BMA hides its policy on charges for access to NHS services

From: David Hickson - campaigner for the NHS

The General Practitioners Committee of the BMA has just announced the launch of a public consultation on GP services - BMA asks the public for their views on GP access and out-of-hours care (28 May 2010).

This consultation fails to address, or invite comment on, a most controversial policy position held by the BMA as declared in its GPC GUIDANCE: USE OF 084 NUMBERS IN THE NHS.

The policy of the BMA GPC is stated to be as follows:

"calls to NHS services should incur as low a charge as possible, but that this must be balanced by the quality of communications service that the patients are accessing"

The suggestion that NHS patients should pay for access to NHS services according to the quality of the service, is a most radical proposal to revise the principles of the NHS. The point at issue is the surcharge to the benefit of the GP that is paid by patients when calling any 084 number. This is in addition to the (acceptable) charge for a normal call as set by their chosen telephone company. When I challenged Dr Richard Vautrey, Deputy Chairman of the BMA GPC, on this point in a BBC Radio 4 "Today" programme discussion, he agreed that it warranted public debate. The current consultation however makes no reference to this radical aspect of BMA policy with reference to the principles of the NHS.

This is the position from which the BMA sought unsuccessfully to oppose the introduction of a ban on use of "expensive" telephone numbers by GPs and other NHS providers. The BMA has therefore shifted its approach to this particular issue, by now claiming that the expensive 084 numbers are not more expensive. This transparent and ridiculous shift of position (which is clearly announced in the “GPC Guidance” document referred to above) has not attracted attention. There is evidence to show that this attempt to now frustrate the implementation of the ban by deceit, after unsuccessfully arguing against it by open declaration of a radical policy, is so far being seen to be effective in practice.

Ø  The Department of Health must now take firm action to prevent those charged with enforcing the principles of the NHS, as now reflected in revisions to the contracts held by GPs, from being misled by blatant misrepresentations of the truth.

Ø  Members of the public wishing to engage in the consultation should understand the position taken by the BMA on this important point and offer appropriate comment.
The many BMA members who undoubtedly oppose this policy should be aware of it and express their views.

Ø Laurence Buckman must be asked to explain this policy and to confirm exactly where the BMA stands on the question of whether NHS services should be "free at the point of need" or subject to access charges levied by providers.

These points need to be addressed in order to ensure that the ban on use of expensive telephone numbers may go ahead. Once this has been achieved, we can address the ease with which those under contract for use of 084 numbers may immediately migrate to 034 numbers, so as to restore application of the principles of the NHS without having to wait for completion of their lengthy contract term.

Ban on use of expensive telephone numbers by GPs starts here

From: David Hickson - campaigner for the NHS

The contract which applies to NHS GPs has now been amended to include a complete ban on use of "expensive telephone numbers"¹.

The advice to Primary Care Trusts to issue these contract revisions was slipped out by the Department of Health during the General Election campaign. GPs are now being notified of these contract variations.

Under the somewhat odd terms of the revised contract, GPs using the expensive 084 telephone numbers are each required to work out for themselves whether their number is more expensive for patients to call than an equivalent call to an ordinary (geographic) number. This is bizarre because the only cases where 084 numbers are not more expensive arise from a perverse effect on some caller's telephone tariffs, due to the partial regulation of BT charges. This is a feature of the tariff applied to the patient by their telephone company, totally outside the control of the GP.

One may state with complete confidence that ALL 084 numbers are always more expensive for patients who call from a Virgin Media landline, a Contract or PAYG Mobile or a Public Payphone. There may be many GPs who are not aware of this simple fact, let alone understand the complexity involved in other cases.

To comply with their contractual requirements, GPs using these numbers will first have to establish that they would never have any patients who would ever call them in this way. They may then need to look in more detail to perhaps confirm that none of their patients use the "Unlimited Anytime" package from BT. 084 numbers should always be more expensive than ordinary numbers because they are invariably subject to "revenue sharing". I cannot imagine that any GP would be able to properly slip through the loophole.

Mis-information

The BMA has advised its members² that there are some 084 numbers which are not more expensive - this is simply untrue. Many GPs have long been repeating nonsense about "lo-call" rate numbers. You can call it what you like, but 40p per minute is more expensive than 20p per minute^3a, 10p per minute plus a call setup fee of 11p is more expensive than a package inclusive call that attracts no charge^3b.

Briefing

I have issued a briefing⁴ to each of the 142 Chief Executives of the 152 Primary Care Trusts, which enforce the GP contracts, to advise them of the situation. One hopes that they will get the message and prevent GPs from following misleading advice given by their telephone system providers.

The alternative

Many GPs use fancy telephone systems using 084 numbers, mostly provided by the Talk Talk Group⁵. Talk Talk, like other network telephone service providers, allows its customers to migrate from a 084 number to the equivalent 034 number, during a long term contract.

As all 03 numbers offer the same technical benefits as 08 numbers, but calls to them must be charged at no higher rate than an equivalent call to an ordinary (01/02) number, this may provide the simple solution which is required.

If GPs were to give up their fancy systems they would not only lose the benefit of potentially useful features, but they would also incur sizeable contract termination penalties. They cannot however charge patients for the use of these features, in the same way that they cannot charge patients for the use of any other technology deployed in their surgery to deliver NHS services.

The revised contract demands that if a GP is unable to cease use of an expensive number, they would always have to call back. Migrating to a 034 number would undoubtedly be a cheaper option all round.

An appeal!

Please help me convey this good news to long-suffering patients, GPs who have been misled about the cost of calling their numbers, others in the public service who need to follow this example and the new government, which needs to help PCTs in doing their job.

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Notes

1 - The contract variation notice is published at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_115587.pdf

2 - The BMA GPC Guidance is published at: http://www.lmc.org.uk/uploads/files/guidance/084numbersguidanceandfaqs080110.pdf

3 - One could give very many examples of call cost differences, I chose two relatively simple examples:

3a - Orange PAYG rate for calling any 084 number [40ppm] vs. an ordinary (01/02/03) number [20ppm], see http://www1.orange.co.uk/service_plans/downloads/PAYG_PriceGuide_v10(20090918).pdfpp 7, 9, 11, 15 and 17 - Racoon (p13) is only 15p per minute for ordinary calls.

3b - Virgin Media Talk Unlimited rate for calling a 0845 number [11p + 10ppm] vs. an ordinary (01/02/03) number - see http://allyours.virginmedia.com/pdf/003817-Residential-Cable-Apr-V8_100311.pdf pp 4 and 5 - a surcharge of 2.5p per minute applies to other tariffs.

4 - My latest briefing to PCTs is published here - http://nhspatient.blogspot.com/2010/05/implementation-of-ban-on-use-of.html. This includes links to many other briefings.

5 - Opal Telecom (the business arm of the Talk Talk Group) is shown as the provider of most of the expensive numbers used by NHS GPs.