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Wednesday, 2 May 2012

Supporting Surgery Line

Since I commented on “Surgery Line - Statement of Compliance with NHS Regulations”, published by Daisy Group in February 2012, two new versions have been released.

The latest version, now entitled “Surgery Line - NHS Regulations – Supporting GPs with Compliance - Effective April 2012” has been circulated. An intermediate, March 2012, version is published here.

Daisy offers its interpretation of the requirements imposed on NHS GPs with effect from 1 April 2010, covering use of non-geographic telephone numbers. As the leading provider of non-geographic numbers for use by NHS GPs, Daisy cannot but reflect its own strong commercial interest in this matter.

I have no personal interest in this matter to declare. I am a campaigning citizen, concerned for the lasting principles of ‘our NHS’ and their preservation.

My response on the topic of “Supporting Surgery Line”

I have now responded with my own “Supporting Surgery Line” document, (follow the link below).

Its full title is - “Supporting NHS GPs using Surgery Line in compliance with the contractual requirements for non-geographic telephone numbers”.

I invite those who are keen to see Daisy's inevitably ‘interested’ comments placed in a broad context, and to see its claims and interpretations judged critically, to read my comments. I have no issue with the Surgery Line system as such. If used as a means of accessing NHS services however, it must be paid for properly, not subsidised by patients. All use of 084 telephone numbers provides subsidy to the user, at the expense of callers.


My “Supporting Surgery Line” document refers (with direct hyperlinks to the relevant section) of:

→    an annotated copy of the Daisy document

→    the text of the contractual requirements.

Readers may either open (and perhaps print) these cited documents for continual parallel reference using the above links, or use the hyperlinks in my text to switch back and forth as required.

My comments

I quote below some extracts from my document, (with links for them to be seen in context).

The essential issues raised

For those already using non-geographic numbers on 1 April 2010, the action required depends on the determination of: “whether, having regard to the arrangement as a whole, persons pay more to make relevant calls than they would to make equivalent calls to a geographical number”.

If they do not pay more, then no further action is required. If they do pay more, then contractors must take “reasonable” steps to ensure that this situation ceases.

Those not using non-geographic numbers on 1 April 2010 are simply prohibited from entering into an arrangement whereby callers pay more.

Adding a concurrent Daisy local rate line

If the original number being used is not more expensive to call, then compliance is not in question.

If the original number is retained, offering the benefit of a better service alternative at higher cost, this would represent an additional breach of the fundamental principles of the NHS - offering what is known as a ‘two-tier’ service.

Migration to 03 - the reasonable step available

For those seeking to, or contractually obliged to, retain the features of a non-geographic number (sometimes referred to as “enhanced telephony”), the only way of achieving compliance is by migrating to a 03 number.

Surgery Line is offered on the 034 range of 03 numbers. Migration to 03 is therefore a step that is available to Surgery Line customers. Whether or not it is a “reasonable step” depends on whether Daisy follows standard industry practice, or if it seeks to exploit or penalise those wishing to follow this obvious path to compliance.

The approach to compliance suggested by Daisy

The “arrangement as a whole” does indeed refer to “the surgery as a whole”, including each and every patient that it serves. By suggesting an approach that is incompatible with the NHS Constitution from the start, it would seem that Daisy either does not understand the NHS, or seeks to change or undermine it.

A selective view

Since 2004, Surgery Line has been promoted on the basis that it costs callers no more to call a 0844 number than to call a geographic number, even though this has never been true. Having been required to cease considering only BT and then to cease considering only landlines, it is quite remarkable to see attempts to maintain this fiction continue.

This latest effort is characterised by considering only Out of Plan and Out of Bundle penalty charges for calls to geographic numbers, even though they only represent a small proportion of calls made. In the case of Mobile Phones it has also been necessary to use aggregated figures, including numbers that are cheaper to call than those used for Surgery Line.


I believe that every practice will have a significant number of patients and other callers who subscribe to BT Unlimited Anytime - the most widely used residential landline tariff, … or a mobile contract call bundle that they do not exceed. These persons pay more to make relevant calls than for an equivalent call to a geographic number, so a “reasonable” step that is available must be taken to ensure that this ceases.

Monday, 23 April 2012

Virgin Care does not use 0844 telephone numbers in providing NHS services - its partners do that

Virgin Care provides "over 100 NHS services across the country with a focus on community and primary healthcare". This includes "GP practices where the appointment times are designed around real people’s lives and needs".

It has "a network of GP provider companies across the country". These "provide NHS services by combining the clinical skills and expertise of the local GPs with the business and service expertise of Virgin Care".

Its website includes links identifying the services provided by its GP partners. These include the following surgeries, where the terms of the current NHS GP contract are being breached by the continuing use of 0844 telephone numbers.

