bazzerfewi has asked me to post this reply which he has received from his MP:

10^th January 2012


Dear Baz,

Thank you for contacting me with regard to the use of 0844/5 numbers by medical practices and doctor's surgeries in Barnsley. As you know, I agree that the use of non-geographic telephone numbers means an unfair surcharge on patients who need to use a mobile phone.   Further, I disagree with such numbers being used as a means of revenue-generation for medical practices.

Further to previous communications, I can confirm that I have now received information from the various agencies that have been contacted as part of my investigation into this matter.

I have been informed by NHS Barnsley that all practices within the jurisdiction of the Primary Care Trust have been directed to discontinue use of 084/5 numbers.  Some have already done so and those that remain are in the process of ceasing use of these numbers, subject to contracted notice periods.

I am assured that it is expected for all 0844/5 numbers to be ceased by the end of the financial year.
I hope you find this response helpful, if there is anything else I can help with, please do not hesitate to contact my constituency office.

Yours sincerely,

Dan Jarvis MP
Barnsley Central

Is it me?   Why can they not change, I had thought providers were supposed to make change to geo/03 possible in these circumstances?   More to the point, generally what is the use of call back because by the time you've got through, you've already incurred possible large costs, particularly if you're in a queue?  Also, with the amount of info they require, presumably to prevent any errant BT customer from gaining a percieved(?) benefit, the caller will have been engaged in a lengthy premium rate call & the reception staff wasting a lot of time on non-medical unnecessary nonsense.   What a waste of time becuase they have no conscience about the sick at all!

Dave wrote on Jan 18^th, 2012 at 4:54pm:
... and has taken the necessary action, albeit belatedly.

Members may be assured that campaigners are engaged with KCOM and the PCTs in trying to get this mess sorted out. Further representations may of course be made to either or both.


Barbara wrote on Jan 18^th, 2012 at 1:55pm:

Providers are invariably able to arrange migration from 084 to the equivalent 034 number, and it is normally the case that they do permit this.

It may well be that providers are able to arrange migration to a geographic number, however that cannot be guaranteed, nor may it be desirable if the technical features of non-geographic numbers are used to advantage.


Barbara wrote on Jan 18^th, 2012 at 1:55pm:

The Quote:

... is not strictly correct. The regulations do not prohibit use of a call back arrangement, but that is not to say that they allow it as an acceptable alternative to ensuring that callers pay no more than the cost of an equivalent call to a geographic number.


Variations to the GP contract can only compel a practice to take "reasonable" steps in respect of existing commercial arrangements. Only if a practice can show that there is no "reasonable" step open to them may they continue to use a 084 number. In such cases they are required to "consider" a call back arrangement.

The only call back arrangement that would be suitable is one which automatically accepts requests for call back, rather than placing a caller in a queue, and ensures that the call back is delivered at the appropriate point in the processing of the queue. This technology is available and is used by some call centres. It is however probably far too expensive and complex for use in a GP surgery. It is also known to be not wholly effective in practice, because many of those called back do not answer the call.

I would expect all practices to decide not to follow this course, although they are required to "consider" it.


The key point rests in establishing that migration to 034 (although other reasonable steps may be preferred) is an option that is both available and reasonable in every case. I have not yet seen any clear evidence to show a case where this is untrue. There are of course many claims that migration is not possible (such as that quoted above), but I have not seen any evidence to sustain them. The BMA advises members to claim that meeting the full cost of their telephone system, without subsidy at the expense of patients, (a consequence of migration from 084 to 03) would be an "unreasonable" cost for a practice to bear - this is, of course, nonsense.


The Firth Park Surgery is not prohibited from following its rather elaborate call back policy. This is obviously intended to avoid the practice from incurring the cost and inconvenience of calling back, unless there is a good reason why it should do so. The declared policy appears absurdly over-elaborate and excessively formal. One hopes that a more practical and sensitive approach is followed in reality. There will always be situations in which it is appropriate for a surgery to call back.

(I am concerned that the genesis of this policy may be from someone mistakenly believing that a formalised call back policy, which rightly protected the interests of practices, was an acceptable alternative to taking "the necessary reasonable steps".)


Barbara wrote on Jan 18^th, 2012 at 1:55pm:

Is it me?   I seriously doubt that there is any such callousness on the part of GPs or any others involved in this matter. One notable exception however springs immediately to mind!

I suspect that there are good intentions at the heart of this, although they have been misguided and administrative nonsense has ended up having to play too big a part.

This is fantastic new, lets see how many follow suit to comply with the law

Dave wrote on Jan 18^th, 2012 at 8:29pm:

This is not compliance with the terms of the contract revisions approved by parliament.

Unless it can be shown that KCOM refuses to allow practices to meet the cost of their telephone systems in full - by migration to a 03 number - then they remain in breach of the terms of the contractual provisions.


The idea that some half-baked concept of a call-back arrangement is an acceptable alternative to full compliance seems to be a local invention. If this has been a policy determination by the PCT, then it stands in breach of its statutory duty.

