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Tuesday, 7 September 2010

Millions Fail to Get Through to Local GPs - Millions Pay their NHS GP for Telephone Access

Network Europe Group has just released research "Millions Fail to Get Through to Local GPs" (pdf) which suggests that 20 Million patient calls to GPs receive engaged tone, whilst 5 Million always join a queue as a result of calling the expensive 0844 numbers it uses for its "Surgery Line" system.

Because 0844 numbers are "revenue sharing", "revolutionary co-funded" is the term preferred by NEG, the additional cost of the queuing facility is indirectly paid for by callers, through the additional (premium) rate that their telephone company charges them for these calls. note 1

Under their revised NHS contracts, GPs are required, by 31 March 2011, to only use numbers that "cost no more than equivalent calls to a geographic number" (see clause 29B). 0844 numbers cannot possibly meet this requirement. note 2

03 numbers offer all the same enhanced facilities available with 0844 numbers. Users can migrate from a 0844 number to the equivalent 0344 number within the term of their contract for telephone service. note 3

03 numbers are required by regulation to be (indeed, they are in practice) charged at the same rate as equivalent calls to a geographic number. This applies to calls from all landlines, mobiles and payphones, including the terms of inclusive packages.

NEG and Talk Talk have less than 7 months left in which to assist their customers in migrating from 0844 to 0344 numbers.

If NEG believes that patients, rather than GPs (funded by the NHS), should continue to pay for enhanced telephone facilities in GP surgeries, then it is free to oppose the position of the government, which maintains that the NHS should remain “free at the point of need”. It must however declare its commercial interest if it wishes to participate in this type of political debate. It would also be helpful if NEG ceased commenting on the charges levied by telephone companies over which it has no control and of which it apparently has little knowledge.

Additional points

I have to thank EHI Primary Care for drawing my attention to the NEG announcement – see “Call to add 0345 to NHS Direct-111 mix”. This wide-ranging article also highlights my involvement in the broader aspects of this issue, i.e. NHS bodies as well as contractors.

There are many figures in the NEG release which are not fully explained, are misleading and are therefore difficult to counter. I will not attempt to engage with unsubstantiated assertions for which I have no contrary evidence, no matter how bizarre (e.g. the implied assertion that 93% of calls to GP surgeries without Surgery Line result in an engaged tone). I can however state with confidence that the assertion of the “Surgery Line” system meeting the requirement of calls being no more costly than equivalent calls to a geographic number is simply nonsense. It is the telephone number, not the system, which is at issue. If, as is the case with Surgery Line, a 0844 number is used, then calls are more costly for at least some callers, so the requirement is not met. note 2

NEG has no control over how originating telephone companies obtain the money to provide the revenue share from which it and its customers benefit by using 0844 numbers. They naturally raise it from their customers through premium charges. Even though BT alone is regulated in what it can charge, it cannot afford to include 0844 calls in Call Plans. The ignorance of telephone charges demonstrated by NEG is quite disturbing. It appears even to be unaware that its own partner Talk Talk invariably charges its customers more to call the 0844 numbers that it uses, than for equivalent calls to geographic numbers.


I suggest other possible sources of comment [in red].

1.     It is important to understand that not only do Surgery Line callers pay whilst queuing; the whole call is subject to an additional charge to pay for the provision of the queuing facility. The revenue share also subsidises many other aspects of the surgery telephone facility, including the switchboard, handsets etc. [NEG will doubtless be happy to explain the statement “With your own 084 number, you keep about 2p from every call to re-invest in your practice”, which appears throughout its marketing literature. (The total value of the revenue share is around 4p per minute.)]

2.     BT alone is regulated in what it may charge for calls to 0844 numbers, so these are relatively cheap for those without a BT call plan (from which they are excluded). All other telephone users incur the cost of the subsidy from which the GP using a 0844 number benefits. NEG has issued an assurance about call costs, however this applies only to GPs who only serve patients without mobiles, without landline service from anyone other than BT, without a BT call plan and who never use public payphones. I have no figures, but I doubt that there are many GPs in this position. [The Department of Health appears to believe that there are many such GPs, as it leaves them to determine whether or not patients will pay more to call 084 numbers. It may wish to offer evidence to support this assertion.]

3.     Equivalent 034 numbers were reserved for users of 084 numbers when they were introduced. Telephone service providers will be happy to confirm that they support migration and that this may be achieved within the term of an existing service contract. [The Talk Talk Group, which provides the telephone service used by NEG customers will doubtless confirm that it shares this industry-wide policy. I suspect that, given its longstanding involvement in this scandal and its public reputation, Talk Talk will be especially keen to do all it can to assist its NHS customers.]

4.     NEG and the GP Committee of the BMA are at one on this issue. The latter states its policy as being that patients should pay providers for access to NHS services according to the quality of the service provided (see its Guidance Note, which also contains some misleading information). [The BMA may wish to confirm its policy on NHS charges, given proposals for GPs to have a more central role in managing NHS services.]

5.     In its recent media release, NEG urges the government, in effect, to compel NHS GPs to introduce charges for access to their services by telephone. Whilst this source of NHS funding may be attractive to the government, it has not yet presented any such proposal for sanction by parliament (as required under the NHS Constitution), nor is the topic even mentioned in the Health White Paper. [The Government may wish to confirm that it has no plans to reverse current regulations, so as to allow NHS providers to indirectly charge patients for access to NHS services through use of revenue sharing or premium rate telephone numbers.]

6.     Call queuing (to a reasonable level) does not necessarily require use of the enhanced facilities available on non-geographic numbers. If these expensive facilities are required (as in the case of Surgery Line), then they must be provided using 03 numbers, unless the cost of the extra facilities should properly be carried by the caller. [Many telephone service providers offer systems to GPs which enable queuing of calls at busy times without requiring the expense of the highly advanced features available on non-geographic numbers.]

7.     I hope that NEG will now openly declare its position regarding who should pay for the enhanced facilities that it commends. The NEG release would have had more credibility if it had made reference to how it is assisting its customers to comply with the current revisions to their contract. An explanation of why this was being left to the last minute, given the approach of the March 2011 deadline, would have perhaps been informative. [NEG may wish to comment on this omission, or perhaps on its efforts to get the new government to remove the requirement to cease using expensive numbers before its customers fall into a breach of their NHS contracts.]

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