Virgin Care PartnershipPartnerSurgeryTelephone numberCall type
DarlingtonCarmel Medical PracticeDr Metcalfe & Partners - Nunnery Lane, Darlington, County Durham DL3 9SQ0844 477 8758 (g6)
Felix House SurgeryMARSHALL & PARTNERS - Middleton Lane - Middleton Lane, Middleton St George, Darlington, County Durham DL2 1AA0844 477 3139 (g6)
BlackpoolThe Arnold Medical CentreArnold Medical Centre - The Arnold Medical Centre, 204 St Annes Road, Blackpool, Lancashire FY4 2EF0844 499 6984 (g6)
LeedsHyde Park SurgeryDr O'shea T S & Partners - Hyde Park Surgery, Woodsley Road, Leeds LS6 1SG0844 375 6070 (g6)
Manor Park SurgeryDr Tolley J M & Partners - Manor Park Surgery, Bellmount Close, Bramley, Leeds LS13 2UP0844 477 3145 (g6)
Robin Lane Medical CentreDr Belderson L & Partners - Robin Lane Medical Centre, Robin Lane, Pudsey, Leeds LS28 7DE0844 477 3074 (g6)
Sunfield Medical CentreDr Broom C & Partners - Sunfield Medical Centre, Sunfield Place, Stanningley, Pudsey LS28 6DR0844 477 3900 (g6)
Westgate SurgeryWestgate Surgery - Westgate, Otley, Leeds LS21 3HD0844 576 9050 (g6)
Yeadon Tarn Medical PracticeThe Thakur Practice - Silver Lane Surgery, Suffolk Court, Silver Lane, Yeadon LS19 7JN0844 477 2553 (g6)
East RidingSt Nicholas SurgerySouth Holderness Medical Practice - South Holderness Med Practice, St Nicholas Surgery, Queen Street, Withernsea HU19 2PZ0844 477 3562 (g6)
St Nicholas SurgerySouth Holderness Medical Practice - The Surgery, St Patricks Green, Patrington HU12 0PF0844 477 3572 (g6)
The MarshesThe Marshes - Butt Lane, Snaith, Goole DN14 9DY0844 477 8699 (g6)
VertisBridge SurgeryDr G A Caranci & Partners - The Bridge Surgery, 8 Evesham Road, Headless Cross Redditch, Worcestershire B97 4LA0844 477 1758 (g6)
Church Hill Medical CentreDr C H Mc Gregor & Partners - Church Hill Medical Centre, Tanhouse Lane, Church Hill Redditch, Worcestershire B98 9AA0844 477 9455 (g6)
New Road Surgery (Rubery)Dr J N H Cheetham & Partners - New Road Surgery, 104-106 New Road, Rubery, Birmingham B45 9HY0844 556 0011 (g6)
New Road Surgery (Bromsgrove)Dr W G H Dowley & Partners - New Road Surgery, 46 New Road, Bromsgrove, Worcestershire B60 2JS0844 477 2419 (g6)
St Stephen’s SurgeryDr S J Parkinson & Partners - St Stephen's Surgery, Adelaide Street, Redditch, Worcestershire B97 4AL0844 477 3197 (g6)
The Medical CentreDrs Hakeem & Ahmad - Church Hill Medical Centre, Tanhouse Lane, Church Hill Redditch, Worcestershire B98 9AA0844 387 9666 (g11)
Winyates Health CentreDr N P Doherty & Partners - Winyates Health Centre, Winyates, Redditch, Worcestershire B98 0NR0844 477 3803 (g6)
Woodrow Medical CentreDr S Ananthram & Partners (Main Surgery) - Woodrow Medical Centre, Woodrow, Redditch, Worcestershire B98 7RY0844 477 3035 (g6)
CoventryAllesley Village SurgeryDr WHEATLEY & partner - 163 Birmingham Road, Allesley, Coventry, W Midlands CV5 9BD0844 477 3885 (g6)
LeicestershireBurbage SurgeryDr DA Jones & Partners - Tilton Road, Burbage, Hinckley, Leics LE10 2SE0844 477 1883 (g6)
Bushloe End SurgeryDr C Prideaux & Partners - 48 Bushloe End, Wigston, Leics LE18 2BA0844 815 1425 (g6)
Hollycroft Medical CentreDr N P Scarborough and Partners - Barwell Medical Centre, Jersey Way, Barwell, Leicestershire LE9 8HR0844 477 3917 (g6)
Long Lane SurgeryDr N R Pulman & Partners - Beacon House, Long Lane, Coalville, Leics LE67 4DR0844 477 3722 (g6)
Rosemead Drive SurgeryDr S Z Husain & Partners - 33 Harborough Road, Oadby, Leicester, Leics LE2 4LE0844 499 2858 (g6)
The Central SurgeryDr MJ Davies & Partners - Brooksby Drive, Oadby, Leicestershire LE2 5AA0844 499 6973 (g6)
CambridgeLensfield Medical PracticeLensfield Medical Practice. - 48 Lensfield Road, Cambridge, Cambs CB2 1EH0844 387 8222 (g11)
Red House Surgery96 Chesterton Road - The Red House Surgery, 96 Chesterton Road, Cambridge, Cambs CB4 1ER0844 477 3124 (g6)
Lea ValleyCastlegate SurgeryWATSON LJ - 42 Castle Street, Hertford, Herts SG14 1HH0844 815 1224 (g6)
ChelmsfordHumber Road SurgeryHumber Road Surgery - Humber Road Surgery, 27 Humber Road, Chelmsford, Essex CM1 7PE0844 387 8773 (g11)
Stock SurgeryStock Surgery - Common Road, Stock, Ingatestone, Essex CM4 9NF0844 477 3088 (g6)
MinervaWest View SurgeryDr Wj Coe & Partners - West View Surgery, 9 Park Road, Keynsham, Bristol BS31 1BX0844 880 2800 (g6)
WiltshireAdcroft SurgeryAdcroft Surgery - Adcroft Surgery, Prospect Place, Trowbridge, Wiltshire BA14 8QA0844 477 8988 (g6)
Bradford Road Medical CentreBradford Road Surgery - 60 Bradford Road, Trowbridge, Wiltshire BA14 9AR0844 477 3052 (g6)
Lovemead Group PracticeLovemead Group Practice - Lovemead Group Practice, Roundstone Surgery, Polebarn Circus, Trowbridge Wiltshire BA14 7EH0844 477 8952 (g6)
St James SurgerySt James Surgery - St James Surgery, Gains Lane, Devizes, Wiltshire SN10 1QU0844 477 8648 (g6)
The Southbroom SurgeryThe Southbroom Surgery - The Southbroom Surgery, The Green, Devizes, Wiltshire SN10 1LQ0844 477 8657 (g6)
Westbury Group PracticeEastleigh Surgery - Eastleigh Surgery, Station Road, Westbury, Wiltshire BA13 3JD0844 477 8760 (g6)
Westbury Group PracticeWhite Horse Surgery - Westbury Hospital, Hospital Road, Westbury, Wiltshire BA13 3EL0844 477 8762 (g6)
Westbury Group PracticeBratton Surgery - The Tynings, Bratton, Wiltshire BA13 4RR0844 477 8761 (g6)
HampshireHackwood PartnershipThe Hackwood Partnership - The Hackwood Partnership, Essex House, Essex Road, Basingstoke Hampshire RG21 8SU0844 477 3400 (g6)
ReadingLondon Street SurgeryDrs Essa & Harrold - The Surgery, 72 London Street, Reading, Berkshire RG1 4SJ0844 477 3950 (g6)
Russell Street SurgeryDr Swami Ml & Partners - The Surgery, 79 Russell Street, Reading, Berkshire RG1 7XG0844 477 8553 (g6)
SurreyStanwell Road SurgeryDr CARTER & partners - 95 Stanwell Road, Ashford, Middlesex TW15 3EA0844 387 9955 (g11)
WandleCheam Family PracticeThe Knoll - The Knoll Parkside, Cheam, Sutton, Surrey SM3 8BS0844 477 8584 (g6)
Cheam Family PracticeGander Green Lane - 263 Gander Green Lane, Sutton, Surrey SM1 2HD0844 477 8785 (g6)

The relative cost of calls to the "Call Types" shown can be found by consulting this table.

The false impression that Virgin Care is itself profiting from NHS patients by use of these expensive numbers is easily gained from the information on the website as quoted above.

