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Tuesday, 12 January 2010

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.


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


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?)

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