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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.

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