There is however no doubt that the "business and service experience" of Virgin Care, including that derived from its sister company Virgin Media, will be of great assistance to its GP partners in recognising that callers pay more to call these numbers so as to provide the financial subsidy from which they benefit.

It will also help them to recognise that they can migrate from their 084 number to the equivalent 034 number within the term of their current contract for telephone service.

Sunday, 4 March 2012

Which? misled about the costs of calling NHS GPs 0844 telephone numbers?

I have been provided with a copy of a draft document issued by NEG (part of Daisy Group) in May 2011, intended as a model for how a NHS GP user of its Surgery Line product, using a 0844 telephone number, should respond to an enquiry from Which?.

I cannot be sure that this document has been used for the suggested purpose, nor have I seen the text of the circular from Which? which it is intended to address. I received it as a result of it having been sent to a PCT to provide evidence of compliance with contractual conditions.

If Which? has received messages reflecting these comments from NEG, then I very disappointed that they have not been published and subjected to criticism from Which?, similar to that offered below. The standing and natural authority held by Which? would enable its criticism to be briefer and more effective, not to mention more widely read, than my remarks which follow.

I do however recognise that it is a more serious matter to successfully mislead a PCT, than to attempt to mislead Which?.

Some of the comments made by NEG are erroneous or seriously misleading. A view about how compliance with the ban on use of expensive telephone numbers should be assessed is offered, however this is based on a false premise and cannot be of any relevance to the particular requirements. This view effectively proposes that no judgement can be made.

I publish the copy document at http://tinyurl.com/dhtiny/doc?NEG_to_Which.pdf. I have highlighted the specific points which I quote below, and on which I comment.

I also quote from the relevant terms of the contract, which are published at http://tinyurl.com/dhtiny/doc?GMS29B.pdf.

"“NHS organisations remain free to use non-geographical number ranges such as 084, providing that patients are not charged more than the equivalent cost of calling a geographical number to do so.”"

Much of the document argues the benefits of "Enhanced Telephony". This was discussed at length in the course of the public consultation. The final determination, which led to the contract revisions imposing the requirement, fully supported use of any type of technology, "providing that patients are not charged more than the equivalent cost of calling a geographical number".

The requirement makes no reference to any specific number range. It recognises that Ofcom may introduce regulatory changes and new ranges at any time. At the time when the requirement was introduced, Ofcom was specifically considering changes to the regulations covering 0845 number. Many expected that this would include adding 0845 to a list of other ranges for which call charges may not be greater than those for calling geographic numbers. Ofcom's considerations have now been widened, however no change has yet been made and the specific option for 0845 referred to is most recently stated as having been removed from active consideration.

Under actual current circumstances, there is NO 084 number for which it can be said that "patients are not charged more …". See the widely used tariffs, which are summarised and linked to on this page.

"084 numbers are not always more expensive to call than a geographic number"

This statement, as it is phrased, is accurate. It is however used as the basis for a false conclusion regarding compliance.

It is equally true to say that "there is no 084 number that is not sometimes more expensive to call than a geographic number. It is the variation between tariffs which makes the statement true, not some characteristic of particular 084 numbers. To achieve compliance with the specific regulations, one would have to be able to reverse the sequence of the words "not" and "always" to give "… always not more expensive …", but that would make the statement false.

As shown on this page, there are some circumstances under which a provider of telephone service to the caller sets their call charges for geographic calls, for some callers at some times, to be greater than (or equal to) the call charges for some 084 numbers. There is however no 084 number which is not more expensive for a significant proportion (in many cases probably a sizeable majority) of callers.

In the context of the terms of the relevant contractual conditions imposed on NHS GPs, the fact that there may be some callers who do not pay more to call a particular 084 number is not the point at issue. The requirement is: "to ensure that, having regard to the arrangement as a whole, persons will not pay any more to make relevant calls to the practice than they would to make equivalent calls to a geographical number".

If "having regard to the arrangement as a whole", a user of a 084 number cannot claim compliance, unless all "persons" are subject to the exceptional circumstances identified. (Further points address this in more detail.)

"The telephony provider therefore has the ability, if they so choose, to set the rate at which a call to their number is charged at the geographic rate or below. …
"This is precisely what our telephony supplier, Network Europe Group, has done and, in doing so, has ensured that we have complied with DH regulations and the relevant BMA guidance to its members."

The telephony provider which has the stated ability is the provider of telephone service to the caller.

This statement would only be of any relevance if NEG were the provider of telephone service to all those who call the practice. NEG is not a provider of residential telephone service to anyone, NHS services are only available to individuals not corporate bodies, so NEG is not the provider to any NHS patient.

What NEG has done in setting its charges is therefore of no significance whatsoever to the "DH regulations".

"… the long-standing industry practice in comparing the costs of calling numbers, adopted by all organisations and public bodies … is to compare against the OFCOM-regulated BT call rate.
"The reason for this is that all other rates are not regulated by OFCOM and therefore can be changed by the provider at literally a day's notice without any notification or consultation.
"Because of the volatile nature of the telephony market, this means that it is impossible for any organisation to provide a comparison against myriad providers' costs which would not run the risk of being out of date within days."

The requirement which is contained in the relevant regulations requires comparison between the cost of a call to the number used by the practice and the cost of an equivalent call to a geographic number. As Ofcom does not regulate the cost of calls to geographic numbers, for BT or any other provider, one cannot therefore limit consideration to only those rates which are regulated by Ofcom.

Ofcom does currently regulate BT, but only in respect of the pence per minute element of its charges for calls to 0844/0843/087/09 (and some other non-geographic) numbers. This regulation is expressed in absolute terms, not with any reference to the rate of charge for calls to geographic numbers. These rates are fixed, in that BT alone is not permitted to add anything to the fixed amount which is paid on by every originating telephone company to the telephone company used by the person called. (The call set-up fee is a separate item. No other provider is subject to any such regulation.)

The industry therefore does indeed use BT rates when quoting the pence per minute element of call costs for these numbers in absolute terms. This is because they are both fixed and the lowest likely to be found - most businesses take a margin on a service, when not prevented from doing so! These costs may be compared, one with another, but they cannot be compared with the cost of a call to a geographic number - the ASA and the Trading Standards bodies act when such false comparisons are made. The practice of doing so may have been long-standing, but it (should have) stopped in 2006, when it ceased to be valid.

As all BT residential customers are now under the terms of Call Plans, whereby calls to geographic numbers (of up to one hour) are subject to a zero call charge, calls to 0844 numbers (which are not included in the Call Plans) will invariably be more expensive.

