The ingress call (from caller to IN) would be on PSTN, not VoiP. This is due to BT charging a PSTN ingress charge to the nearest POP (Point of presence) for the carrier that hosts the NGN.
To deliver this on VoiP to the recipient surgery could easily be accomplished, but it would involve the cost of either an ADSL or SDSL (preferred) service. You would however still require an amount of PSTN lines in case of network fault, router failure or power failure.

To stop the "mine has never gone down" argument before it starts, the highest funded and world's largest VoiP provider had a single outtage that switched of telephony for 20million users for over 12 hours last month. This would not be acceptable in a surgery.

Although BT do carry calls from PSTN to VoiP internally using the CN21 service this has duplicity over PSTN, so an outtage would not affect service. It is a cost saving service for BT, not for their customers.  

This whole situation comes back to economics and service. Does the service justify the cost that is being charged, and is the correct person paying for the service.  

http://www.lep.co.uk/news/MPs-join-attack-on-39ripoff39.3190277.jp

MPs join attack on 'rip-off' phonelines

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Lancashire's MPs have united in condemning public bodies over their use of 'rip-off' phonelines.
The MPs hit out after the Evening Post revealed that GP surgeries were using an 0844 number and public bodies such as Lancashire Constabulary and Lancashire Trading Standards were using an 0845 number.

Although not officially classed as premium rate, the new numbers are up to 4p a minute more expensive to call from standard BT landlines and can cost up to 35p a minute more using a mobile phone.

South Ribble Labour MP David Borrow said councils and the police need to consult with residents over the use of such phonelines.

And the controversial numbers should be scrapped if the public demands it.

He said: "They should be looking to the people they serve, because they are not private companies. They are spending tax payers' money and there should be a system in place to gauge public opinion on this issue.

"If people are not happy then this should be looked at again."

Nigel Evans, Tory MP for Ribble Valley, said: "Quite frankly they should be freephone numbers. People pay for the NHS through taxes and they are paying further for using those services."

Michael Jack, Tory MP for Fylde, added: "I think this practice should be stopped. It is another way of making money out of the unsuspecting public and the public should show their dissent."

Lindsay Hoyle, Labour MP for Chorley, said: "This is just another added burden people could do without. It is unacceptable."

Ben Wallace, MP for Lancaster and Wyre, said: "It is not good enough that we are paying above inflation hikes in council tax and our tax. It now seems they are ripping us off by the back door."

But Preston MP Mark Hendrick called for more competition in the sector which could drive prices down. He said: "With more and more public authorities using these numbers, it might be some of these companies could steal a march by offering such a package."

Gabby Nelson, Lancashire County Council's assistant director of customer access, said: "It is fairer to have one general contact number, as there are many different area codes across the 12 Lancashire districts."

Meanwhile, patients are angry after discovering they face extra charges for ringing up to make an appointment with their doctor.

The Lancashire Evening Post revealed that at least four GP surgeries in Preston have changed their 01772 area code number in favour of a more expensive 0844 prefix.

Now it has emerged that Longton Health Centre has also adopted the controversial telephone line system – prompting a meeting of Longton Parish Council and a letter of complaint to the practice.

Stewart McLoughlin, 60, who lives in Longton and is a patient at the practice, as well as a parish councillor, said: "When I received my itemised telephone bill, I was furious that every time I had called the surgery, the calls had lasted around five minutes and I had been charged while waiting to make an appointment.

"It is ridiculous as in the past, I would only be on the phone for about 30 seconds and would pay much less for the telephone call."

The practice says it does not make any money out of the system and that the new telephone system was brought in after patients complained about the inability to get through to the health centre on the telephone.

But Mr McLoughlin says the parish council are still unhappy and have written another letter.

He said: "It may just be pennies, but pennies make pounds and I object to the NHS making money out of me."
>>

The item regarding doctors surgeries was on the local news on the hour at 7am and there was then a short 5 minute item quoting various local residents followed by comments played on air from David, described as being "a one man national campaign against these numbers".

So David first you are something of a sceptic as to whether it is wrong to charge for calling doctors when the NHS charges for prescriptions or dental treatment but now you have become a national one man campaign against these numbers leaving the rest of us behind.  I wonder what happened to the rest of us involved in the multi man campaign against the numbers.  Are you perhaps getting confused with your own previous one campaign against Silent Calls?

Is this your usual modus operandi so that you try to obtain all the credit for such campaigning and do you have special contacts with the BBC from your professional role (whatever that is) that let you get straight on the program.  When I tried calling I had a job even getting past the switchboard and then Jules the producer of the program seemed distinctly frosty and disinterested in adding my comments for their 8am slot on the item.

I see I am once again not receiving update emails for new posts in this thread.  How did that happen?

