Having had more problems getting through to my GP recently involving calls being dropped from the queue because of high volumes, I again called the health board and lodged a formal protest, a few days later I received a letter from them, the bulk of which I reproduce below. Im working on a reply, but I'd be interested in any comments from other members


Quote:

Thank you for your recent telephone enquiry and for taking the time to contact us about your concerns in relation to the 0844 Telephone numbers being used for patinets at ****** Medical Group. Please accpet our sincere apologies for the distress and inconvenience that this has clearly already caused you. At present there are six surguries in the Hywel Dda area currently using 0844 numbers; these are (list) All practices were made aware, in writing, by the Health Board of the amended GMS regulations relating to telephone services in August 2010, and further reminded in march and April 2011. All practices using 0844 numbers are currently in discussion with the Health Board regarding their use and the expiry of current contracts. I understand that 0844  numbers are charged at up to 5p per minute at all times (certain ranges are charged at either 3,4 or 5p). This is defined as a low call rate because callers pay much more to call other number ranges, including mobile, landline or premium rate numbers. After free phone numbers, low call numbers are the cheapest for the caller. Patients, therefore are paying no more to contact their local surgery than the cost of a local BT call. However telephoning any number from a moblie phone can attract a variety of chargesand it may cost more to telephone the surgery number from a mobile provider. Where patients have telephone payment packages that have "Free Calls", the Health Boardcannot help with this as obviously these packages are a matter of choice for the consumer. Please be assured that we are continuing to work with the practices to ensure the best service for the patients. I hope I have answered your queries in relation to this matter, however if you would like to discuss any further issues about the 0844 numberand the problems you have had obtaining an appointment I would kindly suggest you contact the  (name),  Manager of the practice group who will be able to assist you further Trevor Purt - Chief executive

I can see a few points there that I'm going to pick him up on, but any input is welcome - even if it only confirms my points now. I will post my reply here when I finish composing it.

Mr Purt is not strictly correct, as there are nine surgeries covered by the Hywel Dda Health Board using 0844 numbers, although three are branches; there are six practices and only six different numbers. They are listed here.

A summary covering all of the GIG Bwrddau Lechyd is given here.

This is the current version of the information given in an earlier blog posting GIG Bwrddau Lechyd to enforce principle of "free at the point of need" before the NHS can move forward. I am grateful to a Western Mail reporter for assistance with a little Welsh - see her story Sixty GP surgeries asking patients to call them on high-rate numbers.


A copy of a message currently in the course of being sent to all of the PCT Cluster Chief Executives in England will shortly be published on my NHS Patient Blog. Those following my campaigning activities through my news feeds will be advised of this.

The message for the Chief Executives of the Wales Health Boards is very similar as they have similar duties in respect of identical contractual provisions imposed on GPs.

---

I hope that Mr Purt was not advised by the Health Board's leading authority on the relative cost of telephone calls when drafting his letter. His understanding of the reality of telephone call charges is very weak. The way that it is skewed in favour of 0844 numbers being acceptable causes one to wonder about the objectivity of his source of information.

To suggest that the vast majority of telephone users fall outside the terms of the provisions because they are only offered packages that include some inclusive calls is absurd. All residential BT and Virgin Media customers are thereby excluded as are all contract and some PAYG mobile users.

Mr Purt seems to believe that only those who are compelled to use a particular telephone service (perhaps payphone users?), having no choice, should be considered. He should therefore take a look at the relative cost of calling 0844 numbers from payphones. A list of relative call charges covering commonly used tariffs is published here.

The first thing that Mr Purt needs to do is to review the terms of the relevant contractual provisions and to note the exclusion of the word that is struck through below:


Quote:

... persons will not involuntarily pay more to make relevant calls to the practice than they would to make equivalent calls to a geographical number ...

