NHS Bodies forced to re-assess their policy on tolerating use of 084 telephone numbers

Pressure from campaigners has finally produced a positive response from the Department of Health to the widespread failure to implement the ban on use of expensive telephone numbers in the NHS, which was first announced on 14 September 2009.

Yesterday the Department of Health issued Further Guidance on The use of 084 numbers in the NHS. This was addressed to NHS bodies which themselves use these numbers and to the Primary Care Trusts which are required to enforce the contractual conditions imposed on GPs.

There are currently over 1,000 GP practices using 084 numbers and many NHS bodies also persist in subsidising the cost of their telephone systems at the expense of patients and other callers. All 084 numbers provide a subsidy to the user at the expense of callers.

This only applies to England, although the devolved governments would do well to address this problem also - especially as they have no current plans to replace the NHS with an alternative system.

Details of all the GPs and the costs of calling them are published in my database.

Some of the key NHS bodies are listed here.

The New Guidance

It is important to understand that the "Further Guidance" does not in any way change the formal position. It simply restates what is contained in the relevant Directions and regulations and confirms the understanding which all should have derived from this. Sadly, many have been misled as a result of efforts to maintain this abuse of the principles of the NHS.

The key points made are as follows:

•	To ensure that the requirements may be sustained through forthcoming changes to telephone regulations, there is no explicit permission or prohibition of any particular group of telephone numbers. Determination of what is prohibited is based on meeting the following requirement:
	"Persons should not be charged more to contact an NHS body or Primary Medical Service contractor, than they would if they were calling a geographic number in the same manner."
•	Evidence to enable this determination should be based upon:
	ο	Cost-per-call information from telephony providers.
	ο	Information provided by patients showing the cost of calling as against the cost they incur when calling a geographic number from the same phone.
•	This specifically rejects suggestions that it is appropriate to make the determination in other ways.
	ο	It is not acceptable to use only opinions offered by interested parties, e.g. the provider of telephone service to the GP or NHS Body. An "assurance" that a provider believes that their number should be cheap to call is of no value whatsoever.
	ο	Alleged "industry standard" methods for presenting a minimum call cost, with the proviso that it may be greater are of no use in making a determination.
		It is made clear that the determination must be made on consideration of "the arrangement as a whole", not just the circumstances of a particular group of callers. It is stated:

The conclusion

If one considers the reality of the current situation with telephone tariffs and the variety of tariffs that are used, there is no 084 number that may presently be used in compliance with the regulations and Directions. – See my table of relative costs.

All users of 084 numbers, who are bound to retain use of a non-geographic number from a particular provider due to a contract, or who wish to deploy the benefits of a non-geographic number, are free to migrate to the equivalent 034 number. Calls to 03 numbers are guaranteed to be charged are no greater rate than that of calling a geographic number from the same mobile, landline or payphone, including through the terms of call inclusive packages. All known providers of telephone service to 084-using NHS bodies and NHS GPs are known to offer this facility. Other more appropriate remedies may be available, but this is known to be available in every case.

03 numbers do not provide the financial subsidy (at the expense of callers) that is enjoyed by users of 084 numbers. The consequential increased cost would return that NHS provider to the same situation as other similar providers, who meet their costs from the NHS funding provided for the purpose. There is no way that such a situation could be deemed to be "unreasonable".

There have been suggestions that some providers impose unreasonable costs or restrictions on migration. If this is so, then evidence of this irregular business practice must be provided, so that these providers can be seen to be engaged in unnecessarily intervening in the politics of the NHS.

My comment

I look forward to hearing that NHS Chief Executives have indeed revised their policies after “considering the implications of this further guidance”, as demanded by the Department of Health. The original measures set deadlines of Christmas 2010 for NHS Bodies and 1 April 2011 for GPs to cease using 084 numbers.

Public support for the principles of the NHS, allegedly also seen from GPs and the government, should help to ensure that we are now finally able to get rid of this blight on the NHS.

Health Services Minister, Simon Burns, challenged on NHS GP charges

Please see my open message to Simon Burns, Minister of State (Health Services), published at this link.

This enables the issue of GPs using expensive telephone numbers to be seen in the context of the government's intentions for health service provision in England.

In a recent debate in parliament, Mr Burns made the bizarre assertion that NHS GPs are allowed to charge patients for access to NHS services.

He accused me, and others, of alleging that they were charging more than they "should".

I most certainly alleged that nearly 1,300 surgeries are listing on NHS Choices as having 084 telephone numbers, which means that the cost of their telephone system is subsidised.

This subsidy is generally provided by their patients and other callers, who pay their respective telephone companies more to call these numbers than they would to make an equivalent call to a geographic number. This fact places the GPs in breach of their NHS contracts.

If Mr Burns and his colleagues succeed in introducing a "patient focussed" health service to replace the NHS in England, then it will be natural for patients to expect to get "value for money" from their healthcare providers, as they exercise choice as consumers.

For the time being however we have a "National" Health Service, funded by taxation, and contracted providers are not permitted to make any charge whatsoever, as services are accessed "free at the point of need". I am fighting to defend and retain this.

Mr Burns also dismissed my evidence because it identified only individual GP surgeries, as shown on NHS Choices, rather than the practices which operate the surgeries.

This petty-minded wriggling approach provides a most clear indication that, despite some warm words, Burns is simply not interested in whether or not the principles of the NHS are being upheld.

I hope that those who are concerned about these matters will recognise this precise, concrete evidence of the way in which Health Ministers are currently approaching their duties.

Please contact me for further information and comment.