GP using 0844 number - should this be allowed?

[nolegion]

Thank you NHS Patient. I knew nothing of this and see my GPs as seldom as possible; but this thread has prompted me to check, and indeed, their number is an 0844 one, I am irritated to find.

 

I have briefly but by no means fully explored your fine blog. Please may I ask what, if any, feedback you have from patients who have raised this as a formal complaint under current compliants regulations i.e first with the practice and then 'upwards' to get the matter up to the relevant PCTs (who should, presumably, be enforcing the rules)?

 

I am tempted...

[NHSPatient]

If you were tempted … to suggest that this does not lead invariably to the practice changing its number, apologising to the patient in question and sending a circular letter to all patients promising never to do the same again - then you would have been correct.

 

Pressure is however building to overcome the fierce resistance which has been put up by both the BMA (protecting the financial interests of its members) and the provider of the systems which are funded by this mechanism. They have so far prevented many of the PCTs from properly getting to grips with the issue, but the tide is turning.

 

My attempt to comment on the politics of this matter (the meaning of "consumerism") has been deemed unsuitable for this forum, but there is plenty of the Politics to read on my blog. Most of it simply factual, with quotes from Hansard, leaving the reader to draw their own conclusions.

[Conniff]

Our dr has done the same but there in big writing at the bottom it said - 'calls to this new number will be charged at local rate' so it is your surgery that had decided on it.

 

Make up some leaflets and hand them around the waiting room every time you go in and make a written complaint as well.

 

 

I can only refer you to the post (above) I made back in 2008. There is no national lets rip the public off policy, this is down to your own surgery, so ask them how much a phone call costs and if you are not happy, then write to the practice manager and complain.

[NHSPatient]

I can only refer you to the post (above) I made back in 2008. There is no national lets rip the public off policy, this is down to your own surgery, so ask them how much a phone call costs and if you are not happy, then write to the practice manager and complain.

Conniff

 

If your surgery claimed that calls to 0844 numbers were charged at "local rate" in 2008, then there is little point asking it about the cost of telephone calls, because it clearly knows nothing (or was deliberately seeking to mislead its patients).

 

The distinction between local rate and national rate was abolished in 2004. Calls to 0844 numbers were never charged at "local rate" by any telephone service provider. GPs have no control whatsoever over the charges for calls to any number - unless they themselves provide telephone service to their patients.

 

Every GP that uses a 0844 number is benefiting (indirectly) from the "revenue share" that is passed between the telephone company used by the caller and their own telephone service provider. The cost of this is passed on to the caller. NHS providers may not levy charges on NHS patients, who have the right to access NHS services "free at the point of need".

 

The regulations in place address this by prohibiting use of a number that costs patients (considering all cases) more than the cost of a call to a geographic number. There are examples of callers who incur a "penalty charge" for making a daytime call to a geographic number after selecting a Call Plan that only covers calls made at Weekends or in the Evening, which may exceed the cost of even calls to some Premium Rate Service numbers. If it could be shown that all patients of a practice are in this odd position, then use of a 0844 number could be justified on a technicality.

 

At present, practices are succeeding in misleading patients and PCTs with nonsense such as that referred to.

[Conniff]

Ok, I will drop them an email and check on that and come back with their reply.

[NHSPatient]

Ok, I will drop them an email and check on that and come back with their reply.

Experience suggests that the reply will perhaps include a copy of a letter, identical, or similar, to this circular letter [*1] (there is also a January 2010 version).

 

This is an expression of opinion from an interested party - it has little to do with the reality of the situation which the contractual requirements demand be addressed.

 

It is confirmed as being misleading by recently issued "Further Guidance" from the Department of Health [*2], which includes the following comment in a FAQ:

 

A telephony supplier has told me that the Department is fully supportive of its product …. What do I do?

"The Department does not approve or disapprove of any individual products …"

 

 

I hope it is considered acceptable for me to provide the links in text form, rather than making some unnecessary postings in order to meet the post count required for comments to be supported by external references:

 

*1 - h t t p : / / w w w . thornhillsmedical.nhs.uk/userfiles/docs/0844-number.pdf

*2 - h t t p : / / w w w . dh.gov.uk/health/2012/02/084-numbers/

[Conniff]

So how much is an 084 call per minute and how much for a geographic number ??

[NHSPatient]

So how much is an 084 call per minute and how much for a geographic number ??

 

I have published a table which primarily provides links to published tariffs (so it can be verified), but aims to offer a simple summary.

 

This is found via (apologies for the textual representation) h t t p : / / tiny.cc/GP084Costs.

