The principles of the NHS - challenged now - will this get worse or better?

I respond to the speech on the principles of public service by the Prime Minister on Monday and anticipate reaction to the publication of the Health and Social Care Bill today.

Now is the time for the Government to demonstrate that the principle of the National Health Service being delivered without charge to patients is to be retained and that National principles can only be enforced by clear action from the National government.

If this cannot be achieved now, then will giving GPs more “freedom from central control” make it easier?

Many GPs are part-funding their services through use of "Business Rate" 0844 telephone numbers, which cause a "Service Charge" of 5p per minute to be imposed on patients who call these expensive numbers. This Service Charge is to the benefit of the person called and their telephone service provider. In a current consultation, Ofcom confirms that this is the current position (for all 084 numbers) and proposes that this Service Charge should be declared wherever the telephone number is stated, i.e.

"Calls to the surgery on 0844 xxx xxxx cost 5p per minute plus your telephone company's Access Charge".

If, as he said, the Prime Minister wishes for the delivery of public services to be "more transparent", then those who choose to impose Service Charges, through use of Business Rate telephone numbers, should be using such statements now, without waiting to be required to do so by new regulations. (The same applies to all other public service providers using Business Rate numbers – e.g. NHS Direct, HMRC and DWP agencies.)

If, however, access to NHS services is to be "free to all who need it", as promised by the Prime Minister, then use of Business Rate 084 telephone numbers MUST BE PROHIBITED. (In truth, if transparency was to be applied then use of these numbers would most likely not be sustained anyway! It is only because of public misunderstanding that they are tolerated, with the blame being wrongly placed on telephone companies!)

As a result of contract changes introduced in 2010, NHS GPs have to cease their use of 0844 numbers by 31 March 2011. The terms of the contract however fail to make this explicit, leaving each practice to make the necessary determination.

The BMA believes that patients should pay for access to NHS services according to the quality of service delivered and therefore advises its members to retain these expensive numbers to fund their activities at the expense of patients. To evade the terms of the contract revisions the BMA encourages its members to exploit the current public confusion about telephone charges by falsely claiming that their Business Rate numbers are not more expensive to call than Geographic Rate numbers. (These comments are derived from published guidance.)

Observations and specific enquiries show that these false claims are being granted credence by many PCTs.

If this abuse and lack of control is able to occur under the current regime, then one must fear for the protection of the principles of the NHS if GPs are to be given yet more "freedom from central control", as proposed by the Prime Minister.

However strong its commitment to public service, any private body (such as a GP practice) has a primary financial duty to its owners and shareholders, which demands that it exploits every permitted opportunity to derive income from service users. It is the absence of such a distinct duty from public bodies which causes users to see a difference in who is delivering a public service.

The Prime Minister confirmed on Monday that the government is "in no way abrogating" its responsibility to ensure that "the rights of [public service] users are maintained". If that is to be proved, then the government must take action to affirm this responsibility NOW.

ealth HEalth I invite all those concerned for the principles of "our NHS" to join me in calling on the Secretary of State for Health and his ministers to demand that all Business Rate 084 telephone numbers be removed from the NHS immediately.

Alleged technical or contractual difficulties are spurious. Arrangements for migration from 084 to the equivalent 034 number could be made swiftly and undertaken within the term of existing contracts for telephone service. Where, as in the case of NHS Direct, the cost and confusion of complete removal of a 084 number would be inappropriate, the Geographic Rate equivalent (e.g. 0345 4647) could operate in parallel with the Business Rate (e.g. 0845 4647) number.

The Prime Minister was very clear in stating that the fundamental principles of the NHS must not be diluted by the proposed "modernisation" - LET US SEE HOW TRUE THAT IS.

(Telephone access to other public services, e.g. those provided by HMRC and DWP agencies, is also not "free to all who need it" as they too use Business Rate 084 telephone numbers. As the Prime Minister is not yet proposing that these agencies be granted "freedom from central control", there can be no doubt about where the responsibility for this breach of the principles of public service lies!)