More people to incur surcharges for calling GP 0844 telephone numbers

From: David Hickson – campaigner for the NHS

BT’s moves to get all of its residential customers onto its Unlimited Anytime Call Plan continue.

The Guardian reports details that have been confirmed by BT and I comment - see this link.

BT continuing to increasing the unregulated charge for non-inclusive daytime calls at the rate of 30% per annum creates two effects.

Firstly, more customers move over to the Anytime package, thereby incurring a surcharge of 100% when calling the revenue sharing 0844 numbers used to fund telephone systems used by many NHS GPs.

Secondly, the further increased penalty charge for making an ordinary call outside the time when a call plan is in effect makes the cost overtake the uniquely regulated charge that BT has to make for calls to the 0844 numbers.

Although every other telephone operator imposes a visible surcharge over the cost of an ordinary call (100% for all those with inclusive packages in effect), NEG and other purveyors of these rip off numbers are able to use this particular example from BT as if it were typical. This is done to deliberately mislead the Department of Health and the BMA, as well as many GPs and their patients.

If these efforts, supported by the BMA GPC, are not checked, the recently announced ban on use of expensive telephone numbers in the NHS will not happen.

Government efforts to prevent NHS GPs ripping off patients have failed - this must now change!

Government efforts to prevent NHS GPs ripping off patients through use of revenue sharing telephone numbers have failed
- this must now change!

From: David Hickson - campaigner for the NHS

This story in the Daily Mail - Millions of patients pay 40p a minute to phone their GP - reports a claim by Network Europe Group that

“Up to 200 doctors' practices have switched to the controversial 0844 numbers in the past six months”.

These switches all followed the conclusion of a public consultation in March 2009. This confirmed that there is no significant support for the idea of patients paying a premium rate to subsidise the cost of surgery telephone systems.

Every surgery that has switched since January 2008 has disregarded comments made in parliament by the then Health Minister, Ivan Lewis, warning GPs of the consequences of failing to note that the government was considering its position on the issue - see Hansard 21 Jan 2008 : Col 1334.

This raises the question of what the Primary Care Trusts have been doing to protect the interests of the NHS patients they serve in each locality. With many NHS bodies themselves using 084 numbers, one must wonder how seriously they will take the Directions recently issued to them. All are however now under a legal duty to have regard to the terms of the NHS Constitution – see ... ILLEGAL.

The current Health Minister Mike O’Brien is quoted as saying “Where there is evidence that callers are being charged more than the equivalent of a local rate call, then we expect GPs to take steps to stop it”.

I offer Mr O’Brien the evidence of the telephone tariffs that charge more for patients to call 0844 numbers, as used by NEG clients, than local or other geographic numbers - Telephone tariffs used by NHS Patients. As these tariffs cover all of the UK, this should be sufficient for him to issue guidance that 0844 numbers may not be used.

It is simply a matter of determining that some patients will be using tariffs on Lists 1 and 2 in that document, and that not all are using tariffs on List 3. It can be seen that the former tariffs include those from Talk Talk, the actual provider of the telephone service used by NEG and its customers.

In a recent publication, Talk Talk confirms that NHS GPs using 0844 numbers can change to 0344.

It refers to existing customers being able to “Move to another number range”, noting that “Ofcom has reserved 034x numbers for customers with matching 084x numbers”.

The “steps to stop it” for NHS GPs are therefore very clear, given that they are tied into long term contracts for the supply of telephone service from Talk Talk - they must switch to 03 numbers, which are guaranteed by regulation to cost no more to call than local or other geographic numbers.

This facility is provided by Talk Talk, which claims to offer “flexibility and understanding”. Those who have signed up since January 2008 were warned of the possibility of having to make some such change.

It is not good enough for the government to simply “expect” this breach of the principles of the NHS to stop.
It must ensure that it happens

The guidance from the GPC of the BMA suggesting that practices should obtain undertakings from their telephone service provider regarding the cost of calling their number is essentially unsound.