The exceptional and perverse case with BT arises when calls are made to geographic numbers outside the terms of the selected Call Plan, e.g. if a customer chooses a Call Plan for calling only at Weekends or Evenings and Weekends, but then makes a weekday daytime call to a geographic number. The (unregulated) penalty charge which is imposed for these "out of plan" calls is currently greater than the (regulated) charge for calls to all 084 and some Premium Rate Service 087 numbers.

If it could be shown that all callers were subject to these unregulated and frequently changing "penalty charges" from BT, this could provide a basis for a claim of compliance. NEG seeks to imply that these "penalty charges" are regulated and therefore provide the only valid basis for comparison. The basis for this is however simply untrue. Ofcom ceased regulation of BT's charges for calls to geographic numbers on 31 July 2006.

Any attempt to deal with the absolute costs for a large number of providers, for both geographic calls and calls to the number used by the practice would indeed be likely to require regular updates. (The BT "penalty charges" increase frequently - 3 times during 2011).

That is however not what is required. The requirement is for an assurance that calls to a particular number will not cost more than the cost of an equivalent call to a geographic number. If that assurance cannot be provided, then the number cannot be used. It is clearly absurd to suggest that any number may be used if there is a chance that the current relationship between the cost of calling it and that of calling a geographic number may change in the future. If unregulated charges should be disregarded, then the comparison demanded by the regulations on GPs cannot be made with confidence, so no non-geographic number may be used.

The obvious case which is not referred to is 03 numbers (more on this below). Ofcom regulates the cost of calls to 03 numbers, for all providers, to be no greater than the cost of an equivalent call to a geographic number. If seeking an assurance regarding numbers for which the call cost is regulated in respect of that of an equivalent call to a geographic number, numbers from the 03 range fit the requirement perfectly. "Revenue sharing" is however prohibited on 03 numbers, denying the opportunity for the costs of the telephone system to be subsidised by callers, thereby causing the user to both see and pay its full cost.

"You asked why your surgery currently uses an 0844 number for patients to call? The answer is very simple.
"We do so because it enables us to provide a much better service to our patients, to increase access to the surgery and to offer a better quality patient experience."

All non-geographic numbers offer additional facilities. These are used by the Surgery Line system to provide the benefits stated. The same benefits would be provided if a 080, 087, 070, 09 OR 03 number were used.

Where the features of non-geographic numbers may be required by a system (such as Surgery Line) in order to offer particular benefits, then 03 numbers provide the obvious means for a NHS service provider to take advantage of them. This possibility is specifically covered by the terms of the regulations which allow use of non-geographic numbers, "providing that patients are not charged more than the equivalent cost of calling a geographical number". That stipulation provides a precise definition of the call charge regulations covering 03 numbers. Indeed, the 03 range is the only range of non-geographic numbers, currently in use and as currently regulated, which meets this stipulation.

"You asked if our continued usage of an 0844 number is due to contractual obligation, and if there are there plans for a review when the contract ends.
"I can assure you that we constantly review out arrangements to ensure patients get the best possible service, in line with DH and BMA guidance."

Regardless of any DH and BMA guidance, the practice is under a contractual obligation to "take all reasonable steps, including in particular considering [… varying the terms of the contract or arrangement …], to ensure that, having regard to the arrangement as a whole, persons will not pay more to make relevant calls than they would to make equivalent calls to a geographical number".

As NEG offers migration to the equivalent 034 number for the 084 number in use (see Surgery Line: Number Ranges) the practice was required to take this step "before 1st April 2011", unless it could show that the terms offered by NEG were not "reasonable".


NEG is free to argue the merits of its system. During the consultation period, NEG was free to argue, as it did in common with the BMA, that NHS GPs should be allowed to use expensive telephone numbers if they are providing a better service to patients. Like any individual or corporate citizen, NEG is free to argue that "co-payment" should be a feature of our publicly funded healthcare system. ("Co-payment" is explicitly prohibited, and cannot be permitted, within the NHS, as currently constituted.)

The fact is that the requirements imposed DID NOT permit use of expensive numbers. The representations in respect of allowing the existing situation to continue, from the BMA and from NEG, were not carried forward, although they were "accepted" as being valid arguments. The regulations do not specify which particular numbers are banned, so as to make them sustainable through forthcoming changes.

Daisy Group should now accept that whilst the NHS remains in place, patients cannot be used as a source of finance for its system as they access NHS services. It may propose all manner of odd ways of interpreting the regulations; however PCTs are under a statutory duty to have regard to the NHS Constitution in performing their functions. This duty demands that all patients must be considered when "having regard to the arrangement as a whole" and their right to access NHS services without incurring a charge to the benefit of the provider (albeit indirect) must be enforced.

Prohibition of use of 084 numbers is both a natural informed interpretation of the regulations and the only interpretation that is compatible with the statutory duty to have regard to the NHS Constitution - which also applies to NHS GPs.

Continued use of a 0844 number, by a Surgery Line user, could only be permitted (on a technicality) if there were proof that the terms for migration to 034, as offered by Daisy Group, are not "reasonable". The BMA claims that this is the case and Daisy Group claims that its customers are compliant. Neither has offered evidence to show that the terms which Daisy Group imposes for migration to 034 are unreasonable.

Thursday, 1 March 2012

"Evidence" relevant to NHS GPs in breach of their contracts by using 084 telephone numbers

These comments are to explain the evidence from telephone bills submitted and published at this link - Evidence of NHS GPs in breach of their contract - and to outline the context in which it is provided.

This is a summary of an email message circulated to: Simon Burns MP, Minister of State (Health Services), the MPs serving the constituencies in which the listed practices continuing to use these numbers operate their surgeries, the "complaints" departments of the relevant PCTs and their Chief Executives.

The Context

The message quoted from the comments made by Mr Burns in reply to the parliamentary debate on 24 January, on the issue of NHS GPs in breach of their contracts by using 084 telephone numbers, as listed in this blogging. It concluded with the comment highlighted in this item - "PLEASE SEND US THE EVIDENCE".

I continued, commenting as follows.

I regret the fact that Mr Burns is apparently not seeking the precise, concrete evidence of compliance (i.e. of GP practices and PCTs having looked at published evidence of call costs) that he says is needed. Most claims of compliance are based precisely on carefully selected anecdotal examples of perverse effects and the subjective opinions of highly interested "friendly" parties.