Any requirement that addresses the cost incurred in making a telephone call cannot disregard the fact that there is a wide market for telephone services. Some landline users do have the freedom to choose an arrangement whereby the cost of a "normal" geographic call during the daytime is more expensive than one which includes an amount that is passed on the call recipient. They are however unlikely to choose such an arrangement because of its effect on the relative cost of a call to their GP!

It is complete nonsense to suggest that this perverse situation is any way relevant to these important provisions, which exist to protect the principles of the NHS.

Just put a call into the Welsh Assembly Govt: I asked for clarification of the position of practices using 08444 numbers in relation to the GMS contracts, given that there seems to be a complete lethargy on the part of my Local Health board with regard to ending this abuse use in our area, only to be told that this was a matter for the Local Health Boards to negotiate with the individual practices. He went on about individual negotiations, and how this is devolved to the local area etc, it seemed clear to me that this required a more robust approach.  ;)

At this point I became rather more assertive with the guy and asked him was it not the case that the substantive part of the contract would conform to a "template" with only minor variations to suit local conditions, or was it the case that Patients in Wales were receiving less protection from this de-facto admission charge to the NHS under the Assembly Government, than patients in England were under Westmninster? ;D

He has gone away to see what he can learn and promised to call me later. It really shouldnt be this hard, no wonder Gps can pretty much ignore the whole mess and carry on earning a nice bonus from being forced to use these numbers to (pay) gain admission to the service.

I read in the Western Mail article
Quote:

Dr David Bailey, chair of the Welsh GP committee, said: “While some people will chose to call their GP surgery on their mobile, very few people do not have access to a landline to make that call.

This shows the dismissive attitude that seems to be at work here, where Practices are unwilling to give up the revenue stream until they are forced to... it is time for the fullest use of force. >:(

warweezil wrote on Nov 29^th, 2011 at 10:11am:

... was it the case that Patients in Wales were receiving less protection from this de-facto admission charge to the NHS under the Assembly Government, than patients in England were under Westmninster?

Happily (or sadly!), we are all in exactly the same position. The standard terms of the contract are set nationally, following negotiation, by the respective government. Enforcement is devolved to the local NHS body, with whom the contract, under civil law, exists. (The same principle also applies in Scotland and Northern Ireland, although the form of the contracts are slightly different there.)

The arguments are extremely well made in the quoted posting. Citizens of the UK own a single "National" Health Service. No one government has the authority to steal this from us. Each is only granted temporary management duties for the duration of the respective parliament or assembly, which appoints it from its membership.


It is considered common courtesy for senior forum members to welcome newbies to the forum when replying to their postings. Please accept my apologies for not having done so previously and also a very warm welcome to a determined and eloquent fellow campaigner.

Thank you for the welcome, although I have been using the number checker here for some years now.

No reply from Cardiff, my question seems to be too tough for a prompt answer, I do hope they don't think I will just forget about it.  ;D

It is time for LHB to act and justify their existence. The suspicion grows that the relationship with practies is all too cosy.

It is now a month since I wrote to Hywel Dda, I did get a letter back saying there may be a delay in thier reply, but in all honesty I cant see any reason for it to take a month - maybe they are still looking for a way to justify the continued use of 0844 in this area.

This weekend I will write to them again with a copy of my letter and tell them that they have 14 days in which to respond - after that I will go back to the Welsh Assembly Government and ask them what we can do to force the LHB in this area to listen to us - the citizens for whom they work!

It is time they acted - or justified their inaction.

Have you made them aware of this...  http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132809  ...recent DHS document?

catj wrote on Mar 8^th, 2012 at 8:55pm:

Have you made them aware of this...  http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132809  ...recent DHS document?

Strictly speaking that document, being issued by the Department of Health, only applies to England, as responsibility for the NHS is devolved.

It could however be of interest in Wales as the Welsh government modelled its GP contact revisions on those issued in England. In fact they are identical.

After sending in a reminder I waited 2 weeks then contacted Cardiff... strangely, the very next day I received a reply from Hwyel Dda LHB. While a lot of it addresses changes upcoming to the appointment system currently in place, they did also address the 08444 question.

