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Tuesday, 9 August 2011

NHS Dentists warned of the danger of being misled about the cost of calling 084 telephone numbers

Like their colleagues in General Practice, NHS Dentists are committed to upholding the principles of the NHS as they deliver NHS services to patients.

This article, by practice consultants PSDS, warns that practices can be misled when choosing a telephone system.

The article refers to a particular un-named company providing systems for Dentists and GPs, which requires practices to adopt a 0844 telephone number. All 0844 telephone numbers are "revenue sharing" which means that a premium payment by callers is used to subsidise the cost of the system to the user.

This could be a reference to "the original and still best telephony solution in the UK for dentists", which is described as being a "revolutionary co-funded telephone systems solution , designed specifically for dentists".

The same company also offers "the original and still best telephony solution in the UK for GP’s", which is described as being a "revolutionary co-funded enhanced telephony systems service designed specifically for GP surgery and general practice".

One could reasonably assume that "co-funded" means that part of the cost of the system is paid for by patients, as is the case when 0844 telephone numbers are used.

There is however a further extraordinary claim made about the telephone numbers used to part-fund these particular systems, as they allegedly defy the standard charges levied by all telephone call service providers. It is claimed that the 084 numbers used are "not more expensive to call than using an ordinary number".

I must urge those able to identify the provider of these systems to obtain a clear and accurate understanding of how the systems are "co-funded" and accurate details of how exceptional charges are applied by all telephone call service providers for calls to these numbers.

I see it as most important that inaccurate information about this company and the services it provides is not placed in the public domain. It is vital that the issues raised are discussed with total respect for accuracy by all parties.

NHS Contracts

The contractual terms which apply to delivery of both NHS GP and Dentistry services make it clear that any payment by patients to the benefit to the practice (or a third party, e.g. a telephone system provider) can only be those on standard scales approved by parliament and with exemptions applied as defined. (See GMS contract clause 483 and GDS contract clause 241.)

As this principle had been widely abused, general regulations about telephone numbers have now been applied to GP contracts (see GMS contract clause 29B). It has not yet been seen to be necessary to apply similar general conditions to NHS Dentists.

In 2005, specific regulations regarding only some particular types of telephone number were applied to both. (See GMS contract clause 29A and GDS contract clause 70.) Unfortunately in 2005, the government had itself been misled about the cost of calling 084 numbers, as it made the extraordinary and inaccurate claim that these "offer patients a guaranteed low call rate" (see this media release).

Enhanced telephony

The "enhanced telephony" facilities available on 0844 numbers are equally available on 03 numbers, and may be available on some 01/02 numbers. (Identical facilities are available on all non-geographic numbers: 03, 070, 080, 084, 087 and 09 ranges.)

Calls to 03 numbers are charged on the same basis as calls to geographic numbers for all callers. Use of 03 numbers is therefore fully compliant with the principles of the NHS.

Those offering NHS services, paid for only through NHS payments to the practice and specifically stated and authorised charges, cannot use 0844 (or indeed 0843 or 0845) numbers. Use of 070, 080, 087 and 09 numbers is also prohibited (except where exceptional arrangements are made in the case of 080).

Returning to compliance

The PSDS article fails to indicate that it is not necessary to terminate the entire contract to move into compliance with the principles of the NHS.

Provision of network telephone service is only part of the contract, which is primarily a leasing agreement covering the provision of locally installed equipment. Whilst the revenue sharing financial benefits are derived from use of a 084 number, the enhanced telephony features are available on other numbers.

Any practice which wishes, or has already chosen, to invest in "enhanced telephony" for the benefit of its patients can adopt or migrate to a 03 number at any time - the equivalent 0344 number is reserved for this specific purpose.

It is standard practice in the telephone industry to allow migration from one type of non-geographic number to another at any point in the term of a contract, without penalty. There is no good reason why any system provider would wish to impede a move from 0844 to 0344, as this would do nothing more than shift the on-going cost of the system from the patient to the Dentist / GP.

Any system provider that sought to prevent its clients from complying with the principles of the NHS (and the terms of their NHS contracts), when this involved no compromise of its own interests, would be taking a most extraordinary position. I hope that nobody would suggest that any company is behaving in this way without first verifying the accuracy of such a claim.

It may be noted that the BMA makes such a claim about provider(s) to GPs - "many GP practices have signed multi-year contracts with telephone services providers which cannot be varied, renegotiated or terminated without substantial financial penalty" (I quote from comments on this specific issue in the latest BMA Guidance).

"The leading provider of enhanced telephony to the health sector"

Many would assume that the comments made above all relate to a company which describes itself as "the leading provider of enhanced telephony to the health sector".

My concern is that only accurate information about this company is placed in the public domain. There are concerns about inaccurate information having been published, which have been heightened as a result of its new owner having chosen to take a prominent public position, through the broadcast media.

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