NHS Trusts funded by patients

This message is addressed to those listed on the web page - NHS bodies using 084x (copies to selected media)

On 14 September 2009, the Department of Health announced NHS TO BAN PREMIUM RATE CHARGES. I quote from this announcement.

"Phone numbers that charge the public or patients a premium rate to contact the NHS are to be banned in England, Health Minister Mike O'Brien announced today"

This was the long awaited outcome of a consultation that closed on 31 March 2009.

Implementation of the ban is demanded by over 40,000 citizens who have signed a petition to the Prime Minister that will be presented for a response on 28 November.

"The ban means that GPs and other NHS organisations remain free to use 084 numbers, providing patients are not charged more than a local rate number."

For the time being this qualification effectively excludes all 084 numbers. There is no expectation that every one of the over 200 telephone companies that provide service in the UK will increase the price of calls to local numbers for all customers, so that it exceeds that imposed when they incur the additional cost of revenue sharing on 084 numbers.

As a single example, the call charges I currently incur as a NHS patient, during the daytime, showing the pence per minute rate and set-up / connection fee, are as follows:

	BT (Unlimited anytime)	Virgin Media (Talk Weekends)	Orange (Racoon)
A local number	inclusive (0p)	5.39ppm	inclusive (0p)
0845 number		9.79p + 6.85ppm	20ppm
0844 number (call type g6 / PG6)	8p + 4.894ppm	8.8p + 6.84ppm	12ppm

(I provide links to the published tariff documents to enable verification and an opportunity to review the situation for those on other tariffs.)

It is highly likely that many patients who call you are (like myself) subject to tariffs that cause them to incur premium rate charges. For many the premium is much greater, and not all have the choice that I enjoy when at home. To escape the terms of the ban, I understand that you would have to somehow show that not one of your patients would incur a premium rate charge at any time.

"The ban will be enforced through proposed changes to the GP contract (in consultation with the British Medical Association's GP Committee), and the issuing of Directions to NHS PCTs and Trusts."

I understand that no Enforcement Directions to NHS PCTs or Trusts have had to be issued as yet, and so I trust that you have already privately indicated your intention to comply. Will you please advise when you will be complying with the ban, by ceasing use of the 084x number, so as to avoid enforcement action having to be taken against you. It would be a disgrace if bodies that proudly subscribe to the principles of the NHS had to be reminded of their duty to patients by enforcement action. Whilst the changes to the GP contract are subject to a lengthy process, there is no indication of when the Department will begin issuing Enforcement Directions to PCTs and Trusts that fail to comply.

Please advise if the ban will cause you to withdraw the telephone access currently provided by the 084 number, because the financial subsidy currently being indirectly obtained from patients cannot be replaced.

Alternatively, please let me know what alternative arrangements are in place so that patients may continue to access your services by telephone without incurring premium rate charges. In most cases this is simply achieved by publishing the geographic number to which calls are re-directed. (I accept that this simple option is not available in cases where complex algorithms are invariably involved in routing calls to various call centres. For such cases, a swift migration to the equivalent 034x number is the most convenient option, unless alternative arrangements have been made.)

"NHS Direct will retain its current 084 number [0845 4647]"

Whilst this singular number will, exceptionally, never be subject to the ban, most other 084x numbers will doubtless also remain in use for a period. There is no reason why NHS Direct (like all other NHS providers) could not introduce a temporary alternative during this period to enable patients to avoid premium rate charges. Having two numbers in use concurrently for the same purpose is never desirable, but in the particular circumstances of a transition it represents an essential expedient measure. Any alternative number for access to the NHS Direct telephone advice service would need to published properly, but not in a manner that would cause confusion or undermine the service in any way. 0345 4647 is known to be already setup and available for use.

NHS Direct may prefer to continue to get the full benefit of the £1 million pounds per annum that it currently receives as subsidy (or donates to BT Global Services, as has been alleged) due to the revenue share contributions from callers' telephone companies. Failing to take the obvious measure of offering the 0345 4647 alternative (in a suitable manner) would undermine the consistency of the ban, which is vital for it to be accepted by GPs and other NHS bodies that might demand special treatment. Such failure would also leave the NHS Direct Trust and / or BT Global Services open to accusations of deliberately and unnecessarily profiteering at the expense of NHS patients. Please let me know what will / should be done about this.

Please contact me with your answers and if I can help in any way.