NHS GPs are still adopting 084 telephone numbers, 2 years after this was prohibited

From: David Hickson of the Fair Telecoms Campaign - campaigner for the NHS

New regulations were added to the NHS GP contracts in April 2010, prohibiting use of telephone numbers which cost more than an equivalent call to a geographic number.

Except in a few cases, where callers incur sizeable "out of plan" penalty charges for daytime calls to geographic numbers, the 0844 numbers listed below are more expensive. This applies to callers from landlines, mobiles and payphones.

The higher cost is simply explained by the fact that all 084 numbers attract a "revenue share" (paid by the call originating telephone company to the benefit of the user of the number). The amount varies, but in the case of the numbers listed below, it is equivalent to a 4p per minute subsidy being paid by the caller to the person called.

On 27 March 2012, Secretary of State for Health Andrew Lansley confirmed in parliament:

"We have made it very clear that GPs should not be using 0844 numbers".

There are 1,247 surgeries still using these numbers in England and Wales note. They have failed to comply with their contracts, which demand, in effect, that they vary the terms of their arrangements by migrating to the equivalent 034 number. If they wish, they could cancel their existing arrangements altogether, but this is not demanded.

Of perhaps greater concern is the fact that the following NHS GP practices have newly adopted these expensive numbers in the last couple of months:

◊	Handsworth Medical Practice - Handsworth Avenue, Highams Park, London, E4 9PD - 0844 387 8525
◊	Chadwell Heath Health Centre - Ashton Gardens, Chadwell Heath, Romford, Essex RM6 6RT - 0844 387 8044
◊	Knowle House Surgery - 4 Meavy Way, Plymouth, Devon, PL5 3JB - 0844 387 8895
◊	Abbey Dale Medical Centre - 50 Common Edge Road, Blackpool, Lancashire, FY4 5AU - 0844 387 8685

Positions taken on this issue

(see Possible sources for further comment below)

•	Enforcement of the terms of the GP contracts is currently the responsibility of the (shortly to be abolished) Primary Care Trusts.
	Mr Lansley may care to explain how he believes that the ban may be enforced, and why enforcement is not being carried out.
•	The British Medical Association appears to support this form of co-payment - patients subsidising GPs' telephone systems.
	It claims that practices would not be able to afford the cost of their chosen telephone system without this additional financial support from patients.
•	The four numbers listed above in red are assigned to Talk Talk Business. It appears that they have been allocated to a reseller - NEG Ltd (part of the Daisy Group).
	NEG stoutly defends use of these revenue sharing numbers, especially for the provision of "socially important services".

As well as the practices themselves, it would be interesting to know which of the above believe that access to NHS services should continue to be "free at the point of need". It is fair for us to pay our telephone services providers for calls, but incurring a premium to subsidise the costs of the NHS provider is unacceptable and prohibited.

Some may suggest that in the new "patient-centred" English Health Service, patients should pay to subsidise the costs of a GP's telephone system. I campaign for the retention of the NHS in England.

I comment -

Mr Lansley's ongoing reforms are intended to remove central control from the NHS.

If he cannot ensure that its basic principles, which he affirms, are enforced, then we no longer have a NATIONAL Health Service worthy of the name.

See my proposed remedy below.

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Note: The contractual conditions referred to by Mr Lansley apply only to the NHS in England. Identical conditions apply in Wales, where they are enforced by the Local Health Boards.

Possible sources for further comment:

