kk wrote on Nov 25
th, 2007 at 10:22am:
I have found from long experience that when you complain …, you keep your complaint simple.
We agree. The point I make to Mr Bradshaw and others is not about the cost, but the principle of revenue sharing. That is both simple and indefensible for NHS contractors, who may not receive remuneration from patients (at any level), no matter how it is delivered or distributed.
NHS GPs may not fund their services using money collected from patients.
Further discussion is only necessary to address side issues that may be raised in an attempt to obfuscate the matter. That is what follows.
Whilst one may pick out an illustrative example of the cost difference, a single example (BT Together Option 1 in the daytime, ignoring the call connection charge, at the rates currently being applied) does not provide me with sufficient weight for the necessary argument on a point of principle.
“Revenue sharing” in the context of delivery of NHS services is simply unacceptable, without going any further. It is perhaps inevitable (barring a few perverse exceptions) that a call where some of the revenue is shared will cost more than one where it is not. We may refer to the latter as a "local call".
The two approaches will therefore generally hit the same point, however reliance on a single current example is dangerous. I focus particularly on GPs using 0844 revenue sharing numbers to avoid a problem that some could introduce - what about NHS GPs using 0845 revenue sharing numbers (a point that is best not discussed at length)?
As stated in my previous posting, a clear position
may be drawn from Mr Bradshaw’s statement. We have however seen many more GPs take up 0844 numbers since the “guidance” was issued. This action by the DH is thereby shown to have been ineffective.
In total, the written answer is far from clear as it allows many opportunities to those who may wish to deny the simple interpretation.
It refers to the “local national health service”, a far from simple concept to deal with in these times when partial devolution is used as means of perpetual buck-passing. It refers only to “guidance”, not direction. It uses a technically meaningless term - “local call”, which is not found on most current telephone tariffs.
Furthermore, the guidance was not issued to the telephone companies who levy the charges, but to PCTs and practices, who can neither control them nor be expected to be fully aware of what they are. Charges vary between the many options offered by the many providers and also change over time (e.g. "local rate" was effectively abolished in 2004). We also know that PCTs and practices are susceptible to misleading advice on such matters from those who may claim expertise in this field.
I have found from long experience that most of one’s efforts in campaigning are used in dealing with such nonesense. That is why I have to address the detail of this guidance, however
I do not focus on it.
When calling their NHS GP, unlike most other service providers, callers may not incur any cost that is passed on through revenue sharing (however great or small). My focus for this particular campaign is therefore on “revenue sharing”, because it is contrary to the principle frequently repeated by Ben Bradshaw’s ministerial boss, the Secretary of State Alan Johnson: “the NHS is free at the point of need”. For those who wish to take the trouble to go into even more detail, it is a breach of the terms of clause 483 of the GMS contract.
It is this fundamental principle of the NHS that is at issue here. There are many related issues about the cost of telephone calls that are worthy of attention and need to be addressed in different ways. I hope that this case is seen as being so clear as to demand action. We may hope that such action will be helpful with other cases that are not quite so clear, nor so demanding of attention.
The wording of ministerial questions and the new EDM are starting to move away from the point of illustrative BT call charges to pick up on the underlying issue, so let us hope that we are heading for a proper resolution, insofar as this may be delivered in parliament.
A simple and enforceable direction from the Department of Health that all telephone numbers used to access NHS GP services must begin with 01, 02 or 03 would ensure compliance with the GMS contract.
The same rule could be applied, as a matter of new policy rather than compliance with an existing contract, to the rest of the NHS. Other Departments could issue similar directions to cover all public services that do not advertise a fee for services delivered by telephone.
David