My inner city GP group practice recently changed its phone number to 0870.

Can the Forum offer advice on:

a)
who is profiting from the new revenue stream: the NHS generally, the Primary Care Trust or the doctors/managers individually?  I have not asked yet but I am sure what they will say is that the money will go on practice improvements even though they receive funds from the NHS (i.e. the taxpayer) for maintaining reasonable standards.  

b)
Under the Freedom of Information Act any information held by a public authority is eligible for release.  Is a GP group practice a private contractor to the NHS or are they an integral part of the NHS?.  If the latter, can the FOI Act be invoked to reveal the geographical number underlying the 0870 number? Who does one apply to, the Primary Care Trust?

c)
The 0870 number is clearly causing hardship to patients, many of whom are old age pensioners.  When wanting to make an appointment this morning I was made to hang on for 8 minutes without the phone being answered.  For this experience I paid 64p, out of which BT got 40p and the GP got 24p - I got nothing except the music.  Can a case be made under the Human Rights Act?

I am quite incensed about what I regard as a shameful practice trying to profit from plight of vulnerable people and are determined to take it further.  Any advice on how to proceed would be gratfeully received.
:-[

See the thread "Quick complaint to your MP..." and start with that.
The more MP's are told about it the more chance they have to act on your behalf.

Taking it point by point:

a) the GP

b) ask the GP direct, a GP is covered by the Freedom of Information Act.  Any request must contain your name and address.

c) I would send a letter to your own MP, they will get an answer from a Minister.

There is a big poster in the GP's surgery saying that:

a)
the change to 0870 was to improve service!!!!  :-[  and

b)
0870 numbers are National Numbers, not Premium Rate Numbers (cleary wrong as BT's website also acknowledges)   Are they liable under law for the misinformation?  :-[

Are they legally obliged to display the Premium Rate 8p/min charge for their 0870 number (and perhaps also set it against BT's 3p/min National Rate)?

The following email was sent to the Patient Advisory and Liaison Service (PALS) of the local Primary Care Trust:

I should be grateful if you could offer advice as to whether NHS GPs are allowed to use premium rate 0870 telephone numbers as contact numbers for their patients. These telephone numbers generate a revenue stream for the practice concerned but may cause financial hardship to many patients.  It is also an incentive for the practice not to answer telephone calls promptly - the longer they keep the caller waiting the more revenue they earn.

Premium rate 0870 calls cost 8p/min which compares with 3p/min charged by BT and only 1p/min or less by various other service providers.  Typically the called party receives a profit of 3p/min from calls to their 0870 number.

By this means the practice would make a profit from patients beyond the fee they receive from the NHS for each registered patient.  

Expenses incurred by GPs in providing primary care to their patients are paid back to the profession in full either as direct or indirect reimbursement, so this cannot be an excuse for trying  to generate additional profit.  

I look forward to your prompt reply.

UNBELIEVABLE! (CLICK THE LINK)

There was an interesting interview on You and Yours today (listen here) with Alistair Campbell of Network Europe plc who provide these 0870s to surgeries. He says that these numbers aren't premium rate.

The main justification he put in favour of these numbers was that with the 'old system' with a geographical number, callers could be on hold for a while. This, supposedly, gets round that problem. ::)

Here is the marketing spiel from there website:

Quote:

NEG Surgery Line™ Two years in development - over a million patients using our systems - 96% of callers get through to their surgery first time. NEG Surgery Line™ has an ever growing presence in England, Scotland and Wales. NEG Surgery Line™ is the bespoke telephony solution for GP Surgeries. The revolutionary self-funding Telephone system for GP surgeries is no longer just a telephone system… With offerings for the hard of hearing, personal fax services, queue busting solutions in the waiting room and clinical indicator information generation. 2005 will also see the launch of the online forum and information portal for the ever growing family of extremely happy Surgery Line practitioners. Yes it’s free — Sounds good already! In the majority of applications, NEG Surgery Line™ is completely self-financing! — Want to know how we do it? For an information pack, please click here. ©2004 Network Europe Group Plc

See here.

With a sales pitch like that, what has any surgery got to loose?   :-X

wrote on Jan 28^th, 2005 at 2:40pm:

With a sales pitch like that, what has any surgery got to lose?   :-X

Integrity? Respect of patients? NHS support for ususal purchases - like telephone systems, mortgages etc?

And the usual regard for honesty. How can Premium Rate (BT definition) 0870 be cheaper that 1p per call?

Do these cretins who run the NHS actually believe that this is 'free'?

I have now writtent to the local paper:

The ...... Medical Centre, an NHS GP group practice, recently changed its telephone number to a premium rate 0870 number.  Each call to the practice now costs 8p/min to the caller out of which 5p/min goes to BT and the doctors make a 3p/min profit.

