MPs brought into the fight to eliminate NHS telephone Service Charges

I have today provided each of the 33 MPs having 5 or more 0844-using NHS GP surgeries in their English constituency with a list of the relevant cases from the table found here - UK GPs using 0844 numbers.

A copy of the draft message, along with the circulation is published here.

The following comments supplement the message, providing links to the related information and further explanation.

1. The Ofcom consultation document.

This explains how call charges for "Business Rate" numbers, including all 0845 and 0844 numbers, have a Service Charge and Access Charge element, which are presently bundled together. It proposes separate declaration of the two elements, by the respective beneficiaries - the Service Provider being called and the call originating telephone company. Under the terms of the proposed regulatory changes GPs would have to make the following statement whenever their 0844 number was quoted:

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

The 5p per minute reflects the current value of the Service Charge from which the Surgery and its telephone service provider benefit. Access Charges levied by the call originating telephone company currently vary from a 11.5p call setup fee to a surcharge of 35p per minute.

2. The revised GMS contract. Clause 29B contains the relevant provisions.

Somehow the Department of Health was persuaded not to correct the error it made in 2004 when it erroneously omitted 084 numbers from the list of proscribed numbers given in clause 29A. In fact, there are no 084 numbers that are not more expensive for patients to call. Some BT and other landline subscribers incur high Penalty Charges when calling Geographic Numbers outside the terms of their selected Call Plan, which can distort the expected natural position.

The requirement to have regard to "the arrangement as a whole" however means that GPs cannot disregard the interests of patients who use mobile telephones, public payphones and Virginmedia landlines, or use BT and other landlines within their agreed terms. The NHS is a universal service and so cannot be provided on the basis that all patients incur service charges for contacting NHS providers by telephone simply because this helps some to avoid a penalty charge for calling a normal number outside the terms of their agreement.

3. Guidance from the BMA GP Committee.

The BMA policy that patients should pay for access to NHS services, according to the quality of the service provided, is stated here clearly. This recommendation was however firmly rejected by the government in 2009. The present government proposes that GPs take over responsibility for the local provision of NHS services "liberated" from central control - there must be concern that this may allow implementation of such a policy, in direct contravention of the first of the rights in the NHS Constitution, as currently drafted.

Having negotiated contract provisions that do not explicitly proscribe use of 084 numbers, the BMA advises that (false) statements from telephone system providers should be used as the basis for claiming (falsely) that some 084 numbers are not more expensive to call.

4. A circular letter from NEG, the primary provider of Surgery telephone systems that are generally funded out of the revenue derived from 0844 telephone numbers.

This false and misleading letter misrepresents the position in several respects.

It suggests that total call charges are set by a system provider, such as NEG. Although the Department of Health was somehow persuaded to believe this falsehood, it is only the Service Charge that is determined by the user of a Business Rate number. The rate of 5p per minute (actually 5.105p with 20% VAT) is selected by nearly all NEG Surgery Line users - this is the highest Service Charge that can be imposed whilst avoiding the classification of "Premium Rate". There is no Service Charge applied to calls to a Geographic Rate number.

The call originating telephone company determines the total charge - at present this includes the Service and Access Charge elements bundled together. The only relevant current regulation is a prohibition on BT from applying an Access Charge at a pence per minute rate to any Business or Premium Rate call. Ofcom proposes to remove this restriction on BT. BT can presently only apply the Service Charge as the pence per minute element, plus the standard call setup fee that it applies to all calls made outside the terms of a Call Plan.

There are many other points of detail in the NEG letter which are simply false, e.g. the suggestion that Ofcom regulates tariffs for calls to geographic numbers (it does not). This clearly demonstrates that NEG has no competence in the area that it seeks to address. NEG is not a network telephone service provider and so there is no reason why it should be able to demonstrate competence or awareness of the cost of making telephone calls. This was seen most clearly in the example of comparative call costs that it offered in its representations to the Department of Health as a response to the public consultation. This failed to prove anything of value, as the example used misquoted and atypical rates from only one highly atypical telephone company (see my lengthy comments on this disgraceful item).

The Department of Health has confirmed to me that NEG is mistaken in its alleged understanding that its assurance about call costs would provide sufficient evidence to demonstrate compliance with the terms of the GMS contract. Given the weight of the pressure from the BMA and NEG, the DH has retreated to a neutral position on this issue, leaving it to practices to satisfy their PCT that they have undertaken proper investigation into the cost of calling them. Enquiries suggest that this is not happening; practices are not properly researching the cost of telephone calls, nor are they confirming that they have the option to change their telephone number whilst retaining their Surgery Line system.

Whilst NEG may pretend to be offering an assurance that the cost of calling a 0844 number is no higher than that of calling a geographic number, such a statement would be demonstrably untrue. Although the letter contains a number of falsehoods and conveys a wholly misleading impression to this effect, the author is very careful to avoid actually making this clearly false statement, although it attributes such a conclusion to the Department of Health.

Further comment

I will be delighted to assist anyone with further explanation on any of these matters, which have been made complex to conceal would must be seen as impropriety. I deeply regret the fact that the Department of Health has once again been drawn into promoting confusion and false information. 084 numbers should have been banned from the NHS in 2004.

Now that 03 (Geographic Rate, but non-geographic) numbers are available, (Business Rate) 084 numbers have no valid use in taxation-funded public services. Ofcom is now at last bringing forward measures that will enable this situation to be recognised more clearly.