Quote:

With Regard to the cost of contacting the practice, Negotiations with a third party telephone company have been opened with a view to return to the 01646 exchange sometime in the future. This is in the very early stages and any progress will depend on the financial penalties of ending the current contract before April 2014. The decision to revert to the 01646 number was made at a partners meeting on 23rd March 2012, however due to the aforementioned financial penalties comparisons are still being made between providers, and we are therefore unable to provide a date for the change

So while we have some movement, it seems clear that the practice does not feel any sense of urgency in this matter, and that they have chosen not to port to 03444 996 946 which AFAIK would be possible for a line that seems to be in the hands of TalkTalk at the moment.

Financial penalties.... or is that actually a useful delaying tool to allow another 2 years of revenue sharing?

Cynical? Me? Whatever gave you that idea? ;D

warweezil wrote on Apr 10^th, 2012 at 10:17am:

Financial penalties.... or is that actually a useful delying tool to allow another 2 years of revenue sharing? Cynical? Me? Whatever gave you that idea? ;D

If they are thinking of terminating the typical arrangement which involves GPs using 0844 numbers, then those penalties will be mostly associated with early termination of a leasing agreement.

There is no requirement to incur such costs. This practice (as with all others) could comply with its contractual duty to the NHS by migrating to the equivalent 034 number for the remainder of the term of its telephone service contract - and beyond if it wishes to do so. This will mean that patients no longer pay to subsidise the costs of the telephone system, these would have to be met by the practice out of the money provided (by taxpayers) for the provision of NHS services.

SilentCallsVictim wrote on Apr 11^th, 2012 at 8:39pm:

warweezil wrote on Apr 10th, 2012 at 10:17am: Financial penalties.... or is that actually a useful delying tool to allow another 2 years of revenue sharing? Cynical? Me? Whatever gave you that idea? ;D If they are thinking of terminating the typical arrangement which involves GPs using 0844 numbers, then those penalties will be mostly associated with early termination of a leasing agreement. There is no requirement to incur such costs. This practice (as with all others) could comply with its contractual duty to the NHS by migrating to the equivalent 034 number for the remainder of the term of its telephone service contract - and beyond if it wishes to do so. This will mean that patients no longer pay to subsidise the costs of the telephone system, these would have to be met by the practice out of the money provided (by taxpayers) for the provision of NHS services.

Yes I am about to bounce this right back into Mr Purts lap and tell him that 2 more years funding their phone hardware costs is not an acceptable situation. Is there any on-line resource I can point Mr Purt towards that explains the options available to Argyle Group with child like simplicity?
While I am sure that he is aware of the real reasons behind the reluctance of Argyle Group to move from this cash generating number with any sense of urgency -  it seems I have to spell it out for him very sim-pl-y and sl-ow-ly  ::)

I have checked and it seems the number is owned by TalkTalk business. I have read informal notes about in contract migration and reserved numbers on 03xxx, but I was wondering if there was some official on line "document" from either OFCOM or TalkTalk in this regard.

Hi warweezal

I have just seen your post about your problem - I have a Document that SCV and myself have compiled explaining the 03 Migration Option I hope simply enough and I am about to send it to another Poster who is having the same problem - I will speak to SCV regarding your similar problem and could email it to you as an attachment so that you can print it off - if you like to PM me your email address. Also my Landline number if you need anything explaining.

I hope I can be of help

speedy wrote on Apr 18^th, 2012 at 11:25pm:

Hi warweezal I have just seen your post about your problem - I have a Document that SCV and myself have compiled explaining the 03 Migration Option I hope simply enough and I am about to send it to another Poster who is having the same problem - I will speak to SCV regarding your similar problem and could email it to you as an attachment so that you can print it off - if you like to PM me your email address. Also my Landline number if you need anything explaining. I hope I can be of help

Speedy I would be grateful if you could provide me with a copy of that, if that's ok?