♦	The Department of Health. The Department will be able to clarify the terms of the relevant contractual requirements. Andrew Lansley's office will be able to confirm what he meant by "… should not be using …".
♦	The British Medical Association. Comment may be provided by Dr. Richard Vautrey - Deputy Chairman of the BMA General Practitioners Committee and partner in Meanwood Group Practice, Leeds (0844 477 1799). Each area is served by a Local Medical Committee, representing the interest of local GPs.
♦	Talk Talk. The numbers provided by NEG are on services provided by Talk Talk Business. Talk Talk will be happy to confirm that all of its direct clients are able to migrate from 084 to 034 numbers at any point during the term of their contract, without penalty. If this same facility is not withheld by NEG, then its NHS GP clients are able to utilise it so as to comply with their NHS contractual requirements at a cost which is not unreasonable.
	Talk Talk will also be able to confirm that its residential customers who use their landline for weekday daytime calls are advised to subscribe to its Talk UK Anytime tariff. This charges 13.1p + 6p per minute for calls to the (type "g11") 0844 numbers listed above, as against "zero" for a call of up to one hour to a geographic or 03 number. (Those who subscribe to its Talk UK Evenings and Weekends tariff are penalised for "out of plan" Weekday Daytime calls to geographic numbers at the rate of 13.1p + 7.95p per minute.)
♦	Daisy Group Plc - owners of NEG. Daisy Chief Executive, and "Apprentice" judge, Matt Riley, is ready to defend his company's role in pressing these numbers on GPs and to contradict the view of the Secretary of State. (See this BBC North West Tonight item from 2 August 2011.)
	Mr Riley seems not to understand how the industry works. His broadcast statement could be taken to suggest that Talk Talk, along with all other landline call providers, charge for 0844 calls at "local rates". Nobody has ever done this. Daisy itself charges 6.5p per minute for "type g11" 0844 calls, as against 2p per minute for "local, regional and national" calls (see Daisy Fixed Line Tariffs).
	When he says " we'd only charge a local rate call", Mr Riley fails to suggest under what circumstances Daisy would alter its present charging policy; he is certainly not referring to the situation as it exists.
	The BBC was wrong to suggest that Daisy is in any way a party to the contracts between its GP clients and the NHS. If GPs use information provided by Daisy, it is they who are fully responsible for the accuracy of that information.
♦	Primary Care Trusts. These are now managed on a "Clustered" basis by 50 bodies covering areas of England. Each of the Clusters appears to have adopted a slightly different policy regarding enforcement. In almost all cases this amounts to tolerance of this breach of the principles of the NHS.

My proposed remedy

Where the technical benefits available with "non-geographic" numbers are thought to be cost-effective, these can be provided using 03 numbers - for which calls are charged at the same rate (if any) as calls to geographic numbers in all cases.

03 numbers are not subject to revenue sharing, so GPs choosing to deploy the benefits obtained must meet the full cost of their telephone systems without the benefit of subsidy at the expense of their patients. GPs are funded, from our taxation, to provide NHS services. If they believe this funding to be inadequate, they can argue their case. Whilst the principles of the NHS remain in effect, they cannot be permitted to take money from patients.

For those currently using systems which rely on the features of non-geographic numbers, they must immediately migrate from 084 to the equivalent 034 number. A plan for this can be agreed by the parties. This could include a gesture on the part of Talk Talk Business to relieve some of the costs of using non-geographic numbers.

Parliament to debate 'Use of 084 telephone numbers in the NHS'

Bob Ainsworth MP for Coventry North East will be leading a debate on this topic in Westminster Hall, at 12:30 next Tuesday, 24 January. A government minister will reply.

This will cover the fact that nearly 1,300 NHS GP surgeries in England continue to use these expensive numbers, despite revisions to their contracts which should have brought this to an end by 1 April 2011.

I hope that Mr Ainsworth, and other MPs who may contribute, will stress the need for the government to make the situation clear to all, and in particular to ensure that officers of the Primary Care Trusts fulfil their duties properly by enforcing the terms of the contracts on their GPs.

The key points are as follows:

•	As telephone tariffs stand, there is no 084 number that can be used in the NHS.
	The NHS is universal in its scope and available to all on equal terms. There will always be some who will pay more to call 084 numbers. (See current tariff examples.)
•	GPs tied into long term telephone system arrangements must still comply.
	If necessary, they can change to the 034 equivalent of their 084 number.
	This would mean that they will henceforward incur the full cost of their chosen telephone system, without the benefit of subsidy at the expense of patients.
	The revised contracts demand that they "take reasonable steps" to ensure that patients do not pay more - this step must be considered to be "reasonable".
	Migration to 03 is an option offered by all telephone service providers, including that responsible for most of these cases. (See this note.)
•	The terms of the GP contracts are clear, but are made confusing by those who oppose their intention and purpose.
	Local NHS officers, who have to enforce the terms of the contracts, have not been able to overcome resistance from those who argue that patients should pay some of the costs incurred by GPs and other NHS providers. This is the privatisation of the NHS, which many fear that the government is prepared to tolerate.
	If the government truly believes in the principles of the NHS, now and for the future, then it must intervene to ensure that these principles are fully respected - if necessary, by strong enforcement action against those who continue to breach them.