Many have concluded that Mr Burns wishes to see copies of telephone bills indicating that telephone providers do indeed charge in accordance with their published tariffs, causing callers to actually pay more than the cost of an equivalent call to a geographic number to contact a NHS GP. I think it odd to assume that Mr Burns is challenging the integrity of the telephone companies and demanding precise evidence that they charge properly, whereas he is happy to accept that the most unusual circumstances apply to so many GPs (i.e. that a very particular group of tariffs apply to all of their callers) without requiring any evidence.

I have approached my own MP, a member of the government, who advises me that evidence from telephone bills is required by both Mr Burns and PCTs.

The Evidence

In the course of my campaigning efforts I have frequently spoken with practice managers to gain an understanding of how they see the situation and to verify points of detail about their position in relation to their NHS patients. This has involved me making calls to their expensive numbers, which are shown on my telephone bill.

It is important to understand that, although I am not a registered patient of these practices, these are nonetheless "relevant calls", as defined in the regulations, because I was discussing their provision of NHS services.

I have therefore been able to prepare the evidence which is published here.

I trust that each of those to whom this evidence has been presented will recognise their duties and responsibilities, not to me, but to the citizens whom they respectively serve.

Further points

I understand that many would wish to see information related to the surgeries from where the practices provide their services, rather than the identity of the practice. Unfortunately Mr Burns dismissed the evidence which I had presented of nearly 1,300 surgeries, stating "what they do not say is which practices they are". I had sourced my information from NHS Choices, which does not clearly identify the practice.

I have addressed this point by publishing a cross-reference covering all of the relevant cases at http://tiny.cc/GP084Practices.

I cannot provide any evidence of " overcharging". Quite the reverse, my evidence shows charges precisely in accordance with published tariffs, as it is intended to do.

A precise approach to this matter cannot entertain the foolish assumption that GPs, or their telephone system providers, directly determine any of the charges set by those who provide telephone service to their callers. GPs do need to understand that when their own telephone service provider benefits from a "revenue share" (as currently occurs with all 084 numbers), it is most likely that this additional cost to the call originator will be passed on to callers.

GPs do not however have any control over whether or not this happens, whether or not an additional premium is added, nor indeed any control whatsoever over the cost of an equivalent call to a geographic number. It is the possibility of the latter being less which is all that they have to address.

If anybody has any evidence of a NHS GP levying any charge whatsoever for access to NHS services, then this would indicate a most serious breach of the principles of the NHS.

If a "patient-focussed" health service is ever introduced to replace the "National" health service in England, it would be quite natural and proper for providers to charge for their services. We await proposals for how those charges may be regulated and perhaps subsidised from taxation, but that is for another time, as I see no such proposals in the current Health Bill.


The circulation of the message was as follows:

Simon Burns MP - Minister of State (Health Services);

Jon Ashworth MP; Jake Berry MP; Crispin Blunt MP; Angie Bray MP; Lyn Brown MP; Edward Davey MP; Mark Francois MP; Kelvin Hopkins MP;
Helen Jones MP; Eleanor Laing MP; Karen Lumley MP; Mary MacLeod MP; Greg Mulholland MP; Toby Perkins MP; Gavin Shuker MP; Rosie Winterton MP;

'Leigh Broggi, Customer Care Officer - NHS Kingston'; 'PALS - NHS Ealing'; 'Making Experiences Count Team - NHS West Essex';
'Complaints Team - NHS Leeds'; 'Customer Services - NHS Leicester City'; 'PALS - NHS Doncaster';
'Sonia Spurr, Patient Relations & Involvement Manager - NHS Worcestershire'; 'PALS - NHS Luton'; 'Customer Services - NHS South Essex';
'PALS - NHS Warrington'; 'PALS - NHS Hounslow'; 'PALS - NHS Surrey'; 'Monica Zenonos, PALS Manager - NHS Newham';
'Ms Linda Manson, Complaints Manager - NHS Derbyshire County'; 'Complaints Office - NHS Bolton';

Kathy Doran - Chief Executive - Cheshire PCT Cluster; Mike Burrows - Chief Executive - Greater Manchester PCT Cluster;
John Lawlor - Chief Executive - Airedale, Bradford and Leeds PCT Cluster; Andy Buck - Chief Executive - South Yorkshire and Bassetlaw PCT Cluster;
David Sharp - Chief Executive - Derbyshire PCT Cluster; Catherine Griffiths - Chief Executive - Leicestershire PCT Cluster;
Eamonn Kelly - Chief Executive - The West Mercia PCT Cluster; Angela McNab - Chief Executive - Bedfordshire and Luton PCT Cluster;
Sheila Bremner - Chief Executive - North Essex PCT Cluster; Andrew Pike - Chief Executive - South Essex PCT Cluster;
Anne Rainsberry - Chief Executive - NHS North West London; Alwen Williams - Chief Executive - NHS East London and the City;
Ann Radmore - Chief Executive - NHS South West London; Anne Walker - Chief Executive - Surrey PCT Cluster

Tuesday, 28 February 2012

Daisy Group confirms how its Surgery Line users fail to comply with NHS Regulations on use of 084 telephone numbers

UPDATE !! (1 March 2012)

Since this blog entry was first published, the content of the Daisy Group document being discussed and linked to below has been removed, being replaced with the legend "Update Coming Soon".

I am not aware of any change to the nature of telephone tariffs that could affect what is needed to achieve compliance with regulations that cannot be amended without the approval of parliament.

When the updated version is published, I will reconsider the comments published below.

In the meantime (for reference purposes only), I have uploaded a copy of the release of the document to which the comments below refer. It may be viewed at this link.

Daisy Group has, perhaps unintentionally, placed NHS GP users of its Surgery Line telephone system in an almost impossible position, if they are seeking to pretend that they can continue to use 0844 telephone numbers.

It has published a document, oddly entitled "Statement of Compliance with NHS Regulations". The statement suggest a possible basis for compliance, but only in the event that all callers to the practice can be shown to fall into certain very particular groups. As this does not include subscribers to the most widely-used landline tariff - BT Unlimited Anytime - it is difficult to see how any GP could possibly comply.

This Statement has to be seen in the context of the recently published confirmation of the relevant regulations, issued by the Department of Health - "The use of 084 numbers in the NHS".

This guidance confirms what is necessary for a user of a 084 number to achieve compliance:

The GP must be able to establish that all callers are not paying more to call its number than they would to make an equivalent call to a geographic number.
OR... if it is unable to do so ...
The GP must be able to show that the cost imposed for following any remedy (e.g. migration to the equivalent 034 number) is "unreasonable".

