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Sunday, 1 May 2011

Rip-off GP telephone number provider openly seeks to undermine the NHS

In a most extraordinary development, Network Europe Group (the provider of the "Surgery Line" GP telephone system part-funded by patients, who pay premium rates to call 0844 numbers) has publically declared its opposition to the principle that NHS services are funded by taxation, rather than by patients as they access services.

Quoted in this article - Company defends charges for calling GP practices, in the Leamington Spa Courier,
NEG opposes the action that its GP customers need to take to comply with their NHS contracts, by saying ...

“the cost would be borne by the practice and ultimately the taxpayer”

The reason given is the very reason why practices MUST make the necessary change - switching to a 03 number so as to provide the technical benefits required by Surgery Line, but at no greater cost than that of a geographic call for the caller. It is quite odd to see the basis of funding for NHS services being given as a reason why NHS GPs should not adhere to this principle.

The cost of providing NHS services is properly carried by the practice, ultimately funded by the taxpayer, not the patient as they access the service. This has been the whole basis of my involvement in this issue - I am delighted to see "the other side" now being open about its position of opposition to the principles of the NHS. (NEG continues to misrepresent the position of the Department of Health and misinterpret the requirements actually imposed on GPs. By declaring its clear intention to work against the fundamental principles of the NHS, we can see all of its other statements in a clear context.)

The Surgery Line telephone system is admittedly too expensive for GPs to pay for in the normal way. The number used is however nothing to do with NEG, it is a matter of the arrangement between the practice and the network telephone service provider - normally TALK TALK in the case of Surgery Line users.

Talk Talk allows migration from 084 to 03 numbers at any point during the term of a contract. This is exactly what all of the 1000 or more GPs who are currently in breach of their contract (see below), but want, or are committed, to use non-geographic numbers must do immediately. Other NHS GPs pay for their telephone systems, and other surgery expenses, out of the money given to them from our taxes. That is how the NHS works!

As we are now “pausing and reflecting” on the NHS reforms, perhaps we need to get our thinking clear on the meaning of "free at the point of need". A commercial company, like NEG, finds it difficult to understand and easy to oppose. It can even use an undisguised attack on the fundamental principles of the NHS as a “defence”. As we look for more commercial involvement in the NHS - do we understand this principle and do we want to keep it?


References to other material

I cover the detail of the requirements under the GPs contract with the NHS in this blog entry.
My league table of the areas of England with GPs in breach, and lists of those surgeries.
The equivalent list for Wales, where the situation is identical.
The list covering NHS Coventry and NHS Warwickshire - "the Arden Cluster" (as referred to in the Courier article).
I have previously commented on the views of NEG, although not expressed with the clarity seen in the quote covered by this item.


  1. So the BMA, who support the principle of revenue sharing...and the Department of Health who also support the principle of revenue sharing...are both ALSO fundamentally opposed to the principles of the NHS, are they David?

  2. The only defence they may offer is of ignorance of how it works and they have had plenty of opportunity to learn.

    With that sole qualification, and with regret, I have to answer - YES.

    They should both take the opportunity (as should NEG) to re-consider their positions.

    (Do please use some kind of identity when commenting.)

  3. It does seem extraordinarily arrogant for you to assert that the BMA, which has been in existence and representing doctors since 1832, and the Department of Health - which established the NHS 63 years ago and has run it ever since - should be "in ignorance" of how the NHS works...

    Might it simply be that they have a more rounded and mature view of the intricacies and compromises involved in delivering what remains the most popular and the most equitable system of healthcare ever invented...

    Or do you presume that you have a greater insight and mantle of legitimacy than almost 200 years of providing healthcare to the nation?

    (I would prefer to remain anonymous - as I don't have an ego that requires my identity to be made public and it doesn't detract in any way from the argument I am making)

  4. Anon (I had rather than you had used some nickname by which I could address you.)

    I offered the possibility of a lack of realisation that the revenue share (to be known in future as the "service charge") will inevitably be reflected in the charge to the caller (patient) as a possible explanation for what seems to be a perverse position.

    I agree that it is unlikely for both bodies to be so lost in their proud history as to be unaware that calls from BT landlines now represent less than 25% of non-business telephone calls and that some of these are made under the terms of a call plan.

    It is however not for me to say that such ignorance explains the positions taken. I only suggested the possibility because I was reluctant to give an affirmative answer to the question which you posed, although I surely had to.

    I certainly understand the wording and declared intention of the revisions to the GMS contract and the similarly worded Directions to NHS bodies. I cannot however understand why, after so much research into the issue, the DH felt able to suggest that the requirement could possibly be met by use of any 084 or other revenue sharing number. If this were possible, then there would have been no reason to exempt the NHS Direct NHS Trust from the requirements imposed on NHS bodies, when it is the 0845 range of numbers that comes closest to meeting the requirements (although failing to do so). I also cannot understand how it came to be considered that telephone system providers could possibly determine the rate charged for calls to the numbers used, relative to that for geographic calls, if they were not using 03 numbers. If the requirements were intended to be so limited, then this could have easily have been written into the terms.

    There must remain some doubt about whether the Department of Health truly knows what it is doing. This perhaps could explain why it has now stood back from the issue, leaving PCTs to sort out the mess.

    These are however matters relevant to the workings of the UK telephone system, which have been drawn into this issue at a wholly unnecessary level of complexity. The terms of the requirement are expressed very simply.

    I suspect that many BMA members and even some of its senior officers would be horrified to read the stated policy position of the GPC on this issue. The question of whether "the BMA" (as a whole) is in favour of patients paying to access NHS services must remain in doubt, even though there is no question about the wording of the GPC policy as presented to the DH on behalf of the BMA.

    If you are trying to tell me that both the BMA and the DH are aware and content that the principle of "free at the point of need" is but a slogan, and that patients are seen by both as a legitimate source of funding as they access NHS services, then I would admit to a somewhat naive sense of disappointment. I am sufficiently arrogant in my respect for our beloved NHS to remain unconvinced, as I am also disinterested in comparisons with other healthcare systems and whatever claims they may make about equity and effectiveness.

    (I have no ego to satisfy. I am however content to stand by my assertions, to be held to account and to justify all that I say. My name is but that of a citizen. I have no authority to call on, other than that which I may earn through the arguments that I present and the body of objective evidence I have assembled.)

  5. Hi David

    "I suspect that many BMA members and even some of its senior officers would be horrified to read the stated policy position of the GPC on this issue."

    Could you provide a single quote or piece of evidence to back up your personal suspicion?

  6. Not as such.

    I simply detect a strong feeling that the costs incurred in the provision of NHS services should be met (ultimately) from taxation, rather than payments by patients.

    I suspect that plenty of evidence could be found to support my contention that the idea of the patient sharing in some "balance" of cost with the GP, depending on the GPs choice of telephone system, would not be expected to find widespread support in the BMA. This is however vague, as I am not aware of the issue having been seriously debated.

    The closest I have come to engaging directly on this point was when my fellow contributor was invited to advance the general argument in favour of patients paying for "improved" NHS services in the "Today programme" discussion. As I recall, he withdrew to discuss the benefits of a period of consultation.

    It would perhaps be interesting to know if there was any evidence to show that GPs do believe that such a "balance" is proper. If so, it would surely cover other items of practice expenditure.

    I do not offer this latter point as a challenge, as there has been no explicit contention that commitment to the principles of the NHS is truly as weak as has been implied. There are undoubtedly subtleties to the positions being taken on this issue.


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