GPs may be quick to point out that some NHS hospitals and other NHS bodies also use these numbers, in breach of equivalent Directions issued to them. I argue that these bodies are not only in breach, but are making enforcement of similar requirements unnecessarily difficult. (See the list in my blogging - "NHS Bodies in Breach ...".)

At last - HMRC responds to the call to adopt 0345 telephone numbers !!

I wrote to David Gauke, Exchequer Secretary, on 7 June 2010 asking him to review the use of 0845 telephone numbers by HMRC and consider the need to move to 03xx numbers. (See Ministerial briefing - Fees for access to public services by telephone)

Around 18 months later, the necessary action starts. Mr Gauke announced on Wednesday 19 October, in a written answer, that

"HMRC expect that they will, by the end of the year be able to offer an 0345 number for those customers calling its tax credit helpline (which last year accounted for around 40% of the total calls handled by its contact centre network).

"The provision of a 0345 number is expected to result in significant cost savings for the majority of callers to the line."

This long overdue admission that use of 03xx numbers is not only more equitable, but that it does indeed result in cost savings for the majority of callers, is a most satisfying result.

We now look to the DWP agencies, NHS Direct and other misusers of 084x numbers for the provision of public services (not least NHS GPs) to follow this fine example by immediately adopting 034x alternatives for their primary numbers. There are indeed many others (from the 60%) which HMRC should be addressing immediately.

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Points of detail

My specific proposal to use the option of 034x equivalent alternatives to 084x numbers has been widely promoted. See the following items for extended coverage of the arguments:

•    My proposal for those using 084x numbers for the delivery of public services - September 11, 2010.

•    Coverage of the issue by "BBC Five Live Investigates" - September 12, 2010.

•    My evidence to the Commons Treasury Committee investigating HMRC - November 2010.

This matter has been under review by HMRC at least since the time when I was invited to join a working group addressing the matter in August 2010. Representatives of a number of organisations also serving on this group, who themselves use 084 numbers to obtain subsidy from callers, urged HMRC not to change at that time!

HMRC (and others) are not bound to await a new telephony contract to utilise the simple option of migration to the 0345 equivalent of any 0845 number. Any delay is simply playing for time and extending the period during which service users will continue to subsidise the cost of providing the service. All providers of network telephone service permit migration from 084 to 034 equivalent numbers at any time within the term of a contract without penalty.

The only callers who would not enjoy a cost saving on a total move from 0845 to 0345 are those who incur penalty charges from their telephone service provider, generally BT, for calling geographic rate (01/02/03) numbers outside the terms of their selected Call Plan. If it wished, HMRC could retain a 0845 number, as an alternative, for the benefit of those in this perverse position.

A set-back in the position of DWP was reflected in a written answer this week – see DWP allows Work Programme providers to "charge" participants

DWP allows Work Programme providers to "charge" participants

(See the exchange and the additional information provided by my annotation at this item on TheyWorkForYou)

Background

The current scandal of imposing potentially modest charges for access to public services through use of telephone numbers where the charge paid includes "a revenue sharing component" is rife.

The fact that such charges are collected indirectly, often received only as a subsidy to offset costs and sometimes lost amongst the complexity of telephone tariffs makes it easy for them to be hidden.

This applies to all use of 0843, 0844, 0845, 0871, 0872 and 0873 numbers, which are now classified by Ofcom as " Business Rate". New regulations covering their use are expected to be announced by Ofcom early in 2012.

The benefit derived is (roughly) between 2p and 10p per call minute,
whereas the additional cost (over that of a call to a 01/02/03 number) can be over 40p per minute.

There is not even a direct proportionality; calls to 0845 numbers yielding 2p per minute can incur an additional cost (e.g. for T-Mobile contract customers) of 41p per minute.

My campaigning focus, for this issue, is on HMRC, the DWP agencies, NHS Direct, a number of other NHS Bodies and the large number of NHS GPs who are now in breach of their NHS contracts, by using numbers that cost more than the cost of "equivalent calls to a geographical number". These are perhaps the most important cases, but there are many others.

