Expensive GP telephone numbers are now relatively even more expensive for BT customers

BT has today made further adjustments to its prices for residential customers (see "Some of our prices are changing").

•	The price of the Unlimited Anytime Call Plan is reduced from £5.00 per month to £4.70.
•	The "penalty rate" for weekday daytime (7am - 7pm) calls to geographic numbers outside a calling plan goes up from 7p per minute to 7.6p per minute.
•	The Call Setup fee (which applies to all non-inclusive calls) goes up from 11.5p to 12.5p.

The latter directly affects calls to GP 0844 telephone numbers, which are never included in packages, but the other changes make a difference too.

The "break even" point

It is worthwhile to select the Unlimited Anytime Call Plan, even if one only makes a few weekday calls to geographic numbers. Following these changes, anyone who makes at least the equivalent of 3 calls, each of more than 3 minutes, per week to a geographic number before 7pm, is now best served by the Unlimited Anytime Call Plan (see calculation below).

This should leave very few people paying the "penalty rate" for making otherwise inclusive calls outside the period covered by their Call Plan. Having subscribed to this plan, all other calls (of up to one hour, to "geographic rate" 01/02/03 numbers) at any time are made without any further charge.

Only those who NEVER use their landline during the day, perhaps because they use a mobile for daytime calls, would be likely to choose to continue paying for daytime calls to geographic numbers at these newly increased “penalty rates”.

THIS MAKES CALLS TO (always non-inclusive) GP 0844 NUMBERS INFINITELY MORE EXPENSIVE.

False claims

Some providers of the 0844 (type 'g6') numbers used by many GPs claim that because BT is compelled to charge no more than 5.105p per minute (plus the 12.5 call setup fee), calls to the surgery are "cheaper" than calls to geographic numbers. By regulation which applies only to BT, it is only permitted to charge the amount which is passed on to the other end on these calls - the subsidy from which the GP benefits.

The "cheaper" claim relates to the odd circumstances of BT being unable to add its own charge for these calls. It is only true in relation to those who would pay a "penalty charge". There will now be fewer of them! Furthermore, the increase to the call set-up fee makes the additional cost of calling 0844 numbers greater for all.

Aside from the regulated rates forced on BT; callers using Virgin Media, all mobile phone tariffs and public payphones invariably pay far more to call these 0844 numbers, whether they benefit from a package for geographic calls or not. Mobile voice call packages generally include calls to geographic landline numbers, but never 0844. The highest surcharge for 0844 calls amongst the major providers is 41p per minute (T-Mobile).

Breach of contract

GPs who cause ANY caller to pay more than the cost of a geographic call (by choosing to benefit from the revenue share earned from these expensive numbers) are already in breach of their contract. The noose is tightening around this scam - the BT changes from today will serve to pull it a little tighter.

This briefing addresses enforcement of the regulations on NHS GPs.

Please refer to this table for illustrative call cost examples and links to published tariffs.

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Calculating the break-even point

From today, non-inclusive weekday daytime calls to geographic numbers are charged at 7.6p per minute with a call-setup fee of 12.5p.

Charges include VAT, durations are rounded up to the nearest minute, call charges are rounded up to the nearest penny.

A call of between 3 and 4 minutes costs: 4 x 7.6p = 30.4p + 12.5p = 42.9p rounded to 43p

43p x 3 = £1.29 per week x 4 = £5.16 per month vs. £4.70 Unlimited Anytime subscription

There are innumerable other examples; e.g. 5 calls of just over 10 minutes each per month:

11 x 7.6p = 83.6p + 12.5p = 96.1p rounded to 97p x 5 = £4.85

My point is that this is not "heavy" usage, it is just "someone using their phone". Having passed this point, there is no further charge for any other inclusive call.

The "penalty charges" shown in these examples are clearly not the "standard" charge for a telephone call.

NHS Reforms - Government says "PCTs must carry on with their work"!

The government has confirmed that it is the PCTs, under threat of abolition,
who are responsible for ensuring that GPs provide NHS services “free at the point of need”.

This article in a GP journal raises the issue of over 1,000 GP practices shown by NHS Choices to be in direct breach of their NHS contract, by continuing to use expensive telephone numbers past the 1 April deadline for compliance with new regulations. In response, the Department of Health is quoted as confirming -

"It is up to PCTs to ensure that GP practices comply".

THIS LEAGUE TABLE shows how many cases each clustered grouping of PCTs has to address. I have published a geographic version.

Both link to a full listing of all of the surgeries shown by NHS Choices to be still using expensive telephone numbers, after they should have been given up.

I support my claim that ALL ‘084’ NUMBERS ARE MORE EXPENSIVE for NHS Patients to call, with linked information from published telephone tariffs. All may be readily verified.

I comment:

“We need PCTs to ensure that GPs do not breach the principles of the NHS by charging patients through use of expensive telephone numbers. They have much work to do before the NHS can move forward.
The government needs to explain how GPs will be able to do this job themselves when they take over the work of PCTs!

“The NHS will always benefit from improved effectiveness and efficiency.
The principle of access to NHS services ‘FREE AT THE POINT OF NEED’ cannot be compromised.”

