As Pathfinder GP Consortia stand ready to take over the NHS from public bodies and parliament prepares to debate a NHS (Abolition?) Bill, I seek to recruit MPs to defend the principles of the NHS on behalf of their constituents and all other citizens. (See my message.)
A change to the GP contract was introduced last year, giving GPs 12 months in which to cease use of what are now known as "Business Rate" telephone numbers. Ofcom is currently consulting on proposals which would require all users of 084 telephone numbers to advise the Service Charge incurred by callers e.g.
"Calls to the Surgery are charged at 5p per minute plus your telephone company's Access Charge."
Under the terms of their revised contract NHS GPs have until 31 March 2011 to cease use of telephone numbers that are more expensive to call than a Geographic Rate number, which cannot cause a Service Charge to be incurred. Network telephone service providers enable their customers to migrate from Business Rate 084 numbers to the equivalent Geographic Rate 034 number within the term of their contract for network telephone service, so no major disruption is demanded. One would therefore think that is was a quite straightforward matter for the principle that NHS services are provided without charge to the patient to be re-asserted in practice.
The BMA GPC opposes the principles of the NHS
The General Practitioners Committee of the BMA declares a policy position stating that patients should pay for improved NHS services according to the quality of service provided. It therefore supports use of Business Rate numbers by NHS GPs. As this view was not shared by the (previous) government when it introduced the GP contract revisions, the BMA has sought to undermine their implementation. Working with the primary provider of surgery telephone systems partially funded through Service Charges paid by patients, the BMA has urged its members to utilise a false assurance from this company that Business Rate telephone numbers are not more expensive than Geographic Rate numbers.
This assurance is of course untrue, however there are some cases where landline callers subscribe to a tariff that is based on normal calls being inclusive. They therefore incur a Penalty charge for calling a Geographic Rate number outside the terms of their Call Plan. This Penalty Charge can be greater than the cost of calling a Business Rate number, which is never included in their Call Plan. This perverse effect is a feature of some caller's telephone tariffs and it results from legacy regulation of BT, which Ofcom now proposes to belatedly remove.
This effect has nothing whatsoever to do with the alleged capability of any GP or their telephone company to set a generally low rate for callers – there is no such facility, they can only determine the scale of the premium “Service Charge”. Unfortunately the Department of Health has allowed itself to be misled on this point, into the false assumption that some 084 numbers are not more expensive than Geographic Rate numbers, when this situation can only occur when patients select an inappropriate landline tariff from some telephone companies.
The Department of Health stands back
The Department of Health has refused to acknowledge its error, taking a neutral stance by resting on the fact that if the terms of the contract revision are applied correctly then use of expensive numbers must be ceased. As the terms of the requirement are explicitly based on a false assumption and a false basis for compliance is being recommended to contractors, proper application will not come easily. It is clearly seen that in the nine months which have passed only a handful of the 1000 or so GPs have changed away from their 084 numbers, or intend to do so.
(A similar effect was seen with NHS bodies, who were subjected to the same requirement with a deadline of 21 December 2010. A number of Hospitals and PCTs continue to use 084 numbers in breach of Directions that they should cease the practice. Most notable is NHS Direct, which has the 0345 4647 Geographic Rate alternative to its Business Rate 0845 4647 number set up and ready for use in parallel, but refuses to make this available.)
Parliament to rescue the NHS?
I have today written to the 33 MPs with 5 or more 0844-using GPs in their constituency urging them to become engaged in this matter on behalf of their constituents. As our parliament starts to consider changes to the NHS management structure to "LIBERATE" it from the central control that enforces adherence to its fundamental principles, I urge all those who claim to support "our NHS" to join the fight to ensure that these principles remain and to show that, in this relatively modest case, they can be re-asserted.
The draft of my message to the MPs is published as - Message to MPs brought into the fight to eliminate NHS telephone Service Charges. Further comment, detailed explanation and references is published as - MPs brought into the fight to eliminate NHS telephone Service Charges.