In this case however, Talk Talk would be able to confirm that calls to its 0844 numbers are charged at more than the “local rate” to its residential customers.

The fact that its agent, NEG, is not a registered provider of telephone service, and therefore charges nobody for making telephone calls, makes its assurances about its call charges look somewhat hollow (if not deliberately intended to deceive).

Notes

1. The Talk Talk Group trades as “Opal Telecom” when providing services to businesses.
   
   
2. All users of 084 numbers benefit from a “revenue share” paid by the call originating telephone company to their telephone company. This additional cost is naturally generally passed on to callers in premium charges.
   
   
3. Call charges for callers are not set by users of numbers, their system providers or their telephone service provider.
   
   
4. BT is alone in being regulated in the rate per minute it must charge for calls to the various sub-ranges of 0844 numbers. It cannot therefore include them in packages.
   It’s call set-up fees are not regulated, nor are its charges for calls to geographic numbers when outside the terms of a package.
   BT charges are based on selection of the appropriate call plan for the times when calls are made. Penalty charges apply when calls are made outside these times.
   As these penalty charges are unregulated, the penalty on a call to a (non-revenue sharing) geographic number may exceed the revenue sharing “premium” applied to a call to a 0844 number.
   Pending possible action by Ofcom in the near future, this is one of a number of perverse effects currently seen with charges for 084x numbers.

Use of revenue sharing (084) telephone numbers in the NHS is now ILLEGAL

From: David Hickson - campaigner for the NHS

I quote a Department of Health news release: NHS Constitution now Backed by Law - 19 January 2010 09:30

“From today, all NHS organisations will be legally obliged to take account of the rights and pledges set out in the NHS Constitution.”

The first of the rights in the Constitution states:

“You have the right to receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.”

Parliament (N.B. not the government) has not provided any sanction for use of revenue sharing telephone numbers in the provision of NHS services.

Apart from certain limited exceptions, caused by the imposition of regulations that affect only some BT customers, telephone companies recover the additional cost they incur when originating calls to revenue sharing telephone numbers (including all those beginning 084) by passing it on to callers. As users of these numbers benefit, at least through subsidy of their telephone service costs, this is nothing but a charge – patients are meeting the cost of providing NHS services as they access them. This is now said to be “Illegal”.

(There are other examples of similar practice, on which I am happy to comment.)

The relevant provisions of the Health Act 2009 cover both NHS Bodies - Section 2(2), and contracted providers of NHS services - Section 2(6).

What does this mean

·         The Directions to NHS bodies concerning the cost of telephone calls must be recognised and interpreted by every SHA, PCT, NHS Trust and NHS Foundation Trust, in the provision and commissioning of NHS services, as implementation of a right held by every NHS patient. The duty under the Health Act 2009 demands that the rights under the NHS Constitution must be upheld by the way in which these Directions are applied. The terms of the Directions, issued by the Department of Health, cannot dilute that principle, because they are not sanctioned by parliament.

·         The forthcoming changes to the GP contract cannot alter the legal duty of NHS contractors that now exists under the terms of the Health Act 2009. False assurances about costs to patients from interested parties who have no relevant legal competence or duty to the NHS and the rights of patients are simply meaningless. (see GPC Guidance: Use of 084 numbers in the NHS)

·         All other contracted providers of NHS services (e.g. dentists, pharmacists and ophthalmologists) also share the duty under the Health Act 2009, even though there has not yet been any indication of how the specific terms of their contracts will be amended in respect of use of telephone numbers.

·         Although exempted from the provisions of the Directions, the NHS Direct NHS Trust shares the duty under the Health Act 2009. As it would not be reasonable to replace the 0845 4647 number so close to its potential removal from service, the 0345 4647 alternative that is set up and ready must be immediately brought into use as a quietly advised alternative. The unusual and generally deprecated measure of having an alternative number must be seen as being essential to protect the rights of patients in these unusual circumstances. The 68 other 0845 numbers used by this body (e.g. the Choose and Book Appointments Line - 0845 608 8888) should never have been exempted from the provisions of the Directions.