NEWS STORY

The government's position on the issue of charging for access to public services is neatly summarised in a written answer from Chris Grayling, Minister of State - DWP, to a question about whether Work Programme providers are permitted to use 084 / 087 numbers. See Hansard 17 October c644W.

Mr Grayling confirms that, so long as they meet the minimal requirements on call cost declaration (which currently permit the denial of there being any financial benefit to the user of the number), Work Programme providers are permitted to levy a charge on those seeking to move from benefits to work in this way.

My comment

This scandal will continue until the government - probably through the Cabinet Office - gets to grips with the issue. It must clearly determine where it is appropriate to charge users for access to public services and demand that the existence of this charge be declared (notwithstanding the perversity of telephone tariffs, which are outside the control of users).

I await acceptance of my offer to place my understanding and knowledge of this issue at the disposal of the government.

Premium telephone numbers still being used by NHS GPs - 18 months on from the ban and 6 months after the deadline for necessary changes

Please see the briefing issued to MPs, quoted below. Those copied are found, along with the relevant details, on this "league table".

The key story is that, six months after the deadline, little or no action has been taken to enforce the contractual requirement for NHS GPs to cease funding their surgeries at the expense of their patients.

The NHS is owned by us all. It is only through our MPs that we can apply pressure on the Government to, in turn, provide the assistance necessary to officers of the NHS who have the power and duty to enforce its principles. (Clear eyes are needed to watch the speed at which the buck is passed around on this issue!)

If, as is alleged by the BMA, it is the surgery telephone system providers who are, unnecessarily, blocking the action that needs to be taken, then this needs to be brought into the open so that they may account for their unwarranted interference in the operation of the NHS, in public. At present I have no reason to believe that this is the case.

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To: All MPs with constituents who are not being properly served by the NHS

Further to previous briefings on this topic ...

There are NHS GPs in your constituency in breach of their NHS contracts

... according to NHS Choices, they are continuing to use 084 telephone numbers 6 months after the deadline (31 March 2011) for their removal has passed. In some cases, these numbers have been freshly adopted up to 18 months after such adoption was prohibited (April 2010).

Please find your place on this "league table" and review the relevant list for details, or view this map. Other presentations of my list of NHS GPs funded their surgeries at the expense of NHS patients are indexed here.

The problem

Parliament approved the variations to the NHS GP contracts which are being breached [see SI 2010/578: GMS / PMS]. Responsibility to enforce compliance rests exclusively with the 50 Chief Executives of the clustered Primary Care Trusts.

Many PCTs have failed to act in the interests of the patients they serve, because they claim to have had difficulty in understanding the clearly and explicitly drafted regulations. They are seen to have commonly relied on guidance issued by the BMA GPC - representing the (conflicting) interests of the GP contractors – which offers a very particular interpretation.

At the beginning of this guidance, the BMA declares its continuing opposition to the purpose of the regulations, repeating its proposal that patients should pay more to subsidise the costs incurred by GPs with improved telephone systems (contrary to the principles of the NHS)! This proposal was specifically rejected. The Guidance goes on to outline a wholly unsatisfactory approach to application of the new requirements - use of a meaningless and demonstrably mistaken assurance about call costs from a highly interested but unaccountable party as representing proof of compliance. (Some may say that it would be natural to seek to undermine effective implementation of a measure which one openly opposes!)

Since spring of this year, PCTs have been seeking assistance from the Department of Health, but this has not been provided, despite a request to the Minister from Andrew Love [Hansard 12 July 2011 Col 150].

The unequivocal statement of clarification, given only to the House in response, is seen to have been ignored by PCTs. It may be noted that the BMA immediately issued a statement suggesting that the Minister's statement was untrue [see "Guidance for practices using 084 numbers" on p7 of this BMA GPC newsletter].

Action to resolve the matter

For the sake of the integrity of the NHS and in the interests of your constituents, I must suggest that you urge your local PCT to address this matter properly, by enforcing the terms of the contracts as drafted, not as interpreted by the BMA and others.

I also believe that it would be of benefit to urge the Secretary of State for Health, and / or whichever Minister now holds the relevant brief, to instruct Department of Health officials to ensure that PCTs have all of the assistance that they need to use their powers to enforce the existing contracts, and to require officials to ensure that this is being done.

