David Hickson's Media Releases

My recent bloggings

Monday, 31 January 2011

New "rules" for when to make Silent Calls (is this a joke?)

To follow this briefing, I react to Ofcom's news release - Ofcom warns industry as new silent calls rules come into force.

The point about the “warning” is that Ofcom is asking Silent Callers to comply with rules about how many Silent Calls they make and when they make them.

Ofcom is not saying that habitually hanging up in silence is unacceptable.

Not one of the 9,000 complaints to Ofcom from citizens receiving Silent Calls in 2010, nor of the 6,600 received in 2009, enabled Ofcom to identify even one company that was breaking its rules. 22 unnamed companies have been investigated – not one was found to be practising “persistent misuse of an electronic communications network or service”.

The new rules that will be applied from tomorrow add tolerance of one Silent Call per caller per recipient per day, when obsolete technology designed to detect the clicks and whirrs of a mechanical answering machine mistakes a person for a machine.

This newly formalised tolerance of use of Answering Machine Detection fails to address the fact that every call when this is used begins with a possibly lengthy period of silence, whilst the technology samples and analyses your voice to see if you sound like a machine. Even though an agent was eventually going to speak, many assume these to be Silent Calls.

The existing tolerance of up to 3 in every 100 calls resulting in silence if no agent is available to handle an answered call that has been dialled automatically remains. Ofcom has a "guideline" that such calls should be handled by a live message announcing the name of the caller and apologising for the error, but this is not applied as an absolute requirement.

Rather than using its powers to act whenever it is made aware of a "persistent misuse of an electronic communications network or service", Ofcom fudges the issue by pretending to have regulatory powers and showing a tolerance (albeit qualified) of Silent Calls.

Silent Calls are unnecessary and unacceptable; Ofcom's policy is unacceptable.

Saturday, 29 January 2011

New Ofcom "rules" for Silent Callers - Tuesday 1 February


On Tuesday 1 February, Ofcom implements revisions to its policy on when it may take action against Silent Callers.

Ofcom already disregards cases where up to 3% of automatically dialled calls result in silence if no agent is available to handle an answered call.

From Tuesday it will increase its tolerance of Silent Calls by applying formal approval of the use of equipment that imposes a period of Silence at the beginning of every call and then commonly hangs up in the mistaken belief that a person is an answering machine.

What Ofcom calls its "new rules to ban repeat Silent Calls", permit the first Silent Call and then suggest that further Silent Calls from that caller be deferred until the next day. Ofcom may be expected to emphasise the latter element, which qualifies this weakening of its policy.

In 2006, Ofcom was told by parliament - "we expect you to use your powers to eradicate the nuisance of Silent Calls".

Many reputable companies, including BT and British Gas, proudly admit to making Silent Calls within the terms of the Ofcom policy.

Ofcom's Powers

Ofcom has powers to Notify, Regulate and Penalise specific organisations that commit a "persistent misuse of a communications network or service".

Most of us would regard the habitual practice of hanging up in Silence when calls are answered as a persistent misuse of the public telephone network.

Ofcom has a policy for its use of these powers which specifically rejects this view.

Silent Calls (Type 1)

Ofcom has long applied a policy which treats hanging up in Silence as acceptable if the person responsible makes 33 times as many other calls as they make Silent Calls on any day. This applies to the situation where there is no agent is available to deal with an automatically dialled call that is answered.

This policy has meant that not one of around 20,000 complaints received since Ofcom last used its powers in October 2008 has resulted in Ofcom even issuing a Notification of Persistent Misuse, let alone imposing enforceable regulations or a financial penalty. If not one complaint covered what Ofcom regards as persistent misuse, it is reasonable to assume that all those who are making Silent Calls are doing so with Ofcom's consent.

Probably a more common cause of Silent Calls is where a call centre uses technology designed to detect the clicks and whirrs of a mechanical answering machine (known as AMD). This is what is addressed by the revisions to the policy.

Silent Calls (Type 2)

Use of AMD causes the call to be Silent from the beginning, whilst the technology (not the calling agent) listens to the voice of the person answering. It then analyses the sound in the hope of being able to tell the difference between a live and recorded voice. Many who answer the phone and hear no immediate response to their greeting naturally assume that the caller will remain Silent and hang up.

Ofcom does not even regard this situation as representing a Silent Call!