I don't suppose many of you will have often visited the website www.networkeuropegroup.com but if you do as I have just done today you will find that NEG has just sired a new - child in the form of NEG DentistLine.

Could it be that seeing the writing finally on the wall for their revenue sharing Surgery Line model, due to it breach of GP Contracts with the NHS, that they are now focusing their efforts on the dental industry the large majority of which is entirely privatised and with even the NHS part that isn't being in the habit of charging patients pretty enormous fees.

And with probably no equivalent of the terms restricting direct charging in the GP contract for NHS dentists (and with there not being many NHS dentists anyway) there is nothing that anyone will able to do in order to stop the relentless rollout of NEG Dentist Line.#

About the only hope that it may be stopped is that lethargic Ofcom will finally muster the energy to get off its big fat corporate ass and make some kind of regulations requiring full disclosure of all 0844 revenue sharing and/or that the bad publicity associated with NEG Surgeryline will be enough to scare off most dentists away from signing up with it.

What is the betting that NEG employ the same old tactics of lieing about their DentistLine numbers being local rate and providng the dentists surgeries with big signs saying Low Cost Call against the new 0844 number.

NGMsGhost wrote on Sep 12^th, 2007 at 1:21pm:

However, the ban on 09 and 0870 applies to GPs, NHS dentists, NHS opticians and GP out of hours service providers, so any future extension of it to 0844 and 0845 may do also.

http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4114493&c=2

GPs blame PCTs in phone row

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The GPC has sprung to the defence of GPs who have been criticised for using high-tariff phone lines, claiming practices are being encouraged to switch to more expensive systems by cash-strapped PCTs.

GPs have recently come under fire in the media for using 0845 and 0844 numbers, which critics claim lead to higher patient call charges.

But GPC chair Dr Laurence Buckman said PCTs have refused to supply practices with new telephone systems unless they switch, and claimed trusts were being offered free telephone exchange by telephone companies.

He said: ‘Some PCTs said ‘‘we’re really not interested in paying for these things anymore, we’d like to use this company because they’re offering a free system in return’’. It’s almost entirely to save PCTs money.’

He added: ‘I understand why practices did go with it if it was the only way of getting a new phone exchange, and PCTs were not going to support you unless you used this company.

‘I also understand why patients don’t like it, but to finger GPs are say they’re ripping people off is very unfair.’

The move provides further indication of the range of cost-cutting measures being employed by PCTs.

Despite projections of a near £1bn NHS surplus this financial year, PCTs across the country have embarked on major cost-cutting campaigns which have included telecoms.

Dr Buckman said that ‘lots of PCTs got on to this bandwagon’, adding that he had rejected an invitation from his PCT to switch lines in his own practice because ‘it didn’t seem to be a saving for patients’.

However, Dr Dennis Abadi, a GP in north London, said his practice installed an 0844 number after patient survey results showed no one could get through on the phone. He added: ‘We had 8,700 patients and one incoming line. It was a shocking service in terms of access.’

Dr Abadi said he approached his local PCT for a grant to implement a new system, but was told ‘no money was forthcoming’ which led his practice to approach telephone company NEG, which installed the system free of charge.


He admitted: ‘Part of this is offset by calls. It’s not quite cost neutral, but we’ve had no complaints in more than two years, and it has given us fantastic results for telephone access.’

Dr Simon Parkinson, secretary of Worcestershire LMC and a GP in Redditch, employs an 0844 number in his practice, and believed criticism of GPs was ‘unfair’. He said: ‘The LMC’s view is that there’s nothing wrong with this. People thought it was a worthwhile service for patients; they’ve not gone into it to make money.’

giacobucci@cmpmedica.com

Surgery phones row

• Controversy over surgery telephone costs surfaced this year as the media enjoyed a feeding frenzy over a series of alleged TV phone in scams.

• The allegation was that surgeries were ripping off their patients.

• Although numbers beginning in 0845 cost the caller around the same as local BT rates, callers to 0844 numbers can potentially pay a fixed call price of up to 5p per minute, with calls from mobiles as high as 25p a minute.

Have your say

Are you being pressed to switch lines?

pulse@cmpmedica.com
>>

I have received a reply from Louise Fowler,(Ashton Health Centre),in response to my email to her last week where I quoted,(and supplied the link to),  Lord Warners Letter.


This is what I sent:-

The following is Lord Warner's letter advising PCT chief executives that Ofcom, as a result of its latest consultation, has decided to create a new country-wide number range 

And can be viewed here:- http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcollea...

As you can see it is dated nearly 9 months ago, although the original letter from the DoH was written 11th April 2005,29 months ago!!!  I suggest you take note of it!

This is her reply:-

Thanks for the mail - this option was discussed at length with Telewest on Wednesday and they are persuing this option for us although acknowledging that we need to retain the same level of functionality. I am also meeting with BT to see what options they have next week.

Will keep you informed of progress.

Louise