Who is undermining the NHS - GPs or a private sector businessman?

Despite being given 12 months in which to change their arrangements (from 1 April 2010), over 1,000 NHS GPs in England and Wales 2 continue to breach the terms of their contracts by using 084 telephone numbers. These numbers cost patients up to 41p per minute more to call, than for an equivalent call to a geographic number.

The obvious solution

The obvious way for those who wish, or are contractually obliged, to continue to take advantage of the “enhanced telephony” features available with non-geographic numbers would be to switch to the 034 equivalent of their 084 number - e.g. 0844 477 1799 becomes 0344 477 1799. All calls to all 03 numbers are charged at no more than the cost (if any) of an equivalent call to a geographic number and the cost of the “enhanced telephony” features is met by the user of the number, rather than callers.

The BMA advises it members 3 to claim that it would not be “reasonable” for them to vary their arrangements in this way, as is demanded by the terms of their contract with the NHS. As NHS GPs are provided with funding to meet the costs incurred in providing their NHS services, meeting the cost of their telephone system without subsidy at the expense of patients must surely be regarded as “reasonable”. (This is indeed what the overwhelming majority of NHS GPs do.)

The obstacle?

It is standard practice in the telecoms industry to permit migration from a 084 number to the equivalent 034 number at any point during the term of an arrangement, without penalty. For this variation not to be a “reasonable step” for a GP to take, the telephone service provider in question must therefore be deviating from this standard.

There are roughly 12,177 NHS GP surgeries in the UK. One provider of a Surgery telephone system using 084 numbers, offers migration to the equivalent 034 number 1, although not one of its customers is known to have taken up this offer. It also claims that 1 in 5 (20%) of these surgeries are using its system 1, whereas there are only 1,322 cases (11%) of surgeries using 084 numbers 2. Even if one allows for a little marketing hyperbole (however sickening), there can be no question that this company is primarily responsible for the numbers which the BMA claims cannot be “reasonably” changed to 034 - even though it cannot be responsible for as many as 184% of the cases! (My estimate is around 84%.)

The Chief Executive of this company was seen on television on Sunday evening, declaring that exaggerated claims made him feel sick (view this clip). He was also seen stating that command of the detail of one’s business is absolutely vital (view this clip). I was delighted to see him lay out his principles in this way.

My challenge

I have written to the businessman in question, asking him to confirm that his company does indeed allow its NHS GP customers to vary their arrangements on “reasonable” terms. I stress the need for this to be made clear to those who are responsible for enforcing compliance with the GP NHS contracts. Although I wrote before his TV appearance was broadcast, his broadcast comments present the hope of a swift and accurate response.

If such an assurance is provided, then attention must switch to the BMA. At a time when the BMA is seeking public support for its battle with the government over pension arrangements, it would not be well placed if it were seen to be arguing 3 that it was not reasonable for its members to meet the full cost of their chosen telephone systems, without the benefit of subsidy at the expense of patients.

The Department of Health has been involved in an extensive investigation of this matter, involving both the BMA and the provider of this surgery telephone system. In its recently published Further Guidance 4, it has however failed to make any explicit reference to the option of migration from 084 to 034 numbers.

I comment

If the principles of our beloved NHS are to be retained through the on-going reforms, it is vital that scams such as the improper use of 084 telephone numbers as a way of indirectly obtaining subsidy at the expense of patients are firmly and swiftly eradicated. Those who are opposed to these principles are entitled to express their views, however we need to know where they stand and what we can expect from those who administer the NHS and those who serve it.

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Notes

1.	The claim about the number of users of the system in question and the option to migrate to 034 numbers are found on this web page.
2.	My listing of cases from NHS sources can be found from this summary.
3.	The relevant BMA advice to its members is found, underlined beginning with the words “in cases such as this …”, on the second page of this Guidance.
4.	The Department of Health “Further Guidance” on this issue is published here.