 

This is simply intended to demonstrate that a GP is unlikely to be able to comply with its contractual requirements by using a 084 number. Because it is prohibited from using a number that is more expensive to call than an equivalent call to a geographic number, "having regard to the arrangement as a whole", it would have to show that none of its callers were subject to the tariffs which caused them to pay more. As BT Unlimited Anytime is the most widely used landline tariff, this could be difficult.

The recent DH "Further Guidance" confirms that the costs incurred when calling from mobile phones, public payphones and landlines contracts other than those which impose an "out of plan" penalty charge for calling geographic numbers during the daytime cannot be disregarded. The NHS is a universal service, available to all on equal terms - there is no obligation to have a telephone contract which does not cover calls to geographic numbers before 7pm on weekdays so as to not pay more to call one's GP.

[Conniff]

That does not say how much a geographic call cost versus an 0844 number.

[nolegion]

I wonder if this helps:-

 

http://community.bt.com/t5/Phones/How-much-do-calls-cost-to-0844-numbers/td-p/348503

[NHSPatient]

That does not say how much a geographic call cost versus an 0844 number.

There is no single answer to the question. It depends on the tariff and the time and duration of the call. In some cases, it also depends on the type of 0844 number.

 

I provide links to published tariffs, so that one may look at whatever examples one feels may be relevant. I offer some examples in a table to illustrate the point that GPs may not use 084 numbers if certain listed examples apply to those who call them.

 

Of the 0844 numbers used by NHS GPs: 1,042 are type "g6", 91 are type "g11", 3 are type "g10" and 2 are type "g8". I only show the charges (in all cases) for the first two types.

 

(This information about call types may be of help to those following the previous suggestion to consult only the BT tariff tables. It should however be noted that BT only originates around 40% of residential landline calls = less that 25% of all non-business calls.)

 

 

Assuming a five minute daytime call by a caller who already makes daytime calls to geographic numbers, and would not change their package if their GP offered a geographic number, the relative call costs, in cases where callers pay more to call a 0844 (g6) number, are as follows:

 

Landlines

 

• BT: Unlimited Anytime - 39p vs. 0p
  
• BT: Basic - 29p vs. 0p
  
• Talk Talk: Talk Anytime - 39p vs. 0p
  
• Virgin Media: Talk Unlimited - 76p vs. 0p
  
• Virgin Media: Talk Weekends - 76p vs. 57p
  

Mobiles

• Orange: Pay Monthly - £0.62 vs. £0.00
  
• Orange: PAYG - £2.00 vs. £1.25
  
• Vodafone: Pay Monthly - £1.75 vs. £0.00
  
• T-Mobile: Pay Monthly - £2.05 vs. £0.00
  
• T-Mobile: PAYG - £2.00 vs. £1.00
  

Payphones

• BT: Public Payphone - £1.40 vs. £0.60
  

 

These figures expand the differences shown in my table.

 

Unless a GP has no callers who incur these additional costs, it may not use a 0844 (g6) number. That is the essential point which has to be made with reference to the terms of the NHS GP contract.

 

For completeness, the table also shows those cases where callers pay less because of the penalty charge incurred for calling a geographic number outside the terms of their plan. The regulations do not require one to perform a balancing exercise based on the aggregated duration of calls made under each type of arrangement, so there is no need to consider the other cases. So long as a significant number of callers pay more, the number cannot be used.

 

 

I recognise that some will be keen to explore the wider picture. I am not aware of any statistics which show how many callers choose to incur a penalty charge by making daytime calls under the terms of plans covering only evenings / weekend calls, as against those who make such calls under the terms of plans that cover them. In the case of BT, the Unlimited Anytime Plan has more subscribers than either of the others. I do accept that this does not prove that all callers select the correct plan for their needs; it would however be remarkable if this were not generally true.

 

Ofcom's proposal for "unbundled tariffs", on which a firmer announcement is expected in the coming days, is intended to clear up a lot of the confusion in this area. Perhaps the most significant aspect of these forthcoming announcements will be the removal of the present regulatory restrictions on BT.

 

BT alone is currently prohibited from adding anything of its own to the rates for calls to "NTS" numbers (e.g. 084, 087, 070, 09), whereas it is now free to charge whatever it wishes for calls to geographic numbers. This is what creates the perverse effect of a "out of plan" call to a geographic number costing more than calls to all 084 and some 087 (Premium Rate Service) numbers.

 

BT is still the largest single provider of call services, however the effect of legacy regulations on it alone, dating back to when it had a near monopoly, make it a poor case to use as a model, because it is not representative of the situation as a whole. As stated above, Ofcom figures show that BT originates less than 25% of non-business telephone calls.