Daisy addresses these points as follows:

It suggests ways in which a severely limited and highly selective view of the array of relative call costs incurred under the terms of the many tariffs available to callers could lead one to conclude that callers do not pay more to call the 0844 numbers that it provides to its Surgery Line customers. (See below)
It confirms that Surgery Line users may operate the system effectively by using either 084 or 03 numbers. Daisy confirms elsewhere that this includes the 034 range which is reserved exclusively for the purposes of migration from existing 084 numbers (see "Surgery Line - Different Number Ranges"). Daisy offers no evidence to show that it imposes unreasonable charges on those who choose to migrate.

The latter point is especially important, because this dismisses the argument of the BMA, which claims that the costs of compliance which would be incurred on migrating from a 084 to a 034 number are unreasonable (see "BMA disputes DH guidance on premium rate practice phone numbers").

For the statement to offer a full assurance of compliance, and to support the allegations made by the BMA, it would have to provide clear evidence that Daisy imposes "unreasonable" costs for migration.

How GPs could be able to comply whilst continuing to use a Daisy 0844 number

The relevant regulations have always allowed for the possibility that 084 numbers could continue to be used under very particular circumstances. It is for the GP to demonstrate that these circumstances exist for their callers.

The Daisy statement offers some such examples, suggesting that its customers may be able to demonstrate that these apply to them. As it is necessary to make a determination "having regard to the arrangement as a whole", calls from all types of telephone service and tariff have to be considered. I highlight a summary of the position for each, as given in the Daisy statement, below.

The statement confirms that Surgery Line customers generally use "type g11" and "type g6" 0844 numbers, "because a portion of the income generated from calls (equivalent to roughly 4p and 5p per minute respectively, including VAT) can go towards funding the cost of the enhanced telephony system and other improvements to the surgery". One might think it foolish to pretend that such income could be provided other than through additional call charges, however Daisy contends that a GP may be able to show that only perverse cases apply to callers to its surgeries, so as to support a claim of compliance with the regulations.

Public Payphones

Daisy states that calls from public payphones represent less than 1% of calls made.

As the rate for calls to all 0844 numbers is greater than that for calls to geographic numbers (£1.00 vs £0.60p for the average duration call claimed by Daisy), a GP seeking to show compliance would have to demonstrate that this low rate of usage of public payphones was in fact zero in the case of calls to its surgeries.


Daisy offers only what is described as being the "best possible comparison". These words are well chosen, as is the particular singular example used - "BT Unlimited Weekends". (I refer to "best" as being from the perspective of one seeking to demonstrate compliance - this example is in fact most unusual and even perverse.)

BT is prohibited by regulation from adding to the rate of the revenue share passed on to the benefit of the user of a 0844 number. The rates for these calls are fixed (see above) and they are not included in any Calling Plan. The rates charged by BT for geographic calls are not regulated (this regulation ended in 2007).

BT offers customers the choice of a Call Plan to reflect the times when they make calls. The "Unlimited Weekends" Plan covers calls to geographic numbers made at the weekend. If making calls to geographic numbers at other times there is an "out of plan" penalty charge, currently 7.95 pence per minute for weekday daytime calls.

The most popular Call Plan for BT customers is "Unlimited Anytime", which covers calls to geographic numbers at all times. If any significant number of callers to a GP subscribe to BT Unlimited Anytime" - the most commonly applicable landline tariff, then it cannot comply with the regulations all calls to 0844 numbers will cost more - ensuring non-compliance.

The rates given by Daisy are the "out of plan" charges which apply to " BT Unlimited Weekends" subscribers, for calls to the 0844 numbers provided to its customers (not all 084 numbers, as stated). There is a minor error made in stating the name of the Call Plan - it is given as "the BT weekend anytime plan". I sincerely hope that this error is not likely to cause confusion between the "Weekends" and "Anytime" plans! If anyone were able to show that any such confusion was deliberately generated by Daisy, rather than being the result of an uncorrected error, then this would be a most serious allegation to make.

Choice of this very particular example, exploits the perverse effect of obsolescent regulation on BT (Ofcom proposes to lift this shortly) and ignores the fact that calls originated by BT represent less than 40% of residential landline calls.

A Surgery Line user contemplating a claim of compliance on this basis would need to offer evidence to support Daisy's claim that consideration limited to this one tariff, under which callers incur a penalty charge for "out of plan" calls to geographic numbers, is adequately "comprehensive".

Mobiles - contract

Daisy claims that one cannot consider the possibility of those who benefit from calls to geographic numbers being included in bundles paying more to call 0844 numbers, which are never included. It suggest that to do so one would have to determine an assumed rate for the inclusive call, which it rightly maintains is "virtually impossible to ascertain".

This suggested theoretical approach ignores the reality of the situation, which is that when making a call the caller has already committed to whatever package they have. If the cost of a non-inclusive call is additional (as it would be for anyone who does not exceed their package allowance) then it must be more expensive.

A Surgery Line user contemplating a claim of compliance on this basis would therefore have to offer evidence to show that no caller would be able to call a geographic number within an allowance, i.e. with no additional cost. As many mobile packages offer "unlimited", rather than "bundled", calls to geographic numbers, this would be rather difficult, one could say "virtually impossible".

Daisy refers to evidence about the average cost of "out of bundle calls ... to an 084 number from a contract mobile phone". This data will include calls to the more numerous 0845 numbers, which have a much lower "revenue share" component, are subject to termination rate penalties imposed by BT and are therefore commonly charged at a lower rate. Published tariffs show that "out of bundle" calls to 0844 numbers are frequently far more expensive. This evidence is therefore of no relevance, as it does not address the particular issue. The issue of compliance in respect of callers from contract mobiles is fully addressed above.

Mobiles - PAYG

Daisy points out that PAYG users make fewer calls than contract users. Indeed the high cost of all calls would mean that they would only use them for important calls, such as contacting their doctor.

Daisy claims to have undertaken an analysis of selected providers "having a 55% market share and found that their charges for calls to (unspecified) "non-geographic numbers" were no greater than those of calling geographic numbers. (Daisy makes no comment about the relative cost of calling the particular numbers in question!)

Whilst there could be quibbles about Vodafone, O2 and Tesco Mobile because geographic calls are only cheaper in some cases, there is no question that Orange, T-Mobile, 3, Virgin Mobile and many others invariably charge PAYG users more for calls to 0844 numbers than geographic numbers.

A Surgery Line user contemplating a claim of compliance on this basis would therefore have to show that none of its PAYG callers subscribed to the tariffs of the providers listed above, or, in some cases, not to particular tariffs..