·         If the government wishes for use of revenue sharing telephone numbers in the NHS to continue past today, it must promptly bring the relevant provisions before parliament, so that the charges (cost to patients, financial benefit to providers) may be properly sanctioned.

·        USE OF REVENUE SHARING TELEPHONE NUMBERS FOR THE PROVISION OF NHS SERVICES MUST NOW CEASE

Ofcom action against Silent Callers? - time to decide. Consultation ends on 25 January.

From: David Hickson - (Veteran) Stop Silent Calls campaigner

Big fines for a few - or firm proportionate action against all Silent Callers?

The Department for Business consultation on allowing Ofcom a further increase to the maximum financial penalty to impose on those making Silent Calls ends on 25 January.

I oppose the granting of this further increase unless heavily qualified. Ofcom must finally undertake to use the powers that is has properly - by naming and shaming all those found to be making Silent Calls and imposing a requirement to cease the practice. A balanced and proportionate approach may mean fewer big headlines, but it would address the problem more effectively. We need action not gestures.

The public want Ofcom to stop Silent Calls being made. That is Ofcom’s duty.

Big fines, after 18 month investigations (as we have seen previously) is not the way to stop the practice. When Ofcom was last granted an increase to the maximum penalty available (in April 2006), this came with a clear stipulation from parliament - “We expect you to use your powers to eradicate the nuisance of Silent Calls”. Ofcom has not even attempted to do this - Ofcom allows Silent Calls to be made up to a 5% tolerance limit, and does not even count some Silent Calls within this limit.

Collecting the scale of evidence necessary for even the present maximum penalty to be imposed has prevented Ofcom from taking modest and decisive action swiftly - issuing a formal public Notification and imposing an enforceable requirement to cease making Silent Calls. Any single breach of such a requirement may result in repeated penalties and potentially an injunction and criminal sanctions against the offender. This is what the powers allow – but such a requirement is not normally imposed, because Ofcom only acts after the damage has been done. Ofcom prefers only to take many months over major investigations to produce headline-grabbing cases around the imposition of a major penalty for long-past nuisance. Ofcom reports having done nothing about any new case since April 2007!

We do not care about penalties, we would rather that nobody was penalised because the practice has been halted. Ofcom’s first duty is to Stop Silent Calls being made, not to penalise those who make them, because it has failed in its first duty. An even higher maximum penalty would simply prolong the process further, unless Ofcom changes its approach.

I have been campaigning on this issue for over 5 years now. It is a disgrace that Ofcom is still failing to do its duty. The request for a higher penalty is a red herring, being used to cover up Ofcom’s failure.

I see it as vital that those who are concerned about proper and effective action being taken to stop the nuisance of Silent Calls make it clear to the Department for Business that we demand swift and effective action by Ofcom, using the powers that it has held since 2003 - not further delay and the hope of a few headline grabbing cases.

There is just one week left to make submissions to the consultation - at http://www.bis.gov.uk/maximum-penalty-for-misuse-of-an-electronic-comms-network.

Public opinion on this matter has been disregarded in the past, as has an explicit demand from parliament. With a former fellow Stop Silent Calls Campaigner, Kevin Brennan MP, now in place as the relevant Minister, I trust that this will not happen again.

The DWP Now Offers Free Calls to ALL on 0800, but many issues remain

From: David Hickson – campaigner for Public Services

 

The Department for Work and Pensions has today announced that from Monday calls to around 70 of its 0800 numbers will be free for callers from most Mobile phones (agreements to cover the remainder are pending).

There are still many public services using 0800 numbers which have not made equivalent arrangements (although this does apply in some other cases!)

A more comprehensive resolution of this issue to cover the remainder of public service 0800 calls is needed. Will provide sector providers of 0800 numbers do the same?