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Notes

♦	My full briefing is published here - PCT Clusters to enforce principle of "free at the point of need" before the NHS can move forward
♦	This is a national release. Local and regional briefings could be as follows:
	•	South Yorkshire tops the table for illegal expensive GP telephone calls
	•	149 West Midlands GPs in breach of their contract! - listed
♦	Details of the contractual requirements are given and summarised here
♦	A summary of the basic facts and confusion raised about the cost of telephone calls is provided here
	•	Actual telephone call costs and links to published tariffs are given here
♦	The information as published provides links to the MP covering the area where the surgery is located and to the source information on NHS Choices.

GP telephone system provider NEG joins the debate on NHS reforms - to question "free at the point of need"

In its response to the Ofcom consultation on Simplifying Non-Geographic Numbers, leading Primary Care Telephone System Provider, NEG, argues that the principle of "free at the point of need" does not work for “enhanced” GP telephone systems. Its Surgery Line system is too expensive to be funded properly by GPs themselves.

"Since 2008 we have offered our customers the choice of using a 03 number. None to date has chosen to do so." ....
"Our years of experience of delivering enhanced telephony solutions in NHS Primary Care organisations leads us to conclude that
the reason is the crucial contribution made to their infrastructure and technology costs by revenue sharing, which is permitted on 084 numbers, but not on 03 numbers."

It is of course the revenue sharing element of 084 numbers which makes them more expensive to call than geographic numbers. Calls to 03 numbers must be charged at no more than the rate of a call to a geographic number and included in packages on the same basis.

As the government pauses in its considerations of the NHS reforms, it is surely vital that this argument in favour of using money from patients to provide “investment” in “enhanced” telephone systems be considered - openly and honestly, with the facts on the table. I have always been ready to participate in any such discussion.

My latest published contribution to this debate includes examples of call costs and links to published telephone tariffs. The NEG document, and its supplement, is heavy on quotations and opinion, but light on relevant facts.

I will leave it to readers to draw their own conclusions about why (on page 65/75) NEG pleads with Ofcom to qualify its efforts to introduce greater price transparency, because this would threaten its business (and the NHS!), whilst NEG seeks to suggest that it has nothing to hide.

(The mythical ‘084 number that is not more expensive than a geographic number to call’ has still not been sighted by myself or Ofcom! Whilst it is spoken of by NEG, the BMA and the Department of Health, and even claimed to exist in vast numbers; until an example has been seen one must doubt its existence in truth!)

There is some urgency as, since 1 April, NHS GPs using 084 telephone numbers stand in breach of their NHS contract!

The government will need to move swiftly to amend the NHS Constitution if it wishes to make this, and perhaps other provider-set NHS charges, legal. There is no such provision currently in the Health and Social Care Bill. The only NHS charges currently permitted are those explicitly set by parliament.

We must be clear on whether the reformed and liberated NHS is to be “free at the point of need” or not. I have my view, which is different to that of NEG, but it is most important that we understand what is the true position for “our NHS” in England as we move forward.

GPs now in breach of their NHS contracts - named and shamed by NHS Choices

Breach of Contract

NHS Choices shames over 1000 GPs who obtain subsidy for the costs of running their surgeries at the expense of NHS patients. From 1 April 2011 they stand in explicit breach of their NHS contract.

31 March 2011 was the deadline for compliance with a contractual requirement to cease using telephone numbers which provide subsidy at the expense of callers. The Department of Health chose to identify these cases by the fact that the numbers cost more to call than the cost of a call to a geographic number, rather than because they have the dialling prefix 084. (It all comes to the same in the end, although some like to entertain the hypothetical possibility that there could be 084 numbers that are not more expensive to call.)

This published table provides links, sorted by Primary Care Trust, to the details of over 1000 GPs shown as having failed to comply with contractual requirements that came into effect on Friday 1 April. In every case the GP is still offering a 084 telephone number on "NHS Choices" as the means for patients to contact the surgery.

I have urged every PCT to refer to this information, and take the necessary action to promptly enforce the terms of clause 29B of the GMS contract. Given that there was a twelve month period given during which compliance should have been achieved, it is disturbing that we have got to this point with so many breaches uncorrected.

As well as the links to NHS Choices the document also summarises and provides links to published telephone tariff information from a number of leading providers. By bringing this all together it is very easy for anyone to see what is going on.

The Government and “Free at the Point of Need”

The number of breaches that have remained past the deadline for compliance, demonstrates how the measures introduced by the previous government have not been implemented effectively. I wait to see what action the present government will take to convince us of its commitment to the principle of "free at the point of need".

Will it stand back to allow this present abuse and breach of contractual provisions to continue in an "un-reformed" NHS? If so, what may we expect when GPs are given more authority and further "liberated" from the need to follow centrally set rules?

If Cameron, Clegg and Lansley are doing roadshows, they must be asked if they believe that GPs should be "liberated" to continue taking Service Charges from NHS patients as they make contact by telephone. If not, then they must demand and support necessary enforcement action by PCTs.