Also what part of the DoH guidelines prevent the use of 0844 numbers?

Hi CJT 80

I would be pleased to send you a copy of the 03 Migration Document. This is mainly intended for Practices that are saying they are "Locked into a 4/5 year Contract" and would like to adjust but cant afford the Rumoured Huge Financial Penalties for Termination"

I spoke to 5 Surgeries on 0844 - while I was on an old Metered Tariff with Talktalk before I moved to BT Anytime and of the 5 rung 4 answered and of these 4 only one was aware of 03 but had been told it would still cost a lot - the other 3 hadnt heard of it at all.

Getting back to the 03 Document - I am also reworking/updating another Document again with SCV help and checking for accuracy, intended originally to go to GPs to point out the error of their ways but this needed reworking in the light of the March and April Clarifications from on High - this I am working on now and could take a few days at least.

This could also be usefull to you to kill off the Lies that have been issued by NEG/Daisy in Compliance Letters requested by PCTs as fact and accepted as such, because the PCTs had no understanding of the real facts and Technicalities of this subject and in most cases just accepted these as true. These PCTs now have the embarrasment of having to accept that they were entirely wrong and and are reluctant to admit they hadnt done their job. There are also many that are just ignorant and stick to their Policy come what may.

If you could please PM me your email address I will add it to my list and send both as soon as the 2nd Document is ready, I will look around for the actual words and with SCV help link because it is a whole document not just a few sentences ( I think I have mentioned the Hansard quotes in the 2nd Document )

I have just had a call from the nice lady at the Welsh Assembly Govt. in Cardiff. She has again been in contact with the LHB and is up to speed on developments. She actually put in a call to the LHB following me notifying her that I had been waiting several weeks for a reply from Hywel Dda, but they had actually responded to me by the time she became aware of the issue, and today was the first opportunity we had to catch up - I know I had missed several calls from her.

The interesting thing for me was that she made mention of the possibility of large penalties for the surgery migrating away from 0844 4xx xxx, I drew the impression that this situation was put to her by the LHB, but I am unsure if this was a delaying tactic used by them, or indeed used by Argyle Medical Group.

It seems strange to me that there can be a route to migrate "In Contract", and yet have a large penalty clause attached to such a facility, especially where this migration would be driven by the charges imposed by the provider of the service breaching the "working contract" of the user of the service.

It all seems to be an exercise in delaying this move, the long wait between letters, the terminology from the LHB

Quote:

With regard to the cost of contacting the practice, negotiations with a third party telephone company have been opened with a view to return to the 01646 exchange sometime in the future. This is in the very early stages and any progress will depend on the financial penalties of ending the current contract before April 2014. The decision to revert to the 01646 number was made at the Partners meeting on the 23rd March 2012, however due to the aforementioned financial penalties, comparisons are still being made between the providers, and we are therefore unable to provide a date for the change

Thats a long winded way of saying business as usual, and smells to me to be a way of dragging this whole thing out as far as they possibly can. I mentioned that the number appears registered as a TalkTalk number when I ran it through a checker, but she seemed confused when I mentioned talkTalk - I assume they own the range and wholesale out to resellers - in the same way as I buy my talktalk Internet access through Vivaciti to avoid the TT traffic management and lousy support  ;)

She did say the LHB has a responsibility to see this is sorted out and has said she will be monitoring the situation and will stay in touch with the LHB. I believe her involvement has worried the LHB, which can be no bad thing if they know they are being watched by the WAG.

I have started a draft of my reply to Hwyel Dda, once I add some information to it I will fire it off and see what roadblocks they seek to erect this time  ::)

This is a classic reply. I'm getting the same with Surrey PCT who refer to £10,000s to terminate contracts. I have challenged this. They do not need to cancel contracts but simply convert to the equivalent 0344 number e.g 0844 123456 becomes 0344 123456. They will obviously lose the revenue stream but that is all.

