Some comments on Government policy, as revealed on debating 084 telephone numbers in the NHS

I comment on remarks made in the Westminster Hall debate yesterday on "084 telephone numbers in the NHS". I pick out specific points with reference to government policy for comment. This note does not intend to convey the general thrust of the arguments, nor present a comprehensive summary. In each case, I quote the relevant text from the remark, covered by a link to the Hansard text for context.

At the moment, the Minister is trying to convey to the House that the NHS will not be made unaccountable through his health Bill, and it would really help his argument if he made an effort to show that he is prepared to make the NHS accountable, as it currently is.

This point neatly draws in the wider political context.

The Government’s position is extremely clear—when patients contact their GP or anyone else in the NHS, they should not be charged more than they would be to call their next-door neighbour’s landline. Those are the rules. ... [there is] a contractual requirement for GP surgeries to ensure that that is the case.

This appears to be an unequivocal statement about "the rules". (The catch comes later.)

If they found that patients were being charged more than a standard local landline call, they had one year to take all reasonable steps, which could include varying the terms of their telephony contract, cancelling the contract, or offering an alternative number to call, such as an 03 number, which charges callers at a local rate.

There are two small points of confusion here. Firstly here, as should be said throughout, the point of comparison is with a "geographical call", not a "local call" - there is no longer a distinct "local rate".

Secondly, use of a 03 number arises as an option for varying the terms of the telephony contract (to replace the 084 number). There is no provision in the terms of the regulations or contract revisions to cover publication of alternative numbers alongside those which are "banned".

We must also be clear that the additional services can also be offered on other number ranges—such as 01, 02 and 03—and GP practices should feel able to choose the number that is most suitable for their patients, provided that it does not cost them any more to call.

This expresses the position very clearly.

I fear that banning 084 numbers would not be the panacea that Opposition Members might believe it to be. ... The 2010 regulations make it clear that patients must not be charged more to contact their GP than they would be if they called a local number.

The Minster fails to recognise that the requirements that have been imposed do effectively amount to a ban on use of all 084 numbers, under present conditions. There is no 084 number which does not cause, at least some, patients to be charged "more", by their telephone service provider.

The legislation is absolutely clear that if a person calls a GP surgery with an 084 number from a mobile, landline or payphone, they should not pay more than they would if they called a local landline number from the same phone.

This is nonsense. The regulations cannot address what telephone service providers charge for calls to 084 numbers, neither do GPs or their telephone providers have any control over this. It is because callers do pay more that 084 numbers cannot be used by GPs.

GP practices and their PCTs should look at evidence of call costs to determine whether their patients are being charged more than they should be. Such evidence could include cost-per-call information from providers, such as O2, Vodafone and BT. A suitable sample should be considered, bearing in mind the different contracts that patients can choose to sign up to.

It is not for GPs or PCTs to determine whether customers of telephone companies are being "charged more than they should be". They must consider only what they are paying to call the GP, relative to the cost of a call to a geographic number.

Evidence of the relative call costs incurred under the terms of commonly used tariffs has been published and drawn to the attention of all PCTs and the Minister. (It is available at this link.)

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

This is most likely a reference to a briefing document that I issued prior to the debate; it is however misrepresented.

I refer to "nearly 1,300 NHS GP surgeries in England". This text is covered by a link to a summary by nation and region, in turn linked to lists and maps containing the details of 1,292 cases (some of which are pending removal, so the actual number is a little smaller). These are "surgeries" not "practices", so the number of practices is yet smaller.

I have never implied that it is the practices which impose the charges on callers or that the charges made are improper. The practice only has a duty to determine what callers pay, relative to the cost of an equivalent call to a geographic number.

... overcharging ... overcharging ... overcharging ....

This is not about "overcharging". Telephone call charges are set by telephone companies. It is perfectly reasonable for a telephone service provider to recover the cost of the revenue share that is paid on to the benefit of the user of a 084 number.

GPs only have a duty to ensure that "persons will not pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number". They can only do this by using a number that is assured not to be charged at more than the cost of a call to a geographic number.

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.

It is regrettable that PCTs have indeed, as the Minister says, failed to obtain precise concrete evidence of compliance from GPs. The assurances which they have provided are based on a single "anecdotal" case, which was presented to the Department of Health in the course of the public consultation.

The relative call cost information used by GPs has been obtained not from some authoritative source but precisely from "a friend of a friend". The BMA has commended use of advice from the very provider of the telephone system, the cost of which is subsidised by the proceeds from the revenue share.

Unless the Minister still believes, like his predecessor in 2005, that 084 numbers offer callers a "guaranteed low rate", then it must be for GPs to offer the "precise concrete evidence" of compliance that he demands. The duty to determine relative call costs under the terms of the contract rests on the GP, not on its patients.

The Department will soon clarify the existing guidance, which I hope will help GP practices and PCTs to understand this issue more fully and to dispel some of the myths and misunderstandings about the use of 084 numbers.

I sincerely hope that the Department will also be able to dispel some of the myths and misunderstandings promoted and demonstrated by the Minister. This clarification has however been expected "shortly" (the word actually used by the Minister) since April 2011. This evidence-based interpretation of the word "shortly" may provide some understanding of when the clarification will actually be issued.

This Government are committed to creating a patient-focused NHS ... It is right that GPs remain responsible for their own access arrangements, including their telephone number

The reluctance of the government to ensure enforcement of nationally-set regulations that reflect the principles of a National Health Service is very clear from this statement.

GP practices are adhering to the regulations and not costing patients more than they should. The PCTs vigorously enforce the regulations.

Clearly this is what the Minister wishes to believe. It is simply untrue.

I hope that this debate has not only clarified the situation but has set a challenge to the right hon. Gentleman and others to provide evidence if they have it or come across it, so that if there are any abuses we can put an end to them.

I would have been delighted to hear some meaningful comment on the evidence that I have provided. It is however not clear as to whether this has not been read (as is strongly implied by the suggestion that it does not include a listing of cases) or whether the government regards co-payment for access to NHS services as being acceptable.

In fact, I believe that the government wishes to replace a National Health Service, funded by taxation, with a patient-focussed health service, funded mostly by patients, with some central financial support to maintain the "NHS brand".