In its July 2011 newsletter the BMA General Practitioners Committee disputes the accuracy of a statement made to parliament, and advises members using 084 numbers that they are not bound by the terms of their NHS contracts.
See "Guidance for practices using 084 numbers" in BMA GPC Newsletter July 2011 (p7).
See "GPs (Premium Rate Telephone Numbers)" in Hansard 12 July 2011 Cols 149/150.
The essential argument from the BMA GPC is that if members have been misled by their own telephone system provider, they can continue to breach the terms of their NHS contract, obtaining subsidy at the expense of patients, for the 5 year duration of their arrangement with that provider.
A number of NHS GPs have entered into such arrangements in the last few weeks (contact me for details).
The BMA claims that the Minister misled parliament when stating: "Since April this year, GPs have not been allowed to use a number that charges patients more than the cost of an equivalent geographical call."
To make its point, the BMA relies on the fact that one provider of surgery telephone systems has decided that the only "patients" covered by this statement are those who happen to be subject to a particular tariff of charges from a particular telephone company.
Furthermore, the BMA also denies the fact that all network telephone service companies allow customers to migrate from 084 to 03 numbers at any point during the term of a contract, without penalty.
IT IS A DISGRACE FOR AN ORGANISATION WHICH IS NOW COMMITTED TO CAMPAIGN AGAINST THE DANGERS POSED BY GOVERNMENT NHS REFORMS TO ITSELF BE ACTIVELY ENGAGED IN SUPPORTING THIS MEANS OF UNDERMINING THE PRINCIPLES OF THE NHS.
I am at a loss to understand how the BMA can support and promote the notion that only some patients are entitled to access NHS services "free at the point of need".
BMA Guidance to Members
The BMA made its policy position very clear in the original guidance to members it published in January 2010 -
GPC GUIDANCE: USE OF 084 NUMBERS IN THE NHS, January 2010)
"... calls to NHS services should incur as low a charge as possible, but that this must be balanced by the quality of communications service that the patients are accessing."
The government had rejected this argument, refusing to alter the NHS Constitution to cause NHS patients to pay according to the "quality of service" received. Through this guidance, the BMA therefore sought to undermine the objectives of the regulations intended to outlaw use of subsidy from patients.
Following the recent statement in parliament, the BMA has now revised its guidance -
GPC GUIDANCE: USE OF 084 NUMBERS BY GP PRACTICES, July 2011.
It no longer states its policy position, but continues to oppose attempts to eliminate the illegal practice of NHS providers subsidising their costs at the expense of patients.
There are three points in the guidance which highlight this approach.
1 - Cost of calling from Mobile Phones
The answers to questions in parliament included the comment: "It is absolutely clear that there is no distinction between landlines, mobiles or payphones. The directions are very clear that patients should not expect to be charged any more."
The BMA disagrees that this is a fair interpretation of the following statement from the contracts: "persons will not pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number".
The BMA argues that because there is no specific reference to mobile phones, GPs may ignore the fact that many patients will use a mobile phone to call the practice -
"The regulations do not include any specific requirement for practices to consider the cost of calls from mobile phones. In terms of call tariffs, the call rates which patients are charged depend on their mobile phone service provider. It is a matter for individual members of the public to ensure that they are happy with the terms and conditions of the mobile phone arrangements that they enter into with their mobile phone provider."
It is most odd to suggest that in 2009, when the regulations were drafted, "calls to the practice" would not be reasonably understood to include calls from mobile phones and that "persons" who are unable to obtain a landline are not covered by the rights under the NHS Constitution. That is however the BMA position.
2 - Providers of telephone systems to GPs
The BMA suggests that providers of GP telephone systems are competent to advise on whether the number used by the GP is compliant with the terms of their NHS Contract. THIS IS DEMONSTRABLY UNTRUE.
"It is the practice’s responsibility to satisfy itself that the requirements of the regulations are met. One way for a practice to do this is to contact the company providing telephone services for the practice, and ask them to confirm that the practice’s contract is compliant with the current GMS and PMS regulations. As noted above, the main telephone service providers are aware of the new regulations, and should be able to provide this statement on request."
The major provider of surgery telephone systems - Network Europe Group, now owned by Daisy Group (led by "The Apprentice" star Matthew Riley) - advises that all 084 telephone numbers are compliant with the relevant regulations.
In doing so, it disregards the possibility of calls being made:
• ... from Mobile Phones
• ... from Public Payphones
• ... from Landline Call Providers other than BT
• ... within the terms of a BT Call Plan
Whilst there will be some who remain after all of these possibilities are excluded, the NHS is a universal service. There is nothing in the drafting of the contracts under which GPs provide NHS services to suggest that this type of extensive qualification should be applied to a determination of whether or not use of a particular number is prohibited.
3 - The need to incur penalties on varying a contract
The BMA suggests that GPs in long term contracts for telephone service could not vary the terms of this arrangement so to become compliant with the terms of their NHS contract without penalty.
"...many GP practices have signed multi-year contracts with telephone services providers which cannot be varied, renegotiated or terminated without substantial financial penalty"
In respect of the point at issue - the type of non-geographic number being used - THIS IS SIMPLY FALSE.
GPs are commonly using the revenue share earned from 084 numbers (at the expense of patients) to fund lease payments and pay service charges on surgery telephone systems. Early termination of the leasing arrangement would undoubtedly cause a penalty to be incurred, similarly the terms of the commitment to the system may also be rigid. The requirements do not however address these matters, only the improper manner in which they are being funded.
All network telephone service providers (notably Talk Talk - the provider of network telephone service to most of the NHS GPs using 084 numbers) allow customers to migrate from 084 to 03 numbers at any point during their contract for telephone service WITHOUT PENALTY. Calls to 03 numbers are (by regulation and in practice) charged at no greater cost than that of an equivalent call to a geographic number.
There may be other options open, but there is no question that this variation could be accomplished, without penalty, in every case.
All GPs are expected to meet the costs of running their NHS surgery from payments received from the NHS - not from patients as they access NHS services. All NHS GPs should be paying for their telephone system in the same way. The loss of the revenue share benefit derived from the 084 number on migration to 03 returns those GPs currently in breach of their contracts to the same position as other BMA GP members.
I find it extraordinary that the BMA GPC is actively supporting the idea of competition between members on the basis of the cost of calling them!
Some of my other recent comments on this issue