Ofcom approves and encourages use of the technology that causes it. Ofcom argues that this nuisance is in the public interest because the cost savings achieved are passed on in lower prices!

Because there is no definitive way of detecting use of an answering service by analysing what is said, it is common for the AMD technology to make a mistake. Agents are commonly connected to answering services, wasting their time.

Accurate detection rates are improved by using a longer sample, but even the shortest pause before the caller speaks is likely to result in this type of Silent Call. The longer the pause, the more likely it is.

Silent Calls (Type 3)

Where the technology mistakes a person for a machine the period of Silence is concluded by the caller hanging up.

Ofcom now acknowledges that this happens and has consequently revised its policy.

The new policy is for Ofcom to disregard cases where a caller does this only once per day to any person.

The 3% limit for the "no agent available" situation (see above) considers all calls made regardless of who they are to. This could include many calls to the same person.

The new rules only cover the practice of calling to the same person again on the same day after thinking a machine has answered. This will now be regarded as "persistent misuse".

Ofcom does not regard repeating a Silent Call on another day as a "repeat Silent Call".

My conclusion

(In fairness, I must point out that Ofcom’s policy includes consideration of mitigating factors including use of the Informative Message and repetition. These are however only factors that feature in consideration of the severity of the action that is taken – they do not feature is in the vital determination of what is and is not “persistent misuse”.)

Ofcom's position is complete nonsense and represents a neglect of its statutory duty to citizens.

The point about the Silent Call is that the caller fails to respect the basic courtesy required when making a voice telephone call - when someone answers your call you say who you are and why you are calling. Any habitual or systemic failure to follow this practice must be regarded as "persistent misuse".

Ofcom has powers to deal with particular cases of persistent misuse that come to its attention; it has no statutory powers to regulate the activities of call centres in general. In the telecoms area, Ofcom’s regulatory powers only cover providers in the market for telecommunications services. (Part of its timidity in using the persistent misuse powers could be due to the lack of legal support for the light-touch regulatory approach that Ofcom likes to follow in all of its activities.)

By its failure to use its powers and its adoption of a para-regulatory approach, Ofcom has effectively advised call centres that habitually hanging up in silence can be acceptable. Most reputable organisations follow Ofcom's guidance, making the Silent Calls that we are suffering from within the limits that Ofcom sets.

In 2009 Ofcom received reports of 100,000 instances of Silent Calls made by identified callers. It has allegedly investigated 22 of these companies and found not one to be breaching its "rules". After receiving 6,600 complaints about Silent Calls in 2009, Ofcom received around 10,000 in 2010.

This is the clearest evidence we have that the Silent Calls which plague us are all approved by Ofcom - which should be fulfilling the expectations of parliament - "we expect you to use your powers to eradicate the nuisance of Silent Calls."

The solution for the Call Centre Industry

Contrary to what Ofcom is prepared to accept - Silent Calls are unnecessary.

Avoiding "Type 1" Silent Calls

If no agent is available to handle an automatically dialled call that is answered, the obligation for the caller to state their name can be fulfilled by use of a recorded "Informative Message". A simple message giving the name of the caller and apologising for not being able to complete the call is exceptionally permitted under these particular circumstances. Recorded message calls are generally prohibited, primarily under specific statutory regulations, (which should be) enforced by the Office of the Information Commissioner.

This generous gesture in recognition of the needs of the call centre industry for the use of predictive diallers should be acknowledged, as the alternative would have to be a ban on the use of such technology.

Those callers who are (or claim to be) unable to identify themselves immediately when a call is answered have to accept that they must therefore always be ready to conduct a conversation in person. If machinery cannot complete the call, then an agent must always attend. The wording of the Informative Message should be thought of as being the response to the request "Who is calling, please?". One has to wonder who can approach making a telephone call if unable to answer that question!

Avoiding "Type 2 and 3" Silent Calls

If callers wish to avoid an agent being connected to an answering service, they should be using Answering Service Detection technology. This technique detects a "beep" issued by the answering service when it takes a call. This is best suited to network based answering services but may be used on locally connected machines also.

In its consideration of the issue of AMD, Ofcom totally dismissed this alternative, which accepts the reality of the current situation. Network based answering services have always been used for mobile phones and are now commonly used with landlines. Digital answering machines are now more common than the tape based mechanical machines for which Answering Machine Detection technology was designed.