 

 

(P.S. To confirm a point made in a previous posting. Since Ofcom regulation of BT prices ended in 2006, all BT residential subscribers have been on "Call Plans". This includes the social tariff "BT Basic" which is sometimes referred to as being a Call Plan. The former "BT Standard" tariff, which was that regulated by Ofcom, is now obsolete.)

[Conniff]

You are trying to make this as complicated as you possibly can to win a point over.

 

The way you have displayed the chart above says to me that the 084 calls are all cheaper than any other.

[NHSPatient]

You are trying to make this as complicated as you possibly can to win a point over.

You make a strong personal point about my objectives and methods. I must therefore assume that you disagree with the point you believe that I am trying to make.

 

I am not totally surprised to find myself encountering opposition in a forum named to reflect a dedication to the pursuit of consumerism. I campaign for our National Health Service funded by progressive taxation, whereas I am sure that consumerists will support the present government's efforts to replace it with a "patient focussed" service which will inevitably have to be primarily funded by patients, as consumers.

 

With the highly complex situation of revenue sharing telephone numbers being used as a means to levy charges indirectly, it is not easy to present it honestly and comprehensively but simply. I offer additional information to enable an extended understanding, and must apologise if this, or indeed the way in which I describe the essential points, makes the point unnecessarily difficult to follow.

 

The way you have displayed the chart above says to me that the 084 calls are all cheaper than any other.

 

If you believe that this is true, then I can only suggest that you review the published tariffs more closely, and with an awareness of which tariffs apply to callers.

 

If you have suggestions for how the truth of the information could be presented more clearly, then I would be delighted to hear them.

[nolegion]

At the risk of merely further displaying my genuine, and clearly extensive, ignorance about telephone tariffs, I read the comparisons shown in NHSP's post (#36) as showing fairly deftly that you were far more likely than not to be charged more forcalling a GP's 0844 number than you would be for calling a so-called 'geographic', i.e. normal, one.

 

Indeed, it seems many of us use 'call plans' or tariffs which would mean that in the absence of being obliged to call an 0844 number we would be charged nothing at all for a weekday (and private\residential-originated) call - as indeed NHSP's tables set out.

 

The underlying, primary, iniquity seems to be that certain GPs are, directly or indirectly, continuing to trouser some of the revenue from the costs which are being charged to their patients as callers. Patients can't 'opt out'. Clearly, they will collect some charges from the majority of these GP 0844 numbers whatever tariff or plan the patients have chosen personally.

 

After that failure of principle, comes the total lukewarm hash which has been made of the supposed legal remedy to it, which I have now read up about largely courtesy of info derived from NHSP's blog. And that, in my view, is typical of the way supposed obligations and entitlements are rendered inaccessible to patients in the NHS.

 

The new (-ish) clauses inserted into the (statutory form) contract with PCTs under which most GPs are engaged are a) loose\imprecise and b) only directlyenforceable by PCTs, of course. The same goes for many other supposed 'rules'set out in such contracts.

 

You can only 'get at' these clause by initiating the formal complaints procedure, and that's a whole 'nother kettle of woe.

Edited March 16, 2012 by nolegion

[NHSPatient]

At the risk of merely further displaying my genuine, and clearly extensive, ignorance about telephone tariffs, I read the comparisons shown in NHSP's post (#36) as showing fairly deftly that you were far more likely than not to be charged more forcalling a GP's 0844 number than you would be for calling a so-called 'geographic', i.e. normal, one.

 

…

 

You can only 'get at' these clause by initiating the formal complaints procedure, and that's a whole 'nother kettle of woe.

Thanks for the compliment.

 

The NHS is established as a national public service, administered locally, now by 50 clustered PCTs in England. It is they who are charged with the public duty of ensuring that its principles are upheld, guided from the centre. As consumerist localism took hold, under the previous government, the degree of central guidance diminished, except in particular narrow areas where the government wished to be (or was thought to be) accountable - i.e. certain arbitrary targets.

 

When these regulations were introduced they were not accompanied by the detailed information necessary for them to be implemented and enforced properly. This was due, in part, to effective negotiation on the part of the BMA, designed to keep them weak, and powerful misrepresentation of the true situation on the part of a leading provider of the systems which are subsidised by patients. Ignorance and misunderstanding of telephone tariffs is widespread - it extends to many within the Department of Health; this is an area that is ripe for exploitation.

 

Some argue that the attempt to run a National Health Service has failed. It is too big to run from the centre and local public bodies are expensive and not as effective as they should be. This is why the present government has been undermining and trimming the resources of the PCTs, prior to their abolition. It suggests that their work is better carried out by GPs, who are accountable only to their individual patients, not to the state and taxpayers.