A prominent notice in the reception area states that 0870 numbers are National Rate numbers, not Premium Rate numbers.  This is blatant disinformation.  The BT National Rate is 3p/min for most of BT's customers and many people use telephone service providers that are cheaper than BT (e.g. national calls at 1p/min).

The income of many of the patients is a great deal less than that of the doctors.  The NHS is supposed to be free at the point of use yet here NHS doctors, for their personal benefit, impose a levy on patients who wish to contact them.

0870 numbers are also an incentive for not answering calls promptly - the longer callers are kept waiting the more revenue is generated.

An enquiry was sent to the Patient Advisory and Liaison Service (PALS) of the Primary Care Trust asking whether NHS GPs are allowed to use premium rate 0870 telephone numbers as contact numbers for their patients.  Their reply is awaited.
 
GPs are self-employed but get a salary from the NHS (£60-£70k).  Their expenses in providing primary care to patients are paid back to them in full either as direct or indirect reimbursement. There is no excuse for profiteering from patients.

Each 0870 telephone number has an underlying ‘geographical’ number – a number starting with 01 or 02. It may be that under the Freedom of Information Act the practice can be made to reveal their geographical number and also the amount of profit they will be generating from the 0870 number.

Clause 483 of the contract NHS GPs have with their Primary Care Trust ( http://www.dh.gov.uk/assetRoot/04/09/22/39/04092239.doc) provides that:


483      The Contractor shall not, either itself or through any other person, demand or accept from any patient of its a fee or other remuneration for its own or another’s benefit-


483.1    for the provision of any treatment whether under the Contract or otherwise, or


483.2   for any prescription or repeat prescription for any drug, medicine or appliance,


Making appointments by telephone is an integral part of GPs providing a service/treatment to patients, it seems therefore that imposing a levy on patients for the GPs' own financial benefit contravenenes clause 483.

An article from Leeds Today

http://www.leedstoday.net/ViewArticle2.aspx?SectionID=39&ArticleID=920407

Ring in your symptoms at 8p-a-minute
Concern in village at GPs' premium phone line
by ALISON BELLAMY
A MEDICAL centre has caused concern in the community it serves by changing its telephone number.
Shadwell Medical Centre in north Leeds switched to a number starting 0870, which charges a national rate up to 8p a minute at peak times. The average cost for BT daytime call is around 3p.
Users of the Shadwell Lane centre say patients can often be kept hanging on as they use the automated service, offering options to get an appointment, test results or prescriptions.
The service was introduced in November in a bid to cut telephone waiting times.
The surgery does not make money from it, but call provider NEG Surgery Line says it does take a percentage as that is its business. It says six other Leeds surgeries use the service.
Shadwell Parish Council will discuss the matter next month. It says the service could be costly and confusing for ill older people who simply want to speak to someone.
The 0870 number has been historically used by call centres or businesses, but NEG Surgery Line says hundreds of GP surgeries are now using the automated service.
Telecoms watchdog Ofcom is to launch a crackdown on the abuse of expensive call centre numbers after a flood of complaints.
Customers in the UK spent £1.25 billion in 2003 calling 0845 and 0870 numbers - almost one fifth of all fixed-line revenues.
Ofcom proposes that 0870 numbers do not advertise themselves as being a "national" rate or 0845 numbers as being a "local" rate as this can be misleading.
The watchdog says competition between rival telephone companies has brought cheaper prices, yet rates for 0870 and 0845 numbers are unchanged.
Geoff Wilson, chairman of Shadwell Parish Council, said: "It can be extremely awkward for elderly people who may not understand the automated system and just want to speak to a real person.
"It is an issue which affects many Shadwell residents and people are concerned."
One patient, who did not wish to be named, said: "I know of one woman in her 90s who was very confused by the automated system.
"Everyone is talking about the number change, which happened a few months ago."
Nobody at the Shadwell Medical Centre was available for comment, despite repeated attempts by the YEP to speak to GPs, but Scott Russell of NEG (Network Europe Group) Surgery Line, said: "It is designed exclusively for GP surgeries and has taken years of research and development working closely with health professionals and a communications company."
"The service promises that all calls are answered within two rings. Out of hours, patients are put through to NHS Direct. It is faster and more efficient in the long run.
He said average call time had been cut from three minutes, 47 seconds to one minute, 59 seconds.
"Although there is a slight increase in the cost per minute, the call is finished far quicker with no substantial overall increase.
"Terms of service say GPs should not charge patients for treatment.
"If this implies that a patient should not have to pay to ring the surgery then surely an 0800 free-phone number is the only real option?"
alison.bellamy@ypn.co.uk

FACTFILE
HOW THE CALL RATES COMPARE
l 0800 - Free
l 0844/5 - Local rate, from 1p-minute up to 5p-minute
l 0870 - National rate average 7.5p-min peak/3.5p off-peak
l 0871 - Up to 10p a minute
l 055 - 5p a minute
l 0632 - Free
l 0700 - Up to 50p
l 09 Premium rates up to £1.50 a minute

wrote on Feb 1^st, 2005 at 2:52pm:

Out of hours, patients are put through to NHS Direct.