 

The DWP continues to lead the public service providers who use 0845 and 0844 revenue sharing numbers. IN ALL CASES these provide subsidy of the cost of providing the service through “Revenue Sharing” between the telephone companies. This generally leads to the cost being passed on to the caller, however present regulations covering BT creates some perverse distortion. Those who believe that BT charges are “typical” have it the wrong way around – BT is unique in being subject to regulation of the level of some of its charges (see this briefing).

Callers from Public Payphones, Virgin Media landlines and all PAYG and Contract Mobile Phones invariably pay more to call ALL 084x numbers than to call “ordinary” (01/02/03) numbers. (See this briefing)

The DWP and HM Revenue and Customs are amongst the leading public bodies that are content to have the cost of providing their services subsidised by those who use them.

 

The Department of Health is currently engaged in trying to address this issue. It has however completely missed the point made above by saying that NHS GPs, Hospitals and other telephone services may continue to use 084x numbers. The BMA has suggested that a false assurance from one of the providers of Surgery telephone systems could be used to deny the simple truth of what providers to patients actually charge.

Use of revenue sharing numbers (including all 084x numbers) must be ended wherever it is not proper for the caller to be paying the public (or indeed private) company delivering a service by telephone.

Many public bodies are now adopting numbers from the 03xx range. Calls to these MUST be charged at no more than the equivalent cost (if any) of calling an “ordinary” (01/02) number. Numbers from this range provide the solution for those who may benefit from the facilities of a “non-geographic” number and are prepared to meet the cost of these facilities, rather than imposing it on callers (see this note).

 

The BMA fixes a deal on 084 telephone numbers with the Department of Health - it must be un-fixed

From: David Hickson - campaigner for the NHS

The BMA GPC has published its guidance to NHS GPs on 084 telephone numbers in anticipation of revisions to the contracts under which they serve local Primary Care Trusts in providing NHS services in England.

It claims to have done a deal with the government to get around the stated objective that no patient should pay more than the cost of a geographic call to contact the NHS. Reliance on wholly incompetent assurances about the cost of calling is said to enable GPs to continue to benefit from having the costs of providing access to them subsidised by patients.

If this is true, then the Department of Health is party to a dirty deal to ensure that NHS patients continue to pay for access to NHS services.

Key points from the BMA document

The BMA GPC claims to have had a part in setting the Department of Health policy on use of 084 telephone numbers throughout the NHS.

The policy of the BMA is stated as being that the charge to patients for access to NHS services should be as low as possible, according to the quality of the service provided. This represents a most radical departure from the principle that NHS services, of the highest possible quality, are provided “free at the point of need”. The incidental, third party cost of a “normal” telephone call is separate; the point at issue is the subsidy to NHS providers obtained through use of revenue sharing numbers.

On the question of which revenue sharing numbers are acceptable, it advises GPs to obtain a guarantee from the company that provides their telephone service (the initial beneficiary of the revenue share) regarding the rate that patients will be charged for calling. This disregards the fact that this company has no control over the rate charged (except that forced on BT by regulation).

The Department of Health requirement is for all NHS providers to ensure that patients pay no more than the cost of geographic call to contact them.

The BMA states that NEG, the provider of the “Surgery Line” system has given the Department of Health an assurance that every patient who calls a Surgery Line 0844 number will pay no more than the cost of a geographic call.

The truth of the situation

What callers actually pay is not determined by NEG, but by their own telephone service provider.

ANY GUARANTEE FROM NEG IS TOTALLY WORTHLESS

Not only is nobody (not even Ofcom, which only regulates BT) in a position to offer a guarantee regarding the rates for calling 084x numbers that may be charged by over 200 different companies providing telephone service in the UK, but the particular assurance offered by NEG is demonstrably factually inaccurate.

I have done some research into the issue and produced advice for NHS bodies, following the release of the Department of Health Directions on 21 December 2009.