SCV has quoted several times that providers have confirmed that they will do this and not impose penalties for transferring to the equivalent number (he should be able to provide evidence).

Termination is another matter which might involve a penalty, but it is not necessary and is probably being put up as a smokescreen.

I had a small smile to myself when Hywel Dda referred to "returning to the 01646 exchange". The surgery is now and always has been on the 01646 exchange, Simply put - the real number is masked, and it seems clear that LHBs are out of their depth on this, and maybe a matter such as this should be dealt with centrally by people who actually have a clue.

;D Success!  ;D

As of Monday morning Argyle Medical Group will be operating an 01646 geographic number!

How much I had to do with this is debatable - but I like to think I helped nudge the situation along a little. :)

Its only taken a few years   :D

warweezil wrote on Sep 28^th, 2012 at 7:26pm:

As of Monday morning Argyle Medical Group will be operating an 01646 geographic number!

There is a news release from the Health Board about this:

New Phone Numbers At The Argyle Medical Group

Quote:

Argyle Medical Group in Pembroke Dock are making it easier for patients to contact them.

That's funny. That's the exact same reason that was given when they originally moved to the old 0844 number.


Quote:

Following suggestions received from patients of the practice...

No mention of the 2010 ban on using these numbers.


Quote:

not helpful for mobile phone ‘pay as you go’ users, as the tariffs set by mobile phone companies tended to be much higher than rates paid by patients telephoning from local numbers

Yes, that's one reason, but still not quite hitting the nail on the head.


Quote:

we had also noticed an increase in the numbers of concerns received in respect of the old 0844 number

Still no mention of the 2010 ban on using these numbers.


Quote:

there is no extended queuing facility with the local number and that they may experience an engaged tone when trying to contact us at busy times

One wonders whether 03 numbers were considered, or even mentioned as a possibility.

Again, some excellent remarks from catj.

I do want to add some comments on one point.


catj wrote on Oct 30^th, 2012 at 7:20pm:

Quote: there is no extended queuing facility with the local number and that they may experience an engaged tone when trying to contact us at busy times One wonders whether 03 numbers were considered, or even mentioned as a possibility.

Incurring the considerable expense of using a non-geographic number so as to enable unlimited queuing is not necessarily a sound decision for a GP surgery.

There is a limit to the length of time that people will be content to wait to get through (even if they are not paying for the call). Acquiring sufficient lines to enable a reasonable queueing time (= number of waiting callers) is a perfectly proper approach for an operation as small as a GP practice.


The 03 argument applies specifically to those who are committed to a contract from a particular provider and using a system which depends on use of non-geographic numbers. Migration to the equivalent 034 number is the "reasonable step" demanded of them by the terms of their NHS contract.

If the provider in question believes that a solution based on a non-geographic number is genuinely a sensible cost-effective option for NHS GPs, then let it make its case. If it relies on the Service Charge, then it is, as it always was, unsuitable for the NHS.

(The migration to 03 proposal was not only a practical option, it was a way of flushing out an answer to the question of whether 0844 numbers had been chosen for the technical or financial benefits.)


If this practice (and others) is seeking to imply that it cannot provide adequate telephone access without subsidy from patients, then let us have that argument out in the open.

There may be some of the 90% of NHS GPs who do not use non-geographic numbers who are providing inadequate access by telephone. I do not believe that it is every one of them! Where are the other providers of small business telephone systems?

The final comment was posted with the idea that you'd pop up to add more detail on that subject.  :)  Thanks for filling in more detailed information.

My GP has never changed from an 01 number (I did send a pre-emptive email warning of the furore such a move would ignite).

As a result, trying to phone at 8:30am - the time at which the surgery's answering machine is switched off - often results in getting the (free) engaged tone. 

Pressing of the LNR button is all that is required to try again though (and, if necessary, pressing LNR and hanging up in quick succession as necessary normally gets you through within 2 minutes).

I don't consider the surgery (6 doctors) is providing an inadequate telephone service for patients.