And that is an 0845 call - Well done NEG, making even more money   >:(

wrote on Feb 1^st, 2005 at 2:52pm:

Scott Russell of NEG (Network Europe Group) Surgery Line, said: "Although there is a slight increase in the cost per minute ...... "

Scott Russell is a liar.

3p per minute to call any 01 or 02 number in the UK (BT rates) changed to 7.51p per minute to call an 0870 number (BT rates, others charge more) is not "....a slight increase in the cost per minute....."

It's more than a 150% increase

Oh, I'd just love a 'slight' salary increase like that.

idb posted an article from Leeds Today by Alison Bellamy:  

"Terms of service say GPs should not charge patients for treatment.  
"If this implies that a patient should not have to pay to ring the surgery then surely an 0800 free-phone number is the only real option?"  

The logic is flawed.  By using an 0870 number GPs are generating a profit for themselves, i.e. they are "charging" patients in contravention of their contracts with the NHS.  If the surgery has a geographical number the patient only pays 1p -3p/min to BT or others but not to the doctors.

I spoke to my doctors about this and they raised an interesting point.

The NHS do not provide any money for the GP's to buy a telephone system, and if they didn't move to an 0870 they would have to spend money on a new phone system instead of patient care.

This make you think.  Is the real problem not the general run down of the NHS by the government ?

If the government wont pay, it's a simple question of :-

a) Does the GP spend the money on a phone system instead of paying a nurses salary for two years

or

b) Pay a nurses for two years and ask me to pay 24p extra to call the surgery.


In my eyes answer b wins.



p.s.  After speaking to my doctors I got the impresstion that the local newspaper were not really reporting the full story.  Typical BBC bias!

What about all the other things that I understand the NHS buys for the GPs, like the premises under some circumstances?

An interesting point, but GPs are effectively running a business, very often at a high return.

Updating their telephone system is a normal running cost and should be covered by their profits.

NOT by their customers.

Why do they need to update their telephone system anyway, the only reason I can think of is that Mr Campbell of NEG has convinced them that they do.

We have no choice, even if we pay private health insurance, we have to contact the GP first.  And don't
they know it.

J

Tanllan - If the government buys a building for a GP, and doesn't charge them rent and rates, I'd be surprised.  The NHS is short enough on money without buying buildings for GP's.  Look at the state of my local hospital.  Dates back to the 50's.

Juby - My doctors told me there old telephone system was 15 years old and on it's last legs.  If they done nothing, lives could of been at risk.

Look at it this way, If GP's earn so much, why is there a shortage of GP's in the UK currently ?

wrote on Feb 1^st, 2005 at 8:56pm:

Tanllan - If the government buys a building for a GP, and doesn't charge them rent and rates, I'd be surprised.  The NHS is short enough on money without buying buildings for GP's.  Look at the state of my local hospital.  Dates back to the 50's. Juby - My doctors told me there old telephone system was 15 years old and on it's last legs.  If they done nothing, lives could of been at risk. Look at it this way, If GP's earn so much, why is there a shortage of GP's in the UK currently ?

This is irrelevant - new telephone system costs should be dealt with in a similar way to any other capital expenditure and factored into the running costs of the surgery. The problem with 0870 is that it is ALWAYS a rip-off to the customer. Secondly, the rip-off 0870 numbers are touted by companies such as NEG whose spokesmen *lie* to the public about the cost because they make significant profit, doing very little, due to the corrupt numbering system that Ofcom and its predecessor have created. What NEG is doing is a disgrace. It is shameful. It HAS to be stopped, and hopefully the Department of Health will make the NEG spokesmen realize that lying to the public is not a good idea. It would also be good to see NEG having to remove its expensive systems which will eat into its profits from rip-off 0870. NEG is exploiting the vulnerable and the sick. Ofcom could stop this but chooses not to.

I didn't say that GPs earn too much, I was merely trying to point out that they are not on social security like many of their customers.

I agree that Alistair Campbell is "economical with the truth" in fact I heard him lying the other day on the BBC.

There is difference between doctoring the truth in order to put Mr Blair in the best possible light, that is called spin, but when you hear the man lying with your own ears, broadcast on BBC. Then he is.