The relevant section of my advice shows that those calling a Surgery Line 0844 number (call types g6, and more recently g11) during the weekday daytime will pay more than the cost of an equivalent geographic call if using the following telephone services and tariffs:

·        BT Public Payphones

·        Any of the landline packages from Virgin Media

·        Any PAYG or Contract mobile phone from Vodaphone, O2, Orange, T-Mobile, 3, Virgin Mobile (except for its “Addict” PAYG package)

·        BT Unlimited Anytime Call Plan

·        Any Karoo Talk plan (Kingston Communications residential service in Kingston-upon-Hull)

·        Any current tariff for landlines offered by First:, Phone Co-op, Pipex, Saga, Sky Talk, Tesco Home Phone

·        Current landline tariffs offered by Talk Talk

Talk Talk is significant because it is (through its “Opal Telecom” subsidiary) the provider of the telephone service used by Surgery Line customers. As an agent of Talk Talk, NEG appears to even be unaware of the charging policy of its principle.

How NEG can perhaps guarantee that no patient would ever call a practice under the terms of any of the tariffs listed above is beyond me. Whether the Department of Health has actually accepted this guarantee is another issue! (I see it as vital that the Department of Health immediately disowns this ridiculous suggestion.)

Does anyone not pay more to call Surgery Line numbers?

Those who would not pay more are those using the BT tariffs that impose a penalty charge on geographic calls, when made outside the period covered by the respective call plan, e.g. a weekday daytime call on the Unlimited Weekends package. BT is currently regulated so that it must charge for calls to 0844 numbers at fixed rates that are almost entirely made up of the amount that is paid over in revenue share. Because its charges for geographic calls, although these are normally “free” when within the terms of an inclusive package, are not regulated, the penalty charge makes the total cost marginally greater (generally 0.25p per minute) than the cost of a 0844 call, when made outside the terms of the package that the customer has selected. Calls to 0844 numbers are not covered by “unlimited” inclusive packages offered by any telephone service provider.

I have identified just one mobile tariff that charges a single rate for nearly all calls, included those to all geographic and 0844 numbers – there may be other similar tariffs that are not currently offered and published.

In its submission to the recent Department of Health consultation NEG gave a cost illustration using misquoted BT rates. It offered this as showing “the fact” that calls to 0844 numbers cost less than calls to geographic numbers. (See my commentary on this submission, which was provided to the DH to at least raise questions about the competence and integrity of NEG.)

There is an extensive catalogue of examples of misrepresentation and worse from NEG regarding the cost of calling 0844 numbers. Many of these are repeated by its customers, who are perhaps not always aware of the fact that they are deceiving their patients.

The way forward

Immediately

This stitched-up deal must be exposed for what it is. I am not given to hyperbole, so I invite others to choose suitably strong language to describe what is alleged by the BMA to have happened.

Implementing the ban

There is no problem with the wording of the actual essential requirement that “no patient should pay more to contact a NHS provider by telephone than the equivalent cost of a call to a geographic number”. The point is that this has to be interpreted and applied in practice as a ban on use of all 084x numbers, even though that may not be the specific intention, or the terms in which the requirement is expressed.

The ”guarantee”

No provider of telephone service to a GP, or other NHS body, can be expected to be held accountable for the call pricing policies and specific tariffs of every telephone company that may be used by patients to originate calls to it. The fact that it receives a revenue share from those companies should give a fair indication that they are likely to pass this cost onto their customers, however it cannot be sure of this and is unlikely to wish to stress the point!

All 084x numbers are subject to revenue sharing through enhanced “termination fees”, however the cost of calling them is often misrepresented by misleading terms such as “lo-call”. It is also quite common to refer to rates charged by BT as if these were typical, although perhaps subject to variation. This totally misses the point that BT, being exclusively subject to regulation, is the exception. All other providers are free to pass on the cost of the revenue share by imposing premium rates greater than those for calling geographic numbers.

The idea of a “provider’s guarantee” covering rates charged by others is utterly ridiculous. It cannot have any objective meaning, nor be enforceable in any way. The false assurance already given by NEG actually helps to demonstrate how worthless this is.