It is quite extraordinary for Ofcom to dismiss ASD, preferring the obsolete AMD and even encouraging its use, despite the inevitability of it causing Silent Calls in TWO ways.

From 1 February 2011, along with a continuing qualified tolerance of "type 1" Silent Calls, that will be the official policy of the public body with a primary principal duty "to further the interests of citizens with regard to communications matters".

My efforts to cause Ofcom to be called to account before parliament will continue.

DWP claims no benefit from use of expensive telephone numbers - it could therefore save callers a fortune at no cost to the taxpayer

DWP agencies such as JobCentre Plus and the Pension Disability & Carers Service use non-geographic telephone numbers to provide a better service to callers making enquiries about their benefits and other services.

All of these are currently "Business Rate" 0845 numbers, which are charged to callers at premium rates (see below). Normally this premium is used to provide a subsidy to the organisation using the number.

In a written answer on 25 January Chris Grayling, Minister of State at DWP, confirms that there are "no savings from the use of non-geographical telephone numbers".

There is therefore no good reason why the DWP could not migrate immediately to the use of "Geographic Rate" non-geographic 03 numbers, which impose no "Service Charge" on callers. This could be done most readily by initially offering the equivalent 0345 number for every 0845 number as an alternative. This would avoid the need to change existing publicity - callers could simply be invited to substitute a "3" for the first "8" in the number to save money on their call.

If there are no savings from use of 0845 numbers, then clearly it would not cost the DWP any more to use 03 numbers. (That is the only logical meaning that can be applied to the statement from Mr Grayling! - if one assumes that it is accurate and truthful)

If the DWP honours its promise to always call back to those who pay more to call a 0845 number, then it is likely that the 0845 numbers actually end up costing the DWP and the taxpayer (as well as the service user) more, rather than simply offering no saving.

The DWP gave up a revenue share benefit of £500,000 per annum in 2008 (see this written answer), but did so without changing its numbers, so this was of no benefit to callers.

The long overdue switch to 03 numbers must be implemented immediately.

The cost of calling (0845 vs. 03)

The following table shows what it costs users of common telephone services to make average duration calls of 4 minutes to DWP agencies on 0845 numbers. Typical call durations (charges are generally rounded up to the next minute) are given in this written answer. The rates used are from current published tariffs, based on information assembled by Ofcom.


4 minute call cost



Business Rate

03 (01/02)

Geographic rate




Assuming compliance with the terms of the call plan (penalty charges are otherwise incurred on 01/02/03 calls)







Talk Talk



Sky Talk






Assuming a package that allows for landline calls (penalty charges are otherwise incurred on 01/02/03 calls)



















01/02/03 call rates are commonly lower where a top-up package is acquired
















Public Payphone




The DWP telephone service providers receive a benefit of around 8p per 4 minute call to a 0845 number. Normally this would be used to offset the cost of the facilities provided, however Mr Grayling is adamant that no such saving is being made.

The higher premiums charged to callers are explained by the administrative cost of passing on this charge and competition to offer the best rates for normal geographic calls.

The DWP is to be commended for its decision to pay for calls from mobile phones, as well as landlines, to its 0800 numbers, which are used for initial claims. It is quite extraordinary that such an exceptional move was not matched by the much simpler, and apparently cost free, action of adopting 03 numbers for enquiries.

It may however be noted from the table that paying to receive calls by using 0800 numbers, as against using 03 numbers, is only generally of benefit to those with PAYG mobiles. For landlines and contract mobile phones, it is only those with who rarely make calls to Geographic Rate numbers who pay call charges for them. The DWP could have probably saved the taxpayer an enormous sum by adopting 03 numbers throughout and making arrangements to pay only for PAYG calls from mobiles. The only callers who would have been disadvantaged by such an arrangement would have been those who incur penalty charges for calling outside the terms of their contract.

Thursday, 27 January 2011

The Department of Health is NOT implementing a contractual ban on use of expensive telephone numbers by GPs - according to the Health Minister

In the course of changes to the NHS, the government is reluctant to impose regulatory constraints on GPs. This apparently includes neglecting enforcement of a contractual requirement to adhere to the principle of not charging patients for access to NHS services!

Changes to the GMS contract were introduced in April 2010 to prohibit use of telephone numbers that cost more than "Geographic Rate" (see clause 29B of the GMS contract). Many NHS GPs continue to use "Business Rate" 0845 and 0844 numbers as the deadline for compliance (31 March 2011) approaches.