It is theoretically possible for a GP to conduct the extensive research required to establish that all of their callers fall into the particular groups, as suggested by Daisy, and as necessary to prove compliance. One would hope that any PCT verifying compliance would take the trouble to go through this evidence, so as to ensure that no significant possibilities had been missed. It is very difficult to imagine how such an exercise could be undertaken properly, given the numerous possibilities that have to be excluded.

The one important point, and perhaps the "clincher", is that subscribers to BT Unlimited Anytime - the most widely used landline tariff - invariably pay more to call the 0844 numbers used by Surgery Line customers than an equivalent call to a geographic number. It is for Daisy to advise its customers in whatever way it wishes, however it is fair to draw attention to the omission of the most widely used landline tariff from its briefing.

Thursday, 23 February 2012

What to do if you are paying too much to call your NHS GP

If your GP is using a 0844 or 0845 telephone number and this costs you more than the cost of an equivalent call to a geographic number, then the practice is in breach of its NHS contract.

(In theory, there may be circumstances in which it is unable to migrate to the equivalent 034 number, but I have seen no evidence of any such case.)

My suggestions for actions you may wish to take follow. Please contact me at any point for detailed advice, support and assistance.

Update - 24 February 2012

This briefing was published before I became aware of the Further Guidance issued by the Department of Health, as covered by this item. My Suggestions are unchanged, as this Guidance does not in any way change the position. The only possibility is that more PCTs and practices will consider complying, if they had previously failed to take the trouble to understand the terms of contract revisions.

The efforts of Which?

I support the efforts of Which? to use its position to collect a large amount of evidence so as to draw attention to this issue. I do not however believe that the failure of the government to take action has got anything whatsoever to do with it being unaware of what is happening.

My Suggestions

Remind the practice that it is under a contractual duty to "ensure that, having regard to the arrangement as a whole, persons will not pay any more to [call the practice] than they would to make equivalent calls to a geographical number".
οAsk if you are considered as being a person who calls the practice - part of the arrangement as a whole.
οAsk for a copy of any confirmation of compliance provided to the Primary Care Trust, which administers the contract. This may cover the relative cost of calling or the inability of the practice to migrate to the equivalent 034 number.
οLet the evidence speak for itself. It is the duty of the Primary Care Trust to enforce the terms of the NHS contract; this has nothing to do with any contractual relationship between you and the practice. Not yet anyway!
Speak to the Primary Care Trust PALS department and ask if they are enforcing the requirement for GPs not to use telephone numbers that cost callers more than the cost of an equivalent call to a geographic number. You will probably need to continue the exchanges in writing.
Many PCTs have chosen to adopt their own policy of tolerance, rather than enforcing the terms of the contractual requirements.
οIf the practice is deemed to be compliant with the PCT policy, ask for a copy of this policy and the evidence provided by the practice to demonstrate compliance with that policy.
οIf the PCT indicates that it is enforcing the terms of the contract, ask why this requirement has not been enforced in the case of your GP, as the deadline for compliance was 1 April 2011. Offer your assistance.
Contact your local media to advise that the NHS in your area has been suspended as a universal service and that your rights to access services without charge are not being enforced. They will be keen to know of:
οThe reality of the situation for you
οThe false evidence of compliance provided by the surgery
οThe improper policy being followed by the Primary Care Trust
Raise a complaint with the Health Service Ombudsman against the accountable officer for the Primary Care Trust (the Chief Executive of the PCT "Cluster") for failing to discharge their statutory duty to have regard to the NHS Constitution in exercising their NHS functions.
οThe stated policy of the Trust should represent adequate evidence of this failure in respect of:
οThe right to access services without charge.
οFailure to apply the principle that NHS services are available to all on equal terms.
Approach your MP to see if they are prepared to support you in presenting a formal complaint to the Parliamentary Ombudsman regarding the failure by the Department of Health to ensure enforcement of the contractual requirements. This failure is most clearly demonstrated by:
οFailure to recognise evidence of breaches, as declared by the Minister in parliament.
οFailure to contradict false statements about the Department approving use of expensive numbers when provided by a certain company. (False allegations about the Department's position have been accepted by many PCTs.)
οFailure to respond to requests for clear guidance from PCTs. Further guidance has been promised to, and expected by, PCTs since April of 2011 - but none has been issued.

I recognise that many will be reluctant to follow all of these steps. I have myself approached every PCT in England over the last two years with briefings and urging them to respect the principles of the NHS. I have also briefed every MP with constituents who are affected.

My own GP is happily one of the many who support the principles of the NHS. The head of practice has confirmed to me that he "would not touch of on those expensive numbers with a bargepole".

Why this is necessary

The current UK government clearly believes that, like its predecessor, it is responding to public demand in seeking to replace our beloved National Health Service, funded by taxation, with an alternative system which will, in time, be largely funded by insurance and cash payments to GPs and other service providers. It can however only do so for England, unless it reverses provisions of the devolution settlements.

It is for those of us who do not wish for this to make it plain that we are not prepared to accept the principles of the NHS being disregarded, whilst they remain in force, and even before the necessary provisions have been placed before parliament. It is important for campaigners to understand that the current Bill does not itself replace the NHS. It simply removes the structures that enable it to work as a National service and replaces them with alternatives suited to a consumerist alternative. Rather than putting in measures to address the inevitable growth in public spending on healthcare, it opens the door to unlimited spending - in the sure knowledge that this cannot come from the public purse.

Tolerance of a few pence or a few pounds cost to provide a subsidy of a few pence on every telephone call is a very modest breach of the principles of the NHS. A clear and determined failure to respond to the challenge to address this abuse cannot but indicate that these principles mean nothing. What is perhaps worse is that they are being disregarded, whilst being defended with worthless words.

Monday, 20 February 2012

Open message to Simon Burns regarding NHS GPs using 084 telephone numbers

To: Simon Burns MP, Minister of State (Health Services)

Cc: MPs attending the debate on 24 January - notably Bob Ainsworth MP, Primary Health Media, Health Bill campaign organisations

Mr Burns

NHS GPs in breach of their contracts by using 084 telephone numbers

In responding to the Westminster Hall debate on this matter, on 24 January 2012, you stated (at Col 55WH):

"People say that there are 1,300 GP practices that charge more than they should; what they do not say is which practices they are, and they do not provide the robust proof that overcharging is happening".

If you were referring to myself and those who have repeated the statements in my briefing "Parliament to debate 'Use of 084 telephone numbers in the NHS'", then you misrepresented my position.

The number of cases

In my briefing, I stated "nearly 1,300 NHS GP surgeries in England continue to use these expensive numbers".