Continuing use of Surgery Line in the NHS – funded properly

GPs under contract to NEG for Surgery Line will be able to continue to serve out the duration of their contract in full compliance with the DH requirements by the simple expedient of migrating their telephone number to the 0344 equivalent of the 0844 number currently in use. Ofcom has made provision for such migration to the 03xx range, which is charged at no more than the equivalent cost of a call to a geographic number. Talk Talk (Opal) advises that this type of change should be undertaken, during the life of a contract for telephone service, where thought appropriate (see my blog on this topic).

The loss of the patient contribution to the costs of the system (through the revenue share) may be seen as a disappointment to the BMA GPC, which believes that NHS patients should pay for access to “high quality” NHS services. It must however note that the vast majority of its members in General Practice seek to provide high quality NHS services at no charge to their patients, and may be delighted to see their colleagues brought back in line with the principles of the NHS. The head of the NHS practice where I am registered probably spoke for many in his position when he told me that he “would not touch one of these nasty telephone numbers with a bargepole”.

My involvement

I will be delighted to continue to help in any way I can to see the principles of our beloved NHS restored.

The right to access NHS services without charge by the provider to the patient (except where sanctioned by parliament) is embedded in the first of the rights in the NHS Constitution. Once section 1 of the Health Act 2009 is in force there will be the opportunity to instigate legal action against any NHS provider who fails to honour that right. I offer no threat and I sincerely hope that this will not be necessary in respect of charges imposed through the use of revenue sharing telephone numbers.

I believe that the Directions issued and (assuming similar terms) the revisions to the GP contracts, and those for other contracted NHS providers (dentists, ophthalmologists and pharmacists), provide an adequate basis for the removal of use of revenue sharing telephone numbers from the NHS. It is however essential that these are interpreted properly, not circumvented by use of some meaningless “guarantee” as proposed by the BMA. I will do all I can to prevent a repetition of what happened in 2005, when the then Health Minister was misled by a company that offered a “guarantee” about the cost of calling 0844 telephone numbers. (See this item - has anything changed?)

Use of revenue sharing 084x telephone numbers banned in the NHS - Yes or No?

To: NHS bodies in England delivering or commissioning NHS services delivered by telephone (I include the NHS Direct Trust on account of services it delivers for other NHS bodies, notably the East of England SHA, which are subject to the Directions referred to, despite the fact that it is not.)

cc: Media, concerned MPs, Department of Health, Contact Council, Fellow campaigners

From: David Hickson - Campaigner for the NHS

---

On 21 December 2009, the Department of Health issued Directions to NHS bodies concerning the cost of telephone calls, accompanied by a "Dear Colleague" letter.

In essence, these directions prohibit use of 084x telephone numbers in the provision of NHS services.

In fact, the covering letter attempts to suggest that this is not what they are doing, however I cannot see how any NHS body (as each is left to make its own determination) could come to any other conclusion.

Put simply, a 084x telephone number could only be used in circumstances where it was established that no patient would ever call that number from a BT public payphone, a landline provided by Virgin Media or any mobile phone. If the Department of Health has used the time that it has been occupied on this matter seriously then it must have somehow concluded that such circumstances could exist. It has directed each individual NHS body to make this separate determination in respect of every 084x telephone number.

All of the tariffs applicable to the services referred to above charge more for any call to a 084x number than to a geographic number - the criterion that prohibits use of 084x numbers. Whilst some may benefit from cheaper rates, the principles of the NHS could not allow some patients to (indirectly) pay providers for access to NHS services, because other patients have their costs subsidised by other charges levied by their telephone company.

I address these matters in detailed briefings, offered as advice on the Directions, as follows:

1 - Introduction and Summary
2 - Useful information on various points that are commonly misunderstood
3 - List of telephone tariffs categorised according to the relative cost of calling 084x vs. geographic numbers

I hope that the information I provide is found useful.

I will be delighted to assist further.