NHS.Patient Web Page

NHS Direct

(The principles of revenue sharing telephone numbers)

 

Updates

Denial of Revenue Sharing

Release of list of additional telephone numbers

NHS Direct and the Consultation on banning use of 084 numbers

Withdrawn public announcement of an intention by NHS Direct to change to 0345 4647

 

Introduction

These notes address some of the issues that arise with the very particular case of NHS Direct. They cover the general way in which revenue sharing telephone numbers work, notably 0845 numbers. They are relevant to all NHS service providers and indeed any public service delivered “free at the point of need”.

All 084x and 087x telephone numbers are classified by Ofcom as “revenue sharing”.

(BT Global Services and BT Retail are separate businesses within the BT Group.)

 

Links

NHS Direct and how it is funded by calls to 0845 4647

Charges for calling revenue sharing numbers

What NHS Direct is doing

Comments from the Government

My position now

 

NHS Direct and how it is funded by calls to 0845 4647

The NHS Direct telephone advice service is partly funded by patients who call this “revenue sharing” telephone number.

Whilst at the inception of NHS Direct in 1997/8 the 0845 number was charged by BT (now BT Retail) at the same rate as calls to “local” numbers, this is no longer true, as it was never true for all telephone service providers.

BT Global Services, which provides the telephone infrastructure for this service, receives additional income from every call made to this number. That is the basis of “revenue sharing” numbers. That is why calls are charged differently to those to “ordinary” numbers. Revenue sharing is not permitted on calls to “geographic” (01/02) or 03xx numbers. That is why these are charged at lower rates and offered in “call inclusive” packages.

Rather than accepting the revenue share as income, NHS Direct allows BT Global Services to retain it, thereby achieving a discount in the fees paid for its services to NHS Direct. As NHS Direct, like many NHS providers, is not a profit-making organisation there is no effective difference between income and subsidy through reduced cost. Any suggestion that a user of a revenue sharing number does not “profit” thereby are meaningless. (Even for a profit-making organisation, reduced costs contribute to net profit.)

 

Charges for calling revenue sharing numbers

Telephone service providers normally obtain the money required to share their revenue by increased charges to callers. BT Retail and some other residential telephone service providers offer some callers, at some times, rates to call 0845 numbers that are less than, or the same as, those for “geographic” numbers. This selective and perverse approach to a fair distribution of costs to callers should not be allowed to distort an understanding of the principles of revenue sharing.

Whenever a NHS patient calls a revenue sharing number, part of the call charge paid is shared to the benefit of the NHS provider being called. In most cases this means that the charge is greater than that for calling a number where revenue sharing does not apply. The fact that some callers, at some times, do not incur an additional charge does not affect the essential point that those who use revenue sharing numbers are not delivering services “free at the point of need”.

 

What NHS Direct is doing

I understand from communications with NHS Direct that:

NHS Direct recognises that since its launch in 1997/8, the cost of calling 0845 4647 from certain numbers has increased … and has been in discussions with regard to an alternative number for some time. … NHS Direct fully supports the move to an alternative number.”

The possibility of a new three digit national number (probably “888”) for accessing urgent non-emergency NHS and care services being introduced is being discussed in various circles. This would seriously disrupt the current operations of NHS Direct, which provides non-urgent services, and also uses many other different 0845 numbers.

I have been told that a decision has been taken in principle for an alternative 03xx number to be adopted in the event that the “NHS Next Stage Review Final Report”, published by Lord Darzi on 30 June, did not require that 888 be adopted. This report suggests only that local plans for a single number for access to local urgent non-emergency NHS and care services be allowed to go ahead.

There is no prospect of a national number and the consequent re-organisation of NHS Direct, and the equivalent services covering Wales, Scotland and Northern Ireland, in the foreseeable future.

Whilst the objective behind the idea is simplification, it is likely to be found that the necessary designation of the scope of a “888” service, as distinct from those around it, will actually make matters more complex. It could only be made to work if the scope of NHS Direct and the skills of its staff were increased significantly, probably beyond realistic expectations.

 

Comments from the Government

The government has given a “cast-iron guarantee” that use of 0845 4647 will not continue beyond the life of the current contract with BT – Hansard 21 Jan 2008: Col 1334.