I have been pressing Simon Burns, the Minister, to take strong action to ensure that Primary Care Trusts rigidly enforce the terms of this contract revision.

I now have an answer ...

In his response to a parliamentary question on the subject, Mr Burns makes no reference to the changes to the GP contract, referring only to Directions to NHS bodies, which came into force on 21 December 2010. He even uses the term "guidance" when referring to action necessary to protect the fundamental principles of the NHS!

This serves to confirm my fear that "liberating the NHS" means freeing GPs from the obligation not to charge patients for access to NHS services. If existing contractual provisions are not to be enforced, there can be no assurance that further "liberation" will not open up greater opportunities to obtain funding for NHS services from patients, as they access them.

It may be noted that the Directions to NHS Bodies have not been enforced, as many continue to use expensive telephone numbers - e.g.
Northumberland, Tyne and Wear NHS Trust - 0844 811 5522;
Northumbria Healthcare NHS Trust - 0844 811 8111;
North East London NHS Foundation Trust - 0844 600 1200;
Gloucestershire Hospitals NHS Foundation Trust - 08454 222 222;
Gloucestershire Primary Care Trust - 08454 221500.

NHS Direct refuses to offer 0345 4647 (which is setup and ready to use) as an alternative to 0845 4647 for remainder of its life in England - it will continue in Wales. NHS Direct has also taken advantage of an exemption from the terms of the Directions to retain very many 0845 numbers for the Out of Hours GP and other contact services that it provides to a very large number of PCTs.

It should also be noted that access to NHS Dentistry, Pharmacy and Ophthalmology services is not covered by the (supposed) prohibition on use of expensive telephone numbers.

Wednesday, 19 January 2011

The principles of the NHS - challenged now - will this get worse or better?

I respond to the speech on the principles of public service by the Prime Minister on Monday and anticipate reaction to the publication of the Health and Social Care Bill today.

Now is the time for the Government to demonstrate that the principle of the National Health Service being delivered without charge to patients is to be retained and that National principles can only be enforced by clear action from the National government.

If this cannot be achieved now, then will giving GPs more “freedom from central control” make it easier?

Many GPs are part-funding their services through use of "Business Rate" 0844 telephone numbers, which cause a "Service Charge" of 5p per minute to be imposed on patients who call these expensive numbers. This Service Charge is to the benefit of the person called and their telephone service provider. In a current consultation, Ofcom confirms that this is the current position (for all 084 numbers) and proposes that this Service Charge should be declared wherever the telephone number is stated, i.e.

"Calls to the surgery on 0844 xxx xxxx cost 5p per minute plus your telephone company's Access Charge".

If, as he said, the Prime Minister wishes for the delivery of public services to be "more transparent", then those who choose to impose Service Charges, through use of Business Rate telephone numbers, should be using such statements now, without waiting to be required to do so by new regulations. (The same applies to all other public service providers using Business Rate numbers – e.g. NHS Direct, HMRC and DWP agencies.)

If, however, access to NHS services is to be "free to all who need it", as promised by the Prime Minister, then use of Business Rate 084 telephone numbers MUST BE PROHIBITED. (In truth, if transparency was to be applied then use of these numbers would most likely not be sustained anyway! It is only because of public misunderstanding that they are tolerated, with the blame being wrongly placed on telephone companies!)

As a result of contract changes introduced in 2010, NHS GPs have to cease their use of 0844 numbers by 31 March 2011. The terms of the contract however fail to make this explicit, leaving each practice to make the necessary determination.

The BMA believes that patients should pay for access to NHS services according to the quality of service delivered and therefore advises its members to retain these expensive numbers to fund their activities at the expense of patients. To evade the terms of the contract revisions the BMA encourages its members to exploit the current public confusion about telephone charges by falsely claiming that their Business Rate numbers are not more expensive to call than Geographic Rate numbers. (These comments are derived from published guidance.)

Observations and specific enquiries show that these false claims are being granted credence by many PCTs.

If this abuse and lack of control is able to occur under the current regime, then one must fear for the protection of the principles of the NHS if GPs are to be given yet more "freedom from central control", as proposed by the Prime Minister.

However strong its commitment to public service, any private body (such as a GP practice) has a primary financial duty to its owners and shareholders, which demands that it exploits every permitted opportunity to derive income from service users. It is the absence of such a distinct duty from public bodies which causes users to see a difference in who is delivering a public service.