J

The following was posted by Juby in a separate thread:

General Medical Council
Regent’s Place,  
350 Euston Road,
London  
NW1 3JN

I was interested in the post by Mr Magoo. Much of it is word for word from the hand-out lying about in my Group Practice surgery - supplied by NEG! Nuff said.

wrote on Feb 1^st, 2005 at 10:37pm:

I was interested in the post by Mr Magoo. Much of it is word for word from the hand-out lying about in my Group Practice surgery - supplied by NEG! Nuff said.

Freudian wording there iMutley (... lying about ...)!

Incidentally, has anybody else noticed that the BT website has been updated and peak rate 0870 calls, which used to be listed as being 7.91p/minute incl. VAT, are now shown as being at 7.51p/minute incl. VAT?

P.S. I have altered my most on the first page of this thread to reflect that.

Perhaps more interestingly they refer to them as premium rate numbers:

Calls to 0845 and 0870 premium rate services are charged at the following rates, shown in pence per minute, ( inc. VAT )


 Daytime   Evening  Weekend  
0845  3.00 1.00 1.00
0870  7.51 3.75 1.50
0870 09  4.95 2.49 2.00
0870 187  4.95 2.49 2.00
0870 188  4.95 2.49 2.00

see: http://www.bt.com/btcom_redirectLink.jsp?action=redirectLink&targetLinkID=PIS_UK_Call_Prices&vStore=1314&obsPage=%2fPricing%2fpis_summary.jsp%3fshowsub%3dPIS_Residential&obsOID=30195&obsType=LINK

It is not really relevant to our point that BT has reduced the cost of 0870 calls by 0.05 pence per minute, it just provides an argument for the nit pickers.

The fact is that the cost of ringing your doctor has gone up by anything from 500% upwards. The doctors know about this but they "slide it under the carpet" because they know that they have not had to lash out on a new telephone exchange.

We need to get to the those GPs who have not signed up with Campbell.

These GPs are the vast majority of doctors, some of whom are as vehemently against the NEG as we are.

I know it has all been done before, but I wrote to the GMC today asking for their support.

J

wrote on Feb 1^st, 2005 at 8:26pm:

I spoke to my doctors about this and they raised an interesting point. The NHS do not provide any money for the GP's to buy a telephone system, and if they didn't move to an 0870 they would have to spend money on a new phone system instead of patient care.

Most GP's surgeries are self-managed, with responsibility for working out their own budget.

The NHS probably did not specifically predicate funding on any small detail you could think of - blinds or curtains, seating, white lines in the car park, ...

Your doctors are being disingenuous in avoiding acknowledgement of their responsibility for this decision.

I bet this company is certainly not the supplier of the best value phone system anyway - they spent 4 years developing it; what on earth were they doing all that time?

wrote on Feb 2^nd, 2005 at 10:26pm:

- they spent 4 years developing it; what on earth were they doing all that time?

Trying to sell it to sceptical GPs? And eventually someone said yes.

There are two kinds of GPs excluding locums.

There are self-employed GPs who are independent contractors to the NHS.  They are runing businesses and mostly operate as Group practices employing a practice manager as well as other staff. They pay their expenses (e.g. premises, telephone, cleaning, utilities, stationery, etc.) but their expenses are reimbursed to them directly or indirectly by the NHS.

There are also salaried GPs whose salary is in the order of £60,000.  Numerous Primary Care Trusts advertise for salaried GPs at this salary level, e.g. Heart of Birmingham, see link: http://www.bpcssa.nhs.uk/Vacancy/JobFiles/JD2189.doc.

One can safely assume that the self-employed GPs have a higher net income than the salaried ones even after accounting for their expenses.

GPs are therefore not on the breadline as some of their, especially older, patients may be.  There is no denying that most of the GPs work very hard and I for one do not grudge them their income.

What is shameful though that they should seek to supplement their income, and generate income for the 0870 service providers, at the expense of their patients.  It may be that many of them have been duped by the likes of NEG and are not fully aware of the implications of switching to the 0870 system.

If making appointments is an essential part and precursor to treatment, and GPs derive a financial benefit from the process through their 0870 numbers, then they are also in breach of their contracts with the NHS which prohibits them from charging patients for treatment.

"The NHS do not provide any money for the GP's to buy a telephone system, and if they didn't move to an 0870 they would have to spend money on a new phone system instead of patient care. "

Do not be fooled by that nonsense.

Gps get a perfectly adequate payment each year from the NHS to provide all necessary premises and tools for patient care. Anything that they make on 0870 numbers will go into their own pockets.

Have I missed something here, have they stopped using 0870 yet ?

http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotices/fs/en?CONTENT_ID=4104023&chk=JdW4bw