In the course of changes to the NHS, the government is reluctant to impose regulatory constraints on GPs. This apparently includes neglecting enforcement of a contractual requirement to adhere to the principle of not charging patients for access to NHS services!
Changes to the GMS contract were introduced in April 2010 to prohibit use of telephone numbers that cost more than "Geographic Rate" (see clause 29B of the GMS contract). Many NHS GPs continue to use "Business Rate" 0845 and 0844 numbers as the deadline for compliance (31 March 2011) approaches.
I have been pressing Simon Burns, the Minister, to take strong action to ensure that Primary Care Trusts rigidly enforce the terms of this contract revision.
I now have an answer ...
In his response to a parliamentary question on the subject, Mr Burns makes no reference to the changes to the GP contract, referring only to Directions to NHS bodies, which came into force on 21 December 2010. He even uses the term "guidance" when referring to action necessary to protect the fundamental principles of the NHS!
This serves to confirm my fear that "liberating the NHS" means freeing GPs from the obligation not to charge patients for access to NHS services. If existing contractual provisions are not to be enforced, there can be no assurance that further "liberation" will not open up greater opportunities to obtain funding for NHS services from patients, as they access them.
It may be noted that the Directions to NHS Bodies have not been enforced, as many continue to use expensive telephone numbers - e.g.
Northumberland, Tyne and Wear NHS Trust - 0844 811 5522;
Northumbria Healthcare NHS Trust - 0844 811 8111;
North East London NHS Foundation Trust - 0844 600 1200;
Gloucestershire Hospitals NHS Foundation Trust - 08454 222 222;
Gloucestershire Primary Care Trust - 08454 221500.
NHS Direct refuses to offer 0345 4647 (which is setup and ready to use) as an alternative to 0845 4647 for remainder of its life in England - it will continue in Wales. NHS Direct has also taken advantage of an exemption from the terms of the Directions to retain very many 0845 numbers for the Out of Hours GP and other contact services that it provides to a very large number of PCTs.
It should also be noted that access to NHS Dentistry, Pharmacy and Ophthalmology services is not covered by the (supposed) prohibition on use of expensive telephone numbers.