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Thursday, 20 August 2009

Looking forward to the end of use of 084 numbers in the NHS

We are promised that at some unspecified time in September, "the Minister", perhaps Mike O'Brien, or the Secretary of State for Health, Andy Burnham, will make an announcement. This will cover the "outcome" of the consultation on a proposal to ban use of (revenue sharing) 084 telephone numbers in the NHS that concluded in March. The announcement will be made in parallel with publication of the Department's formal response to the consultation. Has publication of the response been delayed so as to avoid stealing the thunder of the Minister? If so, then he will perhaps be making a long-awaited and highly positive statement - "The NHS is free at the point of need" (pause for cheers) "... and so we are going to clear up the mess that was made in 2005 when use of revenue sharing 0844 and 0845 numbers was not only permitted, but encouraged" (pause for sighs of relief and mutterings of "not before time" accompanied by those for whom this past faux pas came as news crying, "WHAT"!!) "..., but not yet.". I am concerned that the work done on this matter by the Department from January to July of 2008 and from December 2008, when the consultation was launched, up until now has still not managed to get the major player needed to contribute to a solution fully on board. Most major actual NHS bodies will have little difficulty in switching from 084 numbers, as they will have been preparing for it for some time. Local providers will mostly go (back) to geographic numbers. 03 numbers will be used for more widely based national services or those cases where the genuine technical benefits of non-geographic numbers warrant use of a 03 number. The 034 range is reserved for those cases where a simple migration is desirable. The main NHS Direct service on 0845 4647 could not sustain the cost of a major number change operation, as its days as a separate service are numbered anyway. Use of the ready 0345 4647 number as an alternative, running in parallel for as long as the service lasts will provide the necessary acknowledgement of the need for change.

The problems will doubtless be found with the private sector bodies who provide NHS services under contract, e.g. GPs.

The "major player" referred to is THE TALK TALK GROUP.

The business division of Talk Talk is sometimes known as Opal Telecom. Talk Talk is part of The Carphone Warehouse Group.

The Talk Talk Group provides around 1,000 revenue sharing 0844 numbers to NHS GPs, through its agent NEG.

The additional revenue derived from the premium charges invariably associated with calling these numbers is used towards funding various elements of the "Surgery Line" system. All elements of this system are sold on a lengthy contract, commonly 7 years. Many parties have urged the Department of Health to allow GPs with such contracts to retain their 0844 numbers until the end of the contracted term. If (or when) a ban on use of revenue sharing numbers is introduced, it would be totally unacceptable for some NHS providers to continue funding their operations with money derived from patients. It is unacceptable anyway, but perhaps apparently more so when others have ceased the practice, and are prohibited from taking it up. TALK TALK can help resolve this problem in two ways. Firstly, it is normal practice in the telecoms business for customers to be able to vary the terms of an existing contract by switching from one type of number to another. Every 0844 GP number could be readily switched to the 0344 equivalent with no disruption to the service. Talk Talk would simply need to confirm that such a variation to the terms of the contract is permissible in these cases. Neither Talk Talk nor NEG has responded to invitations to confirm that this possibility exists, nor has any denial, or reason to suppose that it is not, been offered. (The way in which a representative of NEG addressed the question in a TV discussion is typical.) If such a change were to be undertaken, there remains a problem, which is the second area where TALK TALK is well placed to assist. On switching from 0844 to 0344 GPs would find that the flow of funding from patients to pay for the elements of their telephone system had dried up. Rather than providing money from each call, Talk Talk would be levying a charge for the modest part of the system that it provides. This consequential variation to the terms is a normal feature of such a contract variation. The benefits derived from these systems are mostly obtained from locally installed equipment (quite independent of the exchange and number). This equipment is currently paid for (at least in part) out of the residual shared revenue. Some (notably the BMA) have suggested that telephone companies should provide the revenue share on 0844 numbers at no cost to the caller, at least in the case of NHS providers. This is a direct invitation to TALK TALK to continue paying over the revenue share (although it would no longer be receiving enhanced payments from callers' telephone companies) after the number had been switched to 0344. Looking at the position of TALK TALK, and the Carphone Warehouse Group, I suggest that such a request would be stretching its generosity too far. I would however expect some gesture to be seen to be appopriate in recognition of its role in a very unhappy situation - ripping off NHS patients, as some would see it. Offering the very best commercial terms to GP users (i.e. those that would apply if "the NHS" were a single customer) for the remaining period of their contract would be a modest step, that could perhaps be exceeded.

The "Surgery Line" systems themslves, although generally seen as being grossly over-configured and therefore very poor value for money, are understood to provide an effective solution for most of those who use them. It would therefore be most regretable if they all had to be removed, with high termination charges on contracts and leases being incurred by GPs. Some means of making up the funding shortfall has to be found in each case, given that IT IS UNACCEPTABLE FOR THE COSTS OF SURGERY EQUIPMENT TO BE MET BY PATIENTS.

If GPs end up having to complete contracts on a system that is found to be poor value for money at their own expense, they can have little complaint. They are only fulfilling the terms of an arrangement that they negotiated on behalf of their patients. Whilst they may be disappointed to be learn that that they had no right to commit patients to expenditure to fund their practice, they cannot complain about the level of cost that they committed to.

There may be scope for arguing that the Department of Health or their PCT improperly advised GPs that it was acceptable to use money from patients to pay for surgery facilities. If so, then anyone found to be responsible for such impropriety must accept their responsibilities. If pressed, this could become ugly. As a profitable business with a strong sense of public duty, TALK TALK could have a major part to play in retaining its customers and its public reputation. The more it is able to do to help, the less will be the need for a situation in which it has played a significant role to become 'difficult'. I fear that "the Minister" will make no reference to any such arrangement when he announces that those with contracts in place for revenue sharing telephone numbers will not be required to make the quite normal variation that is possible, but will be allowed to serve out the term of their contract for 0844 numbers from TALK TALK. Should this happen, I believe that those who escape the ban would be placed in an intolerable situation. Their patients will continually be able to point out that the charges they are levying have been deemed to be improper. Neighbouring practices, who have to meet the full cost of their telephone systems, will have grounds for claiming that they are suffering exceptional costs in meeting locally established standards. Amongst those in this situation will be many who perhaps misunderstood the situation that they were getting themselves into, or now regret the decision that was taken. That is no excuse, but they will be very keen to benefit from any way in which their options to move forward could be helped by collective action. It would be wholly unacceptable for the Department of Health to leave some practices stranded by not enforcing the requirement to adhere to the prinicples of the NHS universally and immediately. Assistance from TALK TALK is fundamental to achievement of this.

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