The Department of Health may not be able to direct PCTs, however it should be able to respond to requests for assistance. It should also be able to deny false assertions that have been made about its own position, including alleged endorsement of a particular system - unless the allegations are true [see this copy of a widely used letter]. The system in question is proudly "co-funded" by patients [see references to co-funding, as well as "co-founding", on this site]. Many PCTs have been provided with copies of this letter and may be inclined to treat it in good faith!

Ministers may be asked to report to parliament on the successful (or otherwise) implementation of measures approved by parliament. The principle of "free at the point of need" is far from secure in the NHS, as a loosening of control is proposed.

(I note that the ministerial team will be answering Oral Questions on Tuesday 18 October.)

The resistance by GPs

Some practices claim that patients do not pay more to call their 084 number than to make an equivalent call to a geographic number. This claim is based on the absurd assumption that all patients have a landline phone and subscribe to a particular BT Call Plan, which BT now declares is no longer even its most popular.

Such a claim is clearly false (except where evidence has been produced to show that all patients of a practice do indeed subscribe to one particular unusual telephone tariff and never call the surgery from mobiles, payphones or under the terms of other landline tariffs, including that which is most popular for BT customers).

Other practices claim that they cannot vary their existing arrangement for telephone service, because this would allegedly cause them to incur “unreasonable” penalty charges. Those who are contractually committed to maintain a system which requires a non-geographic number may readily comply by migrating to a 03 number. It is standard practice for network telephone service providers to allow such migration at any time and without penalty. I have been assured by the leading provider of surgery telephone systems that it would not deviate from this principle by blocking a request to migrate from 084 to 03.

There is no evidence to show that some network telephone service providers fail to follow industry standard policy, by not permitting migration to 03 without penalty. If such evidence were to be produced, then the provider in question would need to be subjected to some very serious questions, as it would be seen to be responsible for impeding proper application of the principles of the NHS.

Despite my repeated briefings to PCTs on this subject, they appear to be more ready to follow the guidance offered by the BMA, as the representative of those holding the contracts which are being breached, than to make their own determinations. As an analogy, I am inclined to think of a branch office of a major firm following national guidance on employment policy that is presented by a trades union - the "head office of the firm" must act directly to address this!

I would be delighted to provide all necessary further references, additional explanation, examples of specific cases and information on points of detail. There are a number of relevant briefings on my "NHS Patient" blog.

Conservative Health Minister repeats Labour mistakes by not banning expensive GP telephone numbers

In a written parliamentary answer Simon Burns, Minister of State (Health), shows that he is repeating a key mistake made by his predecessor.

When referring to what should be a total ban on use of 0844 and 0845 numbers for delivery of NHS services, in effect by 31 March 2011, he says:

"Organisations remain free to use non-geographical number ranges such as 084, providing that patients are not charged more than the equivalent cost of calling a geographical number to do so."

This is mindless repetition of nonsense issued by the previous government. ALL 084 NUMBERS ARE MORE EXPENSIVE – there are no exceptions.

(The same mistake has already been repeated by the Welsh government and there are fears that Scotland may also follow.)

All calls to 0844 and 0845 numbers, at what is now known as "Business Rate", are subject to a "Service Charge" - a premium which is paid on to the telephone company at the receiving end of the call. The premium is used to subsidise the cost of the telephone service provided, or paid over as a "cash-back". This applies to every 0844 and 0845 number. Charges for calls to Geographic Rate (01/02/03) numbers do not include this premium.

This means that for all calls from Virgin Media landlines, all PAYG and contract mobiles and public payphones every call to a 084 number is charged at "more than the equivalent cost of calling a geographical number". Unless it could be shown that calls from these sources are blocked, then 084 numbers cannot be used.

I continue with more briefing, concluding with my Message to Mr Burns.

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Calls from BT landlines - why they are different

BT landlines are seen to be omitted from the list of sources given above. BT landline call charges are currently subject to special regulations intended to prohibit BT from making any money out of calls to 084 and other "Business Rate" and "Premium Rate" numbers. BT is however now free to charge whatever it wishes for calls to "Geographic Rate" numbers. This makes the situation for BT landline callers more complex.

