BMA response to the Consultation
The following is a copy of the announcement of the BMA response to the consultation as contained in the GPC newsletter of 20 February 2009, as published by Somerset LMC in this document.
I offer some brief comments below.
The use of 084 telephone numbers in the NHS: DH consultation
The Department of Health (DH) in England is considering banning the use of 084 numbers to access services provided by the NHS and has launched a consultation seeking the views from ‘all interested parties’. The GPC has co-ordinated the BMA response to this consultation, with input from other branch of practice committees.
In our response we highlight that we believe that people should be charged as low a cost as possible to call NHS services but that this has to be balanced by the quality of service the patients are accessing. Many practices value the extra functions that a number such as 084 and 03 numbers can provide, as they want to improve access to patients by providing telephone numbers with extra functionality.
Our main concern is that when the new telephone systems were put in with the new 084 numbers, many surgeries had to sign up to a long contract and even if they want to change, they cannot at moment due to contractual obligation.
We also noted that the Department and PCTs actively encouraged practices to adopt the systems that 084 numbers can provide to improve access, which it has done. Practices should not be penalised for following the Department’s advice and as they brokered a deal with the companies before to move them from the old 0870 numbers to 0844, they should be able to do so again by supporting a move back to local numbers.
We would therefore support a voluntary switch for practices to revert to local numbers but if the Government decides to ban the use of 084 numbers, the Department of Health should ensure that practices are allowed to serve out the terms of their contract if 084 numbers are banned.
We also welcome BT’s decision to allow 0845 numbers to be free within their call packages. This suggests that the Government could encourage all telephone companies to review their call charges to NHS services, and include 084 numbers in comprehensive call packages so that patients do not incur additional costs.
The response starts with the assertion that patients should pay to access NHS services according to the quality of the service that they are accessing.
This extraordinary contradiction of the principle of “free at the point of need” might leave many BMA members gasping for breath.
This consultation is not about the general level of telephone charges, otherwise the BMA would be proposing that mobile users should receive better treatment than BT customers. The point at issue is the surcharges that are incurred when revenue sharing 084 numbers are used to subsidise the costs of the service being accessed. The BMA is proposing a direct relationship between the quality of the NHS service and the price paid by the patient.
In my “Today programme” discussion with Richard Vautrey I suggested that we do not expect NHS patients to pay for an improved surgical procedure, and asked why we should charge for an improved telephone system. I had believed that the point was conceded, but we now find the principle of access charges for improved NHS services apparently being adopted as BMA policy.
The point about contractual obligations is probably false. To my knowledge, it has not been established that the Carphone Warehouse Group, which provides most of the revenue sharing telephone lines used by GPs, would refuse to allow its customers to change from 0844 to 0344 numbers during the term of their contracts. It is normal industry practice to permit such changes on demand.
The contractual obligation which creates a problem for some GPs is the long term lease on surgery equipment which is being paid off using the rebate from the revenue sharing telephone number. The reference to practices not being penalised is a suggestion that the Department of Health should pay off these leases if the source of income (originating from patients) is dried up by a ban.
There is no question that the Department of Health carries some responsibility for the present situation. It is however disturbing to find a body of proudly independent contractors apparently refusing to accept any responsibility for their own independent actions. As stated above, it should require no special intervention from the Department of Health to allow GPs to serve out their contracts whilst complying with a ban on use of 084 numbers.
The suggestion that the recent action by BT could be followed by other providers and that BT and others could add 0844 numbers to packages, or charge for calls to NHS service providers differently, demonstrates a complete lack of understanding of the relevant issues within the telecoms business. It amounts to suggesting that because some GPs have been caught out subsidising their businesses by payments from patients, this subsidy should be provided by telephone companies, or rather by their customers in general. All that BT is doing is subsidising one type of call out of newly increased charges in other areas.
(My own outline proposal for how to deal with the situation of GPs using “Surgery Line” and other similar systems is published here - Surgery Line Solution.)
David Hickson
26 February 2009