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Thursday, 17 September 2009


The Department of Health has spent over 18 months looking into the issue of use of 084 numbers in the NHS and on Monday 14 September 2009 announced:


This was a considerable victory for campaigners, including myself, as it acknowledges the key point of principle:

NHS services are “free at the point of need”. The true and fair cost of providing them must be carried by taxpayers, not patients.

(As I am not totally obsessed with telephones, I can write at length about how this principle applies to issues such as car parking, retail concessions in hospitals, prescription charges, dental fees, eye tests, non-approved drugs, personal care, privatisation, local control and the price paid to one’s telephone company for connecting a normal call, but will not do so in this posting.)

I have had a few days to consider this announcement and the reactions to it.

Everyone applauds the announcement

Some who responded to the public consultation that informed the reported outcome expressed the view that patients should pay NHS providers for access to NHS services. I have however seen very little serious public comment to this effect.

We in the UK value the principles of our NHS and the fact that it has largely survived for over 60 years. We are therefore rightly quick to criticise any failure in its delivery. It seems that very few have spotted that what is stated in the detail of this announcement is undeliverable.

In particular, I have noted support for the announcement from those who have previously defended the use of revenue sharing 084 telephone numbers by NHS providers. I refer to Dean Rayment, Managing Director of Network Europe Group, which provides systems to around 1,000 GPs partly funded by the revenue share earned on 0844 numbers, and Richard Vautrey, Deputy Chairman of the General Practitioners Committee of the BMA, also a contented customer of NEG in his Leeds practice.

There has been no announcement from any telephone company.

Why does everyone agree

The absence of any comment from residential telephone service (fixed and mobile) providers is highly significant. It is they who determine the charge they impose on callers.

When placing calls to 084 numbers they have to share their revenue with the recipient's telephone company. This is at a fixed rate, according to the particular "type" of 084 number, which was selected by the person being called (one hopes with an understanding of what they were doing, and the likley effect). It is therefore quite reasonable and proper for them to charge the caller a premium, i.e. more than they charge when they do not have to give away some of their revenue.This is indeed mostly what happens. There are a few cases where this additional cost is not recovered directly from the caller, but from customers in general through other charges; I do not see this indirect way of distributing the cost of revenue sharing as particularly desirable.

Some seem to believe that all residential telephone service providers, and indeed all of their customers, will be affected by this announcement. It is implied that they will all have to distribute the cost of calls to (some) revenue sharing numbers, rather than apply it as a charge to the caller. Many have reported that there will be changes to telephone tariffs. There is no firm basis for this false and misleading suggestion.

The Department of Health has announced that:
The ban means that GPs and other NHS organisations remain free to use 084 numbers, providing patients are not charged more than a local rate number.”

• This leads Dr Vautrey to commentwe’re pleased that the phone companies who supply these lines to practices have agreed to ensure that their tariffs are in line with local charges”.

• Mr Rayment announces that “new legislation will be introduced to ensure that local patients do not pay more than the cost of a local call to contact the NHS”.

• The Department of Health explains, “The ban will be enforced through proposed changes to the GP contract (in consultation with the British Medical Association’s GP Committee), and the issuing of Directions to NHS PCTs and Trusts. These changes will be put in place as soon as practicable.”

As these three parties have been involved in intense discussions about this matter over the last few months, it is interesting that they hold completely different views about how a ban on premium call charges will be implemented, whilst allowing use of 084 numbers to continue. To put it simply, what is proposed (in detail) –


The Department of Health’s proposed changes to the GMS contract cannot bear on telephone companies.

The BMA has failed to respond to an invitation to offer evidence that the agreement it refers to exists, after this was denied by a number of telephone companies.

NEG is right to suggest that new legislation would be required to fix telephone call charges in this way, however the only legislation referred to by the DH is the Statutory Instrument that will contain the revised standard terms for the GMS contract.

Ofcom has confirmed that any attempt at statutory price-fixing of the type that would be necessary to actually enforce the ban as it is described would fall foul of EU competition law. (Ofcom has been trying something similar with 0870 numbers over the last 2-5 years. This has now resulted in the fact that many, not all, telepohone companies still charge a premium for calling 0870 numbers, even though the receiving party no longer benefits. Ofcom was only seeking to neutralise the position. In this case the DH appears to be trying to be even bolder, going one step further, by seeking the precise opposite of what has been achieved with 0870.)

It is my belief that attempts to resolve this situation are still ongoing and these announcements are simply part of a continuing negotiation process. Each party is trying to ensure that the blame for the expected failure falls elsewhere.

What happens now

Some NHS bodies may abandon use of 084 numbers as they will be advised, by me if no one else, that some callers are incurring premium charges.

GPs will probably stick to the letter of their contracts, ignoring representations from patients on the basis that the necessary changes have not yet come into force and telling them to complain to their telephone company.

NEG will undoubtedly resume signing up GPs to seven year contracts. It can now use the announcement that use of 084 numbers will not be banned to remove the doubt that has hung over it for the last 3 years.

If the proposed discussions between the DH and the BMA on the GMS contract go ahead, it is likely that the BMA will be happy to accept a clause prohibiting premium telephone charges, so long as licence to use 084 numbers is clearly in place. No GP could be held contractually responsible for the actions of telephone companies, as these are totally outside its control.

Is this a Political issue

Some may draw comfort, or seek to take advantage, from this failure by the government. Making an announcement of a change that cannot be implemented should be seen as worse than the years of inaction that followed its previous false announcement that 084 numbers offer patient a "guaranteed low call rate".

The NHS belongs to the nation, to us all, not to any government that happens to be in power for a period of up to five years. The current Ministers of the Crown in the Health Department are but the temporary custodians of a national asset. They have a duty that extends beyond their partisan desire to secure re-election (or not, as the case may be). Similarly, all those accepting election to serve as Members of Parliament have a duty to all their constituents in respect of the affairs of the nation that extends far beyond a wish for them to be served by the best possible candidate following the next election.

All the major parties are committed to the NHS and its principles. The key principle of “free at the point of need” is under threat of being permanently undermined. There is very little room for partisan Politicking here.

What do we do

The apparently worthless announcement must be strongly challenged now. It must be corrected or explained.

The issue has been returned to the public domain. The question of what is to happen must be resolved there, before necessarily private negotiations on how it may be achieved can be resumed.

Those of us who care for our NHS must use whatever resource we have to prevent these negotiations from failing to achieve the intended and declared objective.

The ban must go ahead in a way that works.

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