Example of how PCTs are failing

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UPDATE - This matter was discussed on the Ronnie Barbour Show on BBC Three Counties Radio - Listen here.

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A good example of how the ban on use of expensive telephone numbers is failing to be enforced is highlighted by an article published by Bedfordshire PCT - 22 July 2011 : Dr Cakebread and Partners to get ‘local code’ phone number.

I quote below the text of an email message I have sent, circulated to various interested parties, but aimed directly at the key players:

•    Paul Cooper – Press Officer – NHS Bedfordshire

•    Tony Medwell - Head of Primary Care Commissioning - NHS Bedfordshire

•    Vivien Kinch-Jameson - Managing Partner - Dr Cakebread and Partners

•    Lynnette Brennan - Practice Manager - Dr Cakebread and Partners

The text of my email message follows:

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[The article] includes some errors and a notable omission. As a national campaigner for the NHS, with extensive engagement in this issue, I point these out and comment.

Any belief that a 0844 number may be called “for the cost of a local call” has always been, and remains, false. Under the terms of contractual requirements introduced in April 2010, NHS GPs have a duty to determine whether the cost of calling a non-geographic number may, having regard to the arrangement as a whole, is greater than that of an equivalent call to a geographic number.

By its failure to make a proper determination, the practice was directly in breach of its contract by adopting this number.

As for the allegation that no money was made from this choice of number – this is at best misleading (one hopes that it is false). All 084 numbers are subject to revenue sharing – the call originating telephone company has to pass on part of its call charge to the call terminating company, the provider to the practice. That is why these numbers are more expensive to call.

This financial benefit is normally passed on, by being reflected as a reduction in the cost to the practice of the services provided. If not, then the practice was being “ripped-off”. If the practice did not make any money, as alleged, then it was doubly at fault (or perhaps commercially naive) by allowing its telephone service provider to profit at the expense of its patients.

It should be noted that all of the technical features available on a 0844 number are available on every other non-geographic number. It is only the 03 range which enables these to be utilised “for the cost of a call to a local or other geographic number”. It is the commercial benefit of revenue sharing which is available on 0844, but not 03, numbers. On discovering its error, the practice could have retained all of the same features by migrating to a 03, even the equivalent 0344, number. One suspects that is was on seeing the true cost of these features (which was being borne by patients) that the practice decided to abandon them in favour of a new system.

Ms Brennan may care to note that in the NHS the interests of patients are protected by principles, such as the right to access NHS services without charge to the benefit of the provider. This is not a “view” which they have to articulate. Had some patients expressed a view that they would like to pay the practice for improved services, this request would have had to be denied. It is the PCT, not the body of patients, which is responsible for ensuring that a contracted practice follows the principles of the NHS and respects the rights declared in the NHS Constitution. (The practice itself also carries this statutory duty.)

When Mr Medwell expresses his “strong feelings” he is doing nothing more than reflecting the terms of the contractual obligations which he is required to enforce, although he is clearly failing to do so. According to NHS Choices, NHS Bedfordshire has 8 GP surgeries (6 practices) using 0844 numbers in breach of the terms of their contracts, which demanded compliance (for those with such numbers in place in April 2010) by 31 March 2011.

A list of these surgeries is published at this link.

It is fair to note that Mr Medwell’s failure is echoed in neighbouring PCTs and across England and Wales. More information is available via this link.

I am naturally delighted that this practice has discovered its error and taken the necessary action. I am however disturbed that this was done for the wrong reasons and that the full nature of the mistake has not been acknowledged. Yet more disturbing is the fact that the PCT appears to be totally unaware of its proper responsibilities. If the PCT had discharged those responsibilities properly in respect of the other practices, then it is likely that this mistake would never have been made.

As all parties look to take this matter forward, I would be delighted to assist in any way.