The Prime Minister confirmed on Monday that the government is "in no way abrogating" its responsibility to ensure that "the rights of [public service] users are maintained". If that is to be proved, then the government must take action to affirm this responsibility NOW.

ealth HEalth I invite all those concerned for the principles of "our NHS" to join me in calling on the Secretary of State for Health and his ministers to demand that all Business Rate 084 telephone numbers be removed from the NHS immediately.

Alleged technical or contractual difficulties are spurious. Arrangements for migration from 084 to the equivalent 034 number could be made swiftly and undertaken within the term of existing contracts for telephone service. Where, as in the case of NHS Direct, the cost and confusion of complete removal of a 084 number would be inappropriate, the Geographic Rate equivalent (e.g. 0345 4647) could operate in parallel with the Business Rate (e.g. 0845 4647) number.

The Prime Minister was very clear in stating that the fundamental principles of the NHS must not be diluted by the proposed "modernisation" - LET US SEE HOW TRUE THAT IS.

(Telephone access to other public services, e.g. those provided by HMRC and DWP agencies, is also not "free to all who need it" as they too use Business Rate 084 telephone numbers. As the Prime Minister is not yet proposing that these agencies be granted "freedom from central control", there can be no doubt about where the responsibility for this breach of the principles of public service lies!)

Sunday, 9 January 2011

MPs recruited to fight to eliminate NHS telephone service charges

As Pathfinder GP Consortia stand ready to take over the NHS from public bodies and parliament prepares to debate a NHS (Abolition?) Bill, I seek to recruit MPs to defend the principles of the NHS on behalf of their constituents and all other citizens. (See my message.)

A change to the GP contract was introduced last year, giving GPs 12 months in which to cease use of what are now known as "Business Rate" telephone numbers. Ofcom is currently consulting on proposals which would require all users of 084 telephone numbers to advise the Service Charge incurred by callers e.g.

"Calls to the Surgery are charged at 5p per minute plus your telephone company's Access Charge."

Under the terms of their revised contract NHS GPs have until 31 March 2011 to cease use of telephone numbers that are more expensive to call than a Geographic Rate number, which cannot cause a Service Charge to be incurred. Network telephone service providers enable their customers to migrate from Business Rate 084 numbers to the equivalent Geographic Rate 034 number within the term of their contract for network telephone service, so no major disruption is demanded. One would therefore think that is was a quite straightforward matter for the principle that NHS services are provided without charge to the patient to be re-asserted in practice.

The BMA GPC opposes the principles of the NHS

The General Practitioners Committee of the BMA declares a policy position stating that patients should pay for improved NHS services according to the quality of service provided. It therefore supports use of Business Rate numbers by NHS GPs. As this view was not shared by the (previous) government when it introduced the GP contract revisions, the BMA has sought to undermine their implementation. Working with the primary provider of surgery telephone systems partially funded through Service Charges paid by patients, the BMA has urged its members to utilise a false assurance from this company that Business Rate telephone numbers are not more expensive than Geographic Rate numbers.

This assurance is of course untrue, however there are some cases where landline callers subscribe to a tariff that is based on normal calls being inclusive. They therefore incur a Penalty charge for calling a Geographic Rate number outside the terms of their Call Plan. This Penalty Charge can be greater than the cost of calling a Business Rate number, which is never included in their Call Plan. This perverse effect is a feature of some caller's telephone tariffs and it results from legacy regulation of BT, which Ofcom now proposes to belatedly remove.

This effect has nothing whatsoever to do with the alleged capability of any GP or their telephone company to set a generally low rate for callers – there is no such facility, they can only determine the scale of the premium “Service Charge”. Unfortunately the Department of Health has allowed itself to be misled on this point, into the false assumption that some 084 numbers are not more expensive than Geographic Rate numbers, when this situation can only occur when patients select an inappropriate landline tariff from some telephone companies.

The Department of Health stands back

The Department of Health has refused to acknowledge its error, taking a neutral stance by resting on the fact that if the terms of the contract revision are applied correctly then use of expensive numbers must be ceased. As the terms of the requirement are explicitly based on a false assumption and a false basis for compliance is being recommended to contractors, proper application will not come easily. It is clearly seen that in the nine months which have passed only a handful of the 1000 or so GPs have changed away from their 084 numbers, or intend to do so.