 

Consumer power is exercised primarily through the consumer's ability to withdraw their custom and take it elsewhere. This is the model which is being advanced for provision of healthcare. (This is not a party Political issue, the previous government spoke of competition between GPs when announcing that these regulations would be introduced.) The opportunity for patients to choose their GP has been extended greatly in recent years and is being extended further. This is unquestionably action in favour of consumerism - that is why I suspect that it may have the support of the CAG.

 

I am in favour of consumer rights in areas where the model of a competitive market is the best way of advancing our society. I believe however that this model is not suited to all areas. The National Health Service stands out as being perhaps the most notable case where a different model applies, although there are other cases where creeping consumerism is undermining that which holds us together as a society.

 

I believe that the area of telecommunications services has, in general, benefitted from privatisation. That is not to say that there are not many ills and issues that need to be addressed, but I make this comment to show that I do not have a blnkered view. Having built up the National Health Service in the way that we have over so many years, I believe that it needs reform to reflect the world as it stands today, but I do not believe that it needs to be replaced with a service based around the private relationships between individual patients and providers.

 

Individual consumer complaints can only address individual issues between consumers and providers. It is indeed very difficult for an individual patient to "get at" clauses of contracts specifically addressing "the arrangement as a whole" to reflect the universal nature of the National Health Service.

 

I continue with my efforts to persuade the Clustered PCTs to perform their statutory duty in the interests of all whom they serve, not individual "consumers".

 

(When the PCTs are abolished the task of administering GP contracts will remain with the same officers, although many fewer in number, as these functions of the 50 clustered PCTs are transferred to the 50 local arms of the NHS Commissioning Board. That is assuming that the present Health Bill, which is necessary for the formal change to the structure of statutory bodies, passes.)

[worried33]

Our dr has done the same but there in big writing at the bottom it said - 'calls to this new number will be charged at local rate' so it is your surgery that had decided on it.

 

Make up some leaflets and hand them around the waiting room every time you go in and make a written complaint as well.

 

report to the ASA, 0844 is not local rate.

 

ofcom are currently reviewing this mess, I heard they plan to release the controls on BT so BT 084x will get much more expensive which will go against the misleading local rate claims.

[worried33]

Calls to 0844 cost a maximum of 5p per minute from a BT phone.

 

and its only BT that matters right? (by the way BT is less than a 3rd of calls made these days).

[worried33]

So how much is an 084 call per minute and how much for a geographic number ??

 

the gaps can be hige.

 

eg. on mobile geopgrahical is inclusive in minutes and in some cases can be free if have free to landlines deal, 084x is rarely inclusive so would be something at least 15p a minute.

on landlines it varies a lot eg. on BT its not too expensive but on VM its 11p a minute on top of a 10P connection fee.

[nolegion]

At last…?

 

http://www.gponline.com/News/article/1220363/practices-ordered-drop-084-numbers-despite-heavy-costs/

[Ian011]

The letter from NHS England to non-compliant practices appears to have had some success as the number of 0844 users has reduced over the last few months.

 

However, the Fair Telecoms Campaign reports that as of 2 February 2014 some 440 practices in England are still in breach of their GMS Contract as revised in April 2010.

 

Additionally, a number of 0844 and 0845 users remain in Wales, Scotland and Northern Ireland. Only Wales has similar contractual terms to those found in England.

Edited February 2, 2014 by Ian011

[nolegion]

Many thanks for that update, Ian011

 

Since, the previous poster hasn't yet enough posts at CAG to provide working links, here 'tis:-

 

http://www.fairtelecoms.org.uk/1/post/2014/02/gps-approach-5th-year-of-breach-of-contract.html

 

There is a highly informative list of practices still offending in the report linked. My GPs practice is on it - as I knew it would be - but it is very interesting to see how glaring the minority it is in, for the area concerned.

[worried33]

I will pass this info on to my sister her GP surgery is still 0845.

[nolegion]

Aha! Dropped into my GPs practice and they have just but up notices advising of a change to a non-premium telephone number. Still haven't made the change on their 'NHS Choices' info yet, though - but progress all the same.

[Ian011]

If the new 01, 02 or 03 number is run in parallel with the old 084 number left in place, your practice will still be in breach of their contract with the NHS. The NHS does not offer different levels of service based on ability to pay.

 

The new 01, 02 or 03 number must be a replacement for the 084 number. The old 084 number must be either completely switched off or set to make an announcement about the new number. This can often be done at no cost to the caller.

Edited February 12, 2014 by Ian011

[nolegion]

Good thought. Just tested my practice's 'old' (084…) number.

 

Got an announcement that I had to hang up and dial their 'new local number'.

 

Whether I have been charged for that call, I won't know until I receive my quarterly steam-driven telephone bill…but all being well...

 

...only another 439 practices to go?