I have been told that this contract “… expires in 2011. However, this does not tie NHS Direct into the use of 0845 4647 and instead allows the use of any non geographic number hosted by BT”. This fact undermines the sense of this government guarantee, as it denies the implied need to retain this number for another three years. The logic of the arguments behind the guarantee therefore suggests that there should be no delay at all.

 

My position now

At the beginning of the 61st year of the NHS, I see no good reason why NHS Direct should not immediately go ahead with its plan to move from 0845 to 03xx. All other NHS providers and other public service bodies with a genuine need for a non-geographic number should do the same.

 

David Hickson

5 July 2008

 

Updates

 

Withdrawn BT Wholesale announcement 23 July 2008

BT Wholesale published a Briefing on 23 July 2008 indicating that 0345 4647 has been opened up as the number “which will eventually replace the existing NHS Direct number 0845 4647”.

After attempts to draw attention to this published declaration of a clear intention, this announcement was withdrawn, without comment or any note of cancellation.

A retained copy is available here. This is for historical reference only.

It had been published at the following URL (which no longer works):

http://www.btwholesale.com/pages/downloads/News_and_Briefings/Interconnect_Briefings/Additional_Number_Range_NHS_Direct_13608.pdf.

 

NHS Direct and the Consultation on banning use of 084 numbers - 16 December 2008

The announcement of a three month consultation on a proposed ban on use of 084 numbers in the NHS on 16 December 2008 is interesting the context of NHS Direct. I offer some reflections.

The government had stated that an announcement in respect of the single national urgent non-emergency number and any potential NHS Direct involvement would be made by this time, but nothing has been said. Whilst one could stick firmly to the basic position that I hold, stating that the non-urgent health advice and information service operated by NHS Direct is a totally separate issue, it is foolish to pretend that the two will not be linked in practice.

Enormous efforts are being made to stress to the public that the 999 emergency ambulance service should only be used in appropriate circumstances. If a national number for access to urgent non-emergency health and social care services were to be launched and the number to call for non-urgent health advice and information were to be changed (e.g. to 0345 4647) within a short time of one another, there would be enormous confusion generated if the two were not to be publicised at the same time.

There is considerable doubt being expressed about the cost-effectiveness of the NHS Direct telephone service. Much of the possibly excessive cost incurred in handling calls is due to the fact that procedures cover the possibility of calls being of urgent or emergency status. This begs the question of whether, given that we are already perhaps paying for an urgent or emergency service, we want to establish another.

Despite a government decision to refuse the NHS Direct Trust the opportunity to apply for Foundation Trust status, it continues to recruit members with a view to having this decision reviewed at some stage in the future.

Although the consultation is only about the type of telephone numbers that are used, the particular nature of NHS Direct means that this cannot be considered in isolation, especially when there are other issues of current contention. It is even possible that it was the need to sort out some of these issues that led to the delay of at least three months in proceeding with a ban which is caused by the process of a consultation.

 

Release of list of additional telephone numbers 23 December 2008

In response to a Freedom of Information request, NHS Direct has released a list of all the telephone numbers used for the various NHS services that it provides on behalf of various bodies.

68 of these are seen to be revenue sharing 0845 numbers, 7 are "freephone" 0800 numbers that are free to landline callers, but charged at a premium to mobile callers. The 0845 4647 number is not included in this list.

This is the final list of numbers as provided to me.

My original request was for the detail omitted from this written answer to parliament, including the relevant telephone numbers. An invitation to discuss the detail of the request was not taken up resulting in provision of this list of contracts with no telephone number shown. After a formal review of the decision to withhold all information regarding the telephone numbers, the final list was released, with an admission that it does not correspond with that initially provided. (A full copy of the exchanges of correspondence can be provided on request).

 

Denial of Revenue Sharing

In the course of further correspondence over the handling of the Freedom of Information Request, I received this letter containing the most extraordinary comment from the Interim Chief Executive of NHS Direct - "we must categorically state that NHS Direct receives no revenue share from the use of 0845 numbers either directly or indirectly."

 

Contact

Please contact me at NHS {dot} Patient {at} ntlworld {dot} com