. It is also worth noting that the wording of the new announcement is barely different from what was covered by guidance issued following the 2005 "ban".

    I refer to:

    Letter – Gary Belfield - 11 Apr 05
    Letter – Lord Warner - 19 Dec 06
    Statement - 12 Nov 07
    Letter – Mark Britnell - 03 Mar 08


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