(A similar effect was seen with NHS bodies, who were subjected to the same requirement with a deadline of 21 December 2010. A number of Hospitals and PCTs continue to use 084 numbers in breach of Directions that they should cease the practice. Most notable is NHS Direct, which has the 0345 4647 Geographic Rate alternative to its Business Rate 0845 4647 number set up and ready for use in parallel, but refuses to make this available.)

Parliament to rescue the NHS?

I have today written to the 33 MPs with 5 or more 0844-using GPs in their constituency urging them to become engaged in this matter on behalf of their constituents. As our parliament starts to consider changes to the NHS management structure to "LIBERATE" it from the central control that enforces adherence to its fundamental principles, I urge all those who claim to support "our NHS" to join the fight to ensure that these principles remain and to show that, in this relatively modest case, they can be re-asserted.

The draft of my message to the MPs is published as - Message to MPs brought into the fight to eliminate NHS telephone Service Charges. Further comment, detailed explanation and references is published as - MPs brought into the fight to eliminate NHS telephone Service Charges.

Friday, 7 January 2011

Ofcom announcement causes public bodies to come under attack for use of "Business Rate" 084 telephone numbers

Further to my earlier release, Public service providers must immediately cease using "BUSINESS RATE" telephone numbers, I address the situation with HMRC and NHS GPs in particular.


The Low Income Tax Reform Group has renewed its attack on HMRC for its use of what are now called "BUSINESS RATE" 0845 telephone numbers.
See - Telephone call charges – time for HMRC to act.

This announcement refers to a current Ofcom consultation, which confirms what is happening at present as well as proposing long overdue clarification of the position with all non-geographic telephone numbers.

When the Ofcom proposals are implemented, HMRC, in common with many other public sector bodies including DWP agencies and NHS Direct, would have to add the following statement wherever they publish their 0845 telephone numbers:

"Calls to our 0845 numbers are charged at 2p per minute, plus your telephone company's access charge".

This is the current situation, with access charges varying from a 12p fixed charge per call to a surcharge of 38p per minute. (BT is currently exploiting a specific regulatory provision, which requires it alone to cross subsidise these calls through other charges, by covering them in its Call Plan charges. Ofcom proposes to revise this regulation.)

The Ofcom proposal is essentially for the Service Charge levied by HMRC and others to be unbundled from the Access Charge, which each telephone company would have to advise separately. Whilst there would be expected to be adjustments to regularise the Access Charges; it is proposed, and expected, that the Service Charge will remain largely unchanged.

Once this clarity and transparency is achieved it will clearly be intolerable for benefit claimants, NHS patients and citizens seeking help with errors in their tax to be seen to be paying a Service Fee to a public service provider for a telephone enquiry. This is however exactly what is happening at present - it is just not being declared for what it is.

HMRC and other public bodies must now face up to the truth and either declare it, justifying the imposition of a Service Charge on callers, before they are compelled to do so, or move swiftly to use of 03 (Geographic Rate) numbers wherever a geographic number is not suitable.


NHS GPs who use the more expensive “Business Rate” 0844 numbers impose a Service Charge of just over 5p per minute for obtaining NHS Services - the highest charge possible to avoid classification as "Premium Rate". This is in addition to an Access Charge of up to 35p per minute added by the telephone company. This is a clear breach of the principles of a NHS that is funded by taxation.

Recent revisions to their NHS contract give them until 31 March 2011 to cease using these expensive numbers – see clause 29B of the Standard General Medical Services Contract. They could do so by changing their telephone arrangements totally, or more simply by migrating to the equivalent 0344 (Geographic Rate) number, which is permitted by network telephone service providers within the term of a contract for network telephone service.

The GP Committee of the BMA opposes this move (see this briefing). It promotes a policy which states that it is patients who should bear the cost of improved NHS services, according to the quality of the service delivered. Many would see this as being a most disturbing position to be held by this professional body, especially when the government proposes to hand over the local management of the NHS to GPs, “liberated” from central control!

Despite being content with the idea of patients paying service charges, the BMA GPC briefing however encourages members to get around the terms of the revised contract by pretending that there is no Service Charge applied and that patients do not pay any more to call 0844 numbers. One Surgery system provider even claims to be able to give assurances to this effect. The Ofcom paper clearly shows this to be complete nonsense.


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