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Friday, 7 October 2011

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.

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.

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