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Wednesday, 15 June 2011

Enforcement of the principle of "free at the point of need" in the NHS

The text which follows is that of a message sent to the Chief Executives of a number of PCTs - see list below.

To: Chief Executives of PCTs in the “TOP 20” of those who have not yet eliminated use of 084 telephone numbers by GPs

From: David Hickson – campaigner for the NHS


You and your predecessors have received many briefing messages from me on the topic of GPs using "expensive" 084 telephone numbers. As a lover and part-owner of "our NHS" I am campaigning, as a "concerned citizen", for the principle of "free at the point of need" to be properly enforced.

For those who understand these matters, use of any 084 telephone number represents a breach of this principle because of the revenue sharing that is involved. Contrary to misleading advice from certain quarters, EVERY call to EVERY 084 number involves a transfer of funds from the caller to the recipient (albeit heavily disguised in some cases).

You have a statutory duty, under the terms of the Health Act 2009, to have regard to the rights declared in the NHS Constitution. If you are properly aware of the situation and un-swayed by those who argue for co-payment, you will have no option other than to ensure that use of 084 numbers is eliminated from the NHS.

GPs who are GMS contractors are in breach of the revised terms of the GMS contract (clause 29B) issued around April 2010, with a deadline for compliance of 31 March 2011. PMS contractors are in defiance of the Directions to NHS bodies issued by the Department of Health on 21 December 2009, with a deadline for compliance of 21 December 2010.

These specific directions and contract revisions, if properly understood and applied, provide you with a clear basis for taking action against those who fail to comply.

This briefing

To support my campaigning efforts I have now prepared a further database of cases of non-compliance, based on the information published by "NHS Choices". This includes "Top 20" lists of PCTs, and the equivalent bodies in Wales and Scotland, who are clearly having the greatest difficulty in achieving compliance. This may be due to a failure to properly understand their duties or due to them having adopted a policy of permitting the principle of co-payment to apply for those they serve.

This message is circulated to the Chief Executives of these PCTs, listed in sequence according to the position on the lists by number of cases or proportion. As the question of a policy of permitting co-payment is involved I believe that this demands your attention. The detail is however a matter for the appropriate officers - I hope this message will be passed to them.


Please follow this link to see your place on the “Top 20” lists and to follow a further link (on the name of the PCT) for a list of the cases.

This blog entry describes the database of cases, what it represents and the manner in which it has been prepared.

You may find a further briefing - Resistance to the ban on use of 084 numbers by NHS GPs - to be of value. This covers the terms of the contract variations in detail and addresses some of the devices used by those who seek to evade their duty under the terms of their contract. This briefing expands on, and gives references for, many of the comments in this message.

Action to follow

I will be delighted to offer you any assistance in performing your duty to ensure compliance, if somewhat belated.

If you are not proposing to take immediate action against practices who continue to use 084 telephone numbers, then I would be most grateful to be advised of this decision.

Some who fear that the "NHS reforms" already underway may not achieve the intended cost savings see it as inevitable that co-payment will become a major feature of public health provision in England in the coming years.

I will be most interested to note any areas of the country where co-payment is already officially sanctioned in access to primary care, allegedly under the terms of the NHS. A policy of failing to eliminate use of 084 telephone numbers amounts to such sanction, even if only as a result of ignorance.

This sanction of co-payment may be on the relatively modest scale involved through use of revenue sharing telephone numbers and may have been achieved through misrepresentation and incompetence. These features, even if there are the true explanation, will not be used as the way of explaining it to those whom you serve! The general principle, outlined by the BMA, that the cost of accessing NHS services should be dependent on the quality of service received, will doubtless be used.

Please let me know where you stand on this - your policy and how it is being applied to this matter.

Further comments

It is fair for me to add that I deplore the decision of the Department of Health to leave it to each PCT to work out that calls to all 084 numbers are more expensive for patients than equivalent calls to geographic numbers. This applies to all of the UK; there are NO LOCAL VARIATIONS, neither by locality nor for specific numbers. Actual call costs vary enormously, but we are only concerned with the question of whether a call to a 084 number is more expensive than the cost of an equivalent call to a geographic number. Any call to a 084 number is more expensive than an equivalent call to a geographic number. The only exceptions apply to particular patients who incur penalty charges for calling geographic numbers outside the terms of their Call Plan, which may exceed the premium added for calling a revenue sharing number. This exception is for a CALLER, not a NUMBER.

The BMA declares its position in favour of co-payment openly. It nevertheless urges its members to seek to pretend that there are local variations in the cost of calling 084 numbers. It also encourages them to engage the services of a much stronger advocate of co-payment as the basis for encouraging competition between GPs. This company, which also happens to have a direct commercial interest in this matter, not only supports this false assertion but also offers to make an absurd declaration allegedly covering the tariffs of up to 200 telephone companies. This assertion is readily shown to be untrue by looking at only a handful of tariffs, including that of the network telephone service provider for which it is an agent!

The Department has failed to point out the truth of the matter, refusing even to comment on misrepresentations of its own position. It is therefore for each PCT to plough its way through clouds of misinformation before being able to make a clear decision about whether or not to support the BMA by permitting co-payment. The Department has also failed to advise that every practice committed to a long term telephone system contract which requires a non-geographic number has a perfectly simple and straightforward option for re-arranging their provision of network telephone service so as to comply with the terms of the Directions and contract revisions at any time. References to awaiting the renewal of contracts or considering termination are totally pointless – there is no need to wait.

In my view, the DH decision to devolve this issue of fundamental policy to a PCT, when there are no issues of local variation, denies the essence of a National Health Service. That however is the position. I would be most interested to know if you have made a positive decision to allow co-payment, or if perhaps you would welcome further assistance in eliminating it, albeit some months after the deadline has passed.


Ian Atkinson - Interim Chief Executive - Sheffield PCT
Andy Buck - Chief Executive - Rotherham PCT
Andrew Donald - Chief Executive - Birmingham East and North PCT
Catherine Griffiths - Chief Executive - Leicester City PCT
Catherine Griffiths - Chief Executive - Leicestershire County and Rutland PCT
Denise McLellan - Chief Executive - Heart Of Birmingham Teaching PCT
Ailsa Claire - Chief Executive - Barnsley PCT
John Lawlor - Chief Executive - Leeds PCT
Mike Potts - Chief Executive - Wakefield District PCT
Allison Cooke - Chief Executive - North Lincolnshire PCT
Amanda Fadero - Chief Executive - West Sussex PCT
Kevin Flynn - Chief Executive - Isle Of Wight NHS PCT
David Sharp - Chief Executive - Derbyshire County PCT
Tracy Sanders - Chief Executive - Portsmouth City Teaching PCT
Mike Potts - Chief Executive - Calderdale PCT
Jane Halpin - Interim Chief Executive - Hertfordshire PCT
Robert Bacon - Chief Executive - Walsall Teaching PCT
Debbie Fleming - Chief Executive - Hampshire PCT
Anne Walker - Chief Executive - Surrey PCT
Ann Sutton - Chief Executive - Eastern and Coastal Kent PCT
John Parkes - Chief Executive - Milton Keynes PCT
Jan Stubbings - Chief Executive - Gloucestershire PCT
John McIvor - Chief Executive - Lincolnshire Teaching PCT
Robert Bacon - Chief Executive - Sandwell PCT
Mike Potts - Chief Executive - Kirklees PCT
Simon Morritt - Chief Executive - Bradford and Airedale Teaching PCT
Christine Willis - Chief Executive - Middlesbrough PCT

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