Like other providers BT provides calls to "Geographic Rate" numbers through inclusive packages, imposing a penalty charge for calls made to these numbers outside the terms of the package. For weekday daytime calls, the BT out of package penalty charge rate for calling Geographic Rate numbers is greater than the level of the "Service Charges" that apply to calls to 084 numbers.

Patients who incur the BT penalty charge for making calls to Geographic Rate numbers outside the terms of their Call Plan therefore would not pay more to call any 084 number. This is the exceptional case - it has got nothing to do with particular 084 numbers – it applies to all of them.

The situation is further confused by the fact that because the Service Charge for calls to 0845 number is relatively low (around 2p per minute, rather than up to 5p per minute for 0844) BT can get away with recovering this money through its fees for Call Plans and therefore makes 0845 calls inclusive. BT landline users therefore do not pay more to call 0845 numbers under the conditions imposed by present regulations. This additional confusion does not apply to calls to 0844 numbers, BT landline customers who do not breach the terms of their Call Plan will always pay more to call 0844 numbers.

Although not compelled to do so by regulation, there are some other telephone companies offering calls through BT lines who are able to copy the BT approach to charging.

The big mistake

The attempt to address the problem with use of Business Rate numbers for access to the NHS was sadly made in apparent ignorance of how telephone tariffs apply through the UK – there are no local variations. The new government is continuing to apply this ignorant approach to implementation of rules which are sound if applied properly.

The exceptional cases where callers do not suffer the impact of the Service Charge on calls to 084 numbers, relative to the cost of calling geographic numbers, have got nothing to do with the particular number they are calling, but with their choice of telephone service provider. Due to unique regulation, BT is the exception to the general rule – it is BT rates that vary from the norm. It is because some BT charges are regulated, whereas others are not, that one has the situation where a call that includes a Service Charge is cheaper than one which does not!

I am not aware of any sponsorship deal between BT and the NHS! NHS patients are no longer required to have BT landlines in order to access NHS services by telephone – even if the situation was different 62 years ago.

Virgin Media provides rental free (inclusive) lines to those who subscribe to its cable TV or Broadband service. Many are unable to afford landlines, or may not be at home at times when they need to contact the NHS - they would therefore use mobiles or public payphones. 75% of non-business telephone calls are NOT originated by BT.

BT currently originates less than 25% of non-business telephone calls. Ofcom is therefore consulting on proposals (supported by BT) to implement the long-overdue removal of the remaining restriction on its charges. This currently creates the perverse effect of encouraging use of premium rate numbers and offers the potential for misrepresentation of the relative cost of calling them.

This is linked in with other proposals for making the cost of calling 084, and other ranges that include a Service Charge, clearer. Under the terms of these proposals GPs would have to make the following statement wherever they gave their 0844 number:

"Calls to the surgery cost 5p per minute plus your phone company's access charge."

There is no good reason why such a statement could not be made today. The difficulty is that the phone company "access charges" vary enormously, even within tariffs, with BT compelled to have an access charge of 0 pence per minute. This issue is also addressed by the Ofcom proposals.

If these proposals come into effect in perhaps one or two years time, I wonder if this issue will be seen as insignificant alongside other provider-set charges for access to NHS services!

My message to Mr Burns

Your suggestion that there may be 084 numbers that are not more expensive to call than geographic numbers is FALSE.

If the government is committed to maintain access to NHS services "free at the point of need", then the ban on use of 084 numbers must be implemented NOW.

NHS bodies should have stopped using them by 21 December 2010, GPs have until 31 March 2011. Users of 084 numbers may migrate to the equivalent 034 (Geographic Rate) number within the term of a contract for telephone service - so there can be no excuse for failing to comply.

Whilst it would be absurd for a complete number change for 0845 4647 to be implemented at present, it seems rather greedy of NHS Direct not to formally, but quietly, offer the 0345 4647 alternative for those who could thereby save up to £3.70 (58p on average) on an average duration call, even though this would cost NHS Direct 15p per average call in lost subsidy. A bonus of 43p per average call is a generous gift to the telephone companies. (The NHS Direct NHS Trust also operates many other 0845 telephone numbers, which were excluded from the ban for no apparent reason.)

N.B. The above text includes some drafting revisions from the circulated version of this release.