As you appear only to be interested in information presented by "practice", rather than "surgery", I have now taken great efforts to identify the practice to which each of the surgeries presenting a 084 number on NHS Choices belongs.

I have published this list of practices, with links to the relevant surgery entries on NHS Choices, to be accessible via this link - http://tiny.cc/GP084Practices.

There are 1,050 practices listed, with 222 additional surgeries, giving a total of 1,272 surgeries - "nearly 1,300".

"Overcharging" by GPs

I have never suggested that NHS GPs are over-charging. I am most disturbed by your quoted suggestion that NHS GPs "should" be able to impose some charge, but that the permitted level is alleged to be being exceeded.

I recognise that you are currently seeking to defend proposals for a new "patient focussed" health service to replace the UK’s "National Health Service" in England. Under such a consumerist system, costs would naturally be expected to properly fall on the patient, rather than the nation, through charges imposed by the provider. We are however still dealing with the NHS, not some future system in which the principle of "free at the point of need" is replaced, perhaps by "individuals get what they pay for".

The revised NHS GP contract terms address only the cost incurred by callers as a consequence of the choice of telephone number made by the practice, not any charge that is directly imposed. It should be obvious that, when setting their charges, telephone companies pass on the cost of the revenue share, which they incur when originating calls to all 084 numbers.

Apart from a few tariffs where exceptional circumstances apply, this will cause the cost of a call to a 084 number to exceed that of an equivalent call to a geographic number. The contractual requirement to make determinations "having regard to the arrangement as a whole" precludes exclusive use of these exceptional cases.

I have never made the foolish mistake of suggesting that GPs, or any other third parties, exercise any control over the relative call costs. Furthermore, I have continually sought to draw attention to the fact that the relative cost incurred by a caller cannot be affected by the connected telephone system or the provider of the number. You will be aware that the evidence of compliance offered by most 084-using GPs is based on this false assumption.

Links to the published tariffs of widely used telephone call services are published via the link - http://tiny.cc/GP084Costs, where I also summarise the relevant relative call costs in a table.

In summary

I must urge you to turn your attentions away from a pointless search for evidence of "overcharging" by NHS contractors and to look at the evidence of breaches of the actual contractual requirements which I present to you. Arguments about the permitted levels of charging under your proposed "patient-focussed" alternative health service have nothing to do with this issue, until (if ever) it has replaced the NHS in England.

For the time being, your duty is to administer those aspects of our National Health Service for which you are responsible, on behalf of the people of the UK. The same applies to your opposite numbers in the other three responsible governments and all others holding relevant managerial responsibility. Until the statutes which confer this responsibility are superseded, those duties remain in place.

I would be grateful if you would confirm receipt of my evidence, in response to your specific request, and advise how it will be used in discharging your duties. If there is any aspect of this on which you or your officials are unclear, please contact me and I will be delighted to help you further.

I look forward to hearing from you.

Sunday, 29 January 2012

Open message in response to the letter to the Telegraph - "NHS in peril"

Dr Gordon

I am interested to note your letter to the Telegraph, which has been taken as support for the efforts of the Government to eventually replace our National Health Service, funded exclusively from taxation, with a patient-focussed English Health Service, funded by patients with some central government support. Articles such as this Daily Telegraph piece have presented you and your colleagues as opposing efforts to encourage parliament to reject the bill that would enable this to come about.

I see that 5 of your co-signatories are not currently in general practice, however it is 8 of the remaining 50 that cause me most concern.

I refer to:

Dr Andy HarrisDr Amit BhargavaDr Kamal BishaiDr Stephen Madgwick
Dr Vaishali NandaDr Stewart FindlayCharles BroomheadDavid Eyre-Brook

With the exception of the latter, all serve in practices which use 084 telephone numbers, in breach of the revisions to the respective NHS contracts, which were introduced in 2010.

Dr Eyre-Brook's practice is used as a case study for the most widely used surgery telephone system that is allegedly funded exclusively by patients, and provides an additional 2p of income for the surgery - see "Surgery Line sounds too good to be true".

I raise two points with respect to this matter and these individuals, given that the replacement of the NHS referred to above has not yet occurred.

•    If these individuals are thereby seen not to be personally committed to the principles of "our NHS", as they stand and will remain, then one must question their suitability to have a leading role in procuring NHS services.

•    If, as some have alleged, those who procured these telephone systems for NHS surgeries were not aware that they would be funded by patients, then one must question their competence to lead bodies concerned with commercial matters.

It is vital that NHS money is spent wisely and that current clinical experience, derived from engagement with patients in general practice, is deployed to ensure this.

We cannot however have decisions made within the NHS led by those who are content to disregard its principles, because they support an alternative system for healthcare in England, or who are ready to believe sales pitches that are "too good to be true".

It is my personal view that GPs are better able to serve the NHS from outside its structures, rather than taking on the responsibilities of a public servant. I see their professional focus and skills as continuing to be best focussed on meeting the clinical needs of their patients, regardless of cost to the public purse. Responsibility for the effective, equitable and accountable management of public resources is an onerous and quite separate duty. I accept that we must differ on that point, or alternatively you believe that the NHS will have effectively ended in England from the point when CCGs acquire their authority.

If the latter were to be true, then those who accept the responsibility of public servants would no longer be required to ensure that publicly funded health services were only delivered "free at the point of need". The leaders of CCGs would thereby be able to focus exclusively on patients, without having to be concerned about the wider public interest and nationally set principles.

I would be pleased to hear any response from yourself and from the individuals who I have identified and copied.

If the practices in question may believe that they are not in breach of their contracts, because all callers subscribe to the few telephone tariffs that cause them not to pay more than the cost of an equivalent call to a geographic number to call a 084 number, then I must draw their attention to an appeal from Simon Burns, Minister of State (Health Services).

Responding to a debate in parliament on this matter last Tuesday (Hansard Column 54WH 24 Jan 2012), Mr Burns said "... we need the evidence. We do not need anecdote or the 'friend of a friend', who has said this or that. We need precise, concrete evidence, to be able to pursue this matter" ... "I say to the right hon. Gentleman, and to anyone else who has an interest in this important subject, ‘Please send us the evidence’".

If these practices have complied with the contractual requirement to "consider whether, having regard to the arrangement as a whole, persons pay more to make relevant calls than they would to make equivalent calls to a geographical number", then this evidence will be readily available. If your colleagues wish to show themselves to be keen to protect the NHS from the perils of "co-funding" then I am sure that they would wish to clearly demonstrate that they and their practices reject this and are compliant with their contractual obligations.

I would also be very interested to see a copy of any such evidence myself, as I cannot see how it could possibly have been assembled.

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