If it can be shown that KCOM does not permit migration to 03 in these cases (or imposes exceptional charges) then it must be exposed as interferring with the operation of the NHS for purely political reasons. If this were the case, then the PCT should be congratulated for at least doing something to mitigate the effect.

I am fairly confident about the side on which the truth will lie.


If the PCT had any part in originally commending use of non-geographic numbers to the practices, I can understand that once the true cost is revealed then it would feel embarrassed, not to mention the anger of the practices and the LMC. It cannot however be allowed to use KCOM as a scapegoat. If KCOM is morally guilty in any way, then it may want to take a financial hit by offering exceptionally generous terms for use of 03 numbers.

The one group that cannot be used to pick up the tab are the patients of the practices.

Reply from Surrey PCT below received a couple of weeks ago. Positive news after something in the region of 50 exchanges of correspondence over a period of nearly a year.

With David's help I am still pursuing the issue in letter where it is suggested that some contracts will have to go to expiry as termination will cost £10Ks. We don't believe contracts necessarily need to be terminated and the cost of transferring to an alternative 0344 number should not be significant.

Letter from Surrey PCT:

Thank you for your recent emails regarding the use of 084 numbers by GP practices in Surrey. I understand this is an area of great interest and concern to you and apologise for the delay in responding to you.
I would like to assure you that we have been working closely with our GP practices, together with the LMC, to ensure that where contracts are coming to end 084 numbers are not being used and where arrangements can be varied the practice has done so.
I am aware that six practices still have contracts that use 084 numbers and financial penalties associated with terminating the contracts are significant (some tens of thousands of pounds). This funding would have to be taken from direct patient care. In view of this, the advice that we have been given is that where it is not possible to reasonably vary or renegotiate the contract, it will run to its expiry date. We will work with these practices to ensure that at that point, any new arrangements meet the NHS direction.
I would like to reassure you that we have taken the issue of 084 numbers very seriously and will continue to do so until they are no longer in operation in Surrey. We are monitoring the position with those practices which have contracts for these numbers to ensure that they terminate at the earliest possible point.

bazzerfewi wrote on Jan 20^th, 2012 at 7:03pm:

Put simply, the legal position and the chronology is as follows:

- GPs serve the NHS under a contract with their local PCT, the general terms of which are negotiated and agreed nationally, and approved by parliament. Fine details covering particular services and the value of payments are added in each case locally. It is the PCT that is responsible for enforcement of compliance with the terms. If necessary, this can be done through a civil court - but one hopes never to actually come to the point of legal proceedings.

- The general terms of the contracts (there are actually three different versions, but the relevant wording is identical) were amended to take effect from 1 April 2010. This effectively prohibited adoption of any relatively expensive (i.e. 084) number from that date.

- Those already using such numbers were given 12 months in which to vary or terminate their arrangements so as to ensure that patients and others paid no more than the cost of an equivalent call to a geographic number to contact the GP. Recognising that arrangements may already be in place extending beyond the deadline of 1 April 2011, only "reasonable steps" could be required.


I am prepared to accept that incurring penalty charges for early termination of an equipment leasing agreement would not be "reasonable", but that is not what is necessary in order to comply. The option of migration to the equivalent 034 number is available in every case - this has never been denied. This will cause practices to henceforward incur the full cost of their telephone system, because the subsidy provided from use of 084 numbers is lost. Whatever a GP may think of its telephone system provider, in terms of its duties to the NHS, that cost must be considered to be "reasonable".

For a variety of reasons (all of them bad), the April 2011 deadline has been missed in very many cases. The terms of the contract cannot be easily amended, so no new deadline can be set. I argue that the government must now put all possible pressure on PCTs to properly enforce compliance with the requirements, and do so with no undue delay.

Support from the BMA, and providers such as NEG, would help this process enormously. If necessary, this will have to be engaged through the knowledge that their members / customers will need this assistance in order to avoid facing legal action.

If some informally agreed deadline would help this process, then I would not object, however this cannot be seen as an extension of the period of grace granted initially. It must be understood that all those continuing to use 084 numbers are currently in breach of their contracts, not subject to some new or revised requirement. This latter point will enable patients of every surgery to be aware that their rights under the NHS Constitution are being respected, and it will help them to exert pressure on practices to ensure that they return to compliance as soon as is possible.

bazzerfewi wrote on Jan 20^th, 2012 at 11:15pm:

You are right in all that say and it is indeed the civil law that is involved in the GP/NHS contracts, as would apply to the private sector.  They must "carry the can".

As I understand the situation, where the terms of any contract are varied, a court would throw out any attempt to enforce a new requirement that was "unreasonable". That is why the action demanded is qualified in this way.

I cannot however see how any GP could claim that it is unreasonable to be required to meet the cost of its chosen telephone system without the benefit of subsidy at the expense of patients. This is, of course, what the majority of GPs do.


I suspect that there are far more patients who recognise that they are being robbed than are prepared to stand up and make a fuss about it after their practice has claimed to be compliant with regulations. It is a very bold step to tell your GP that they have lied to you. I want to give those people the confidence to make themselves heard.