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BT/NHS - Working together to deliver N3 (Read 9,264 times)
idb
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BT/NHS - Working together to deliver N3
Oct 3rd, 2007 at 2:03am
 
The document posted below was pulled from either the DH web site or BT web site last year. Unfortunately I cannot locate the original URL. The document is entitled "Carson Recommendation Brief" and is produced by British Telecommunications Plc, 81 Newgate Street, London, EC1A 7AJ.

The front cover displays both BT and NHS logos.

Document date is Oct 18, 2005

I have omitted the preamble, version control history, review, authorization, distribution list and content list.

The document's purpose is "to describe methods that are available to meet the recommendations pertaining to telephony in the Carson Report" - stemming from "The primary telephony focus from a NHS paper (Raising Standards for Patients. New Partnerships in Out-of-Hours Care (October 2000)) written by David Carson, developed what has become referred to as The Carson Recommendation. This recommends Trusts to ensure that when a patient/member of the public attempts to make telephone contact with a doctor or health centre, outside of normal operating hours, only a single phone call is required"

According to the N3 web site -http://n3.nhs.uk/ , N3 is "part of the National Programme for IT (NPfIT). It will provide the entire NHS with fast broadband networking services. Without N3 it would be impossible to deliver other components of the Programme, all of which rely on greater bandwidth than the earlier networks NHSnet and N2 gave. In facilitating Programmes like the NHS Care Records Service, Choose and Book and the Electronic Transmission of Prescriptions, N3 is essential to the future of a modern NHS. It will enable the delivery of better care to patients and a truly 21st century infrastructure. It is the largest Virtual Private Network in Europe and is a project of a scale and complexity that has never been attempted before, in the UK or abroad.

It will deliver:

A fast and reliable network for every NHS site in England, supporting all National Applications, both current and new.

The flexibility to cater to future needs of the NHS, including the ability to take early advantage of updates and improvements in networking technology.
Bespoke networking solutions and services for the individual needs of different NHS organisations.

Support for NHS organisations in implementing innovative new services – for example, the use of video conferencing for appointments with consultants.

Substantial savings on the cost of telephony by enabling NHS organisations to converge their voice and data networks."


The document's original format is MS Word. If anyone requires the original document, please send a PM and I can email it.

(edit - the original document was at www.n3.nhs.uk/n3/publications/ListDocs.cfml?category=4 but it does not appear to be there now!)
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« Last Edit: Oct 3rd, 2007 at 2:42am by idb »  

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Re: BT/NHS - Working together to deliver N3
Reply #1 - Oct 3rd, 2007 at 2:06am
 
1      Introduction.

The primary telephony focus from a NHS paper (Raising Standards for Patients. New Partnerships in Out-of-Hours Care (October 2000)) written by David Carson, developed what has become referred to as The Carson Recommendation. This recommends Trusts to ensure that when a patient/member of the public attempts to make telephone contact with a doctor or health centre, outside of normal operating hours, only a single phone call is required.  This is defined within Recommendation 1 of the report:

[Original document includes an image containing text]

Additionally, within the report, it is stated at point 8 that “PCTs will need to give consideration to the current various models of out of hour’s provision, paying particular attention to any overlap with in hours services”.

This is understood to mean that the system must route the call to a definite manned position automatically without recourse to any redialling.  Trusts were directed to take note of the requirement and develop a strategy for implementation by December 2004.

The complete paper can be found at:-
http://www.dh.gov.uk/assetRoot/04/06/68/28/04066828.pdf]

Additionally, John Pickles of NHS Communicating For Health produced a paper (GP Practice Telephone Numbering Issues, Issue 2 dated 11th November 2004) which not only discusses the Carson Recommendations but also describes methods currently employed by particular NHS Trusts.  A copy of this paper is available by contacting John Pickles directly by email at:–

[I have removed the email address]

The purpose of this document is to describe methods that are available to meet the recommendations pertaining to telephony in the Carson Report.  

2      Call Forwarding Methods
There are several options that Trusts can consider each having benefits. These include:

·      On-net forwarding
·      PSTN Forwarding
·      0845 Call Routing
·      0844 Redirection
·      0870 Redirection

The merits of each will be addressed individually.

2.1      On-net Forwarding.

Where a surgery, health centre and other alternatives are connected to the Local Voice Community by a PABX or Virtual Private Network (FeatureNet Etc.), call forwarding is a standard feature enabling an incoming call to be forwarded by the VPN/PABX in accordance with a standard set of “rules”.  This could be “time of day”, on “no answer”, or if “busy”.  Modern PABXs and VPNs are able to continue to forward calls around the network until the call arrives at an answered extension.  A minimum amount of design work is required to ensure that the caller does not terminate at an unmanned destination or loop around the same group of unanswered extensions. Should all options “fail” then it is usual to direct the call to a voice mailbox where the caller can at least leave a number and a short message.  Although this does not meet the Carson Requirement fully, calls should not be lost nor should callers incur further costs as a result.

When this solution is utilised the Off-net Caller only pays for the call to the initial number, with all other costs being met by the network owner/subscriber. On-net Forwarding is particularly relevant in a VoIP network as the On-net costs are usually minimal for the diverted leg of the call

Historic NHS guidance has encouraged “Trunk to Trunk” barring on PABX installations, thus preventing On-net Forwarding being implemented.  This policy has been recommended to reduce the possibility of through dialling fraud.

2.2      PSTN Forwarding

All suppliers of PSTN services offer this service.  

As with On-Net Forwarding, a minimum amount of design is required to ensure that calls are properly terminated during the forwarding process.

The renter of the service pays the appropriate dialled call rates for the diverted leg of the call. The caller only pays for the call to the number dialled. For some suppliers, the charge for change of ‘divert-to' number is a one-off payment, and is charged on a per occasion basis. It should be noted that when using a Call Diversion service it is not possible to divert calls using Indirect Access codes (as used for a CPS service), the correct PSTN number for the “Directed To Number” (DTN) must be used. The NHS has advised that when utilising PSTN Forwarding on BT supplied lines where CPS is in use, checks should be made to ensure that the forwarding does operate as required.  Depending upon the service, the DTN is usually altered by a call to the service administration number (protected by an authorisation code).  This call is normally at local rates but can vary between suppliers.  

...

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Re: BT/NHS - Working together to deliver N3
Reply #2 - Oct 3rd, 2007 at 2:08am
 
...

2.3      0845 Call Routing

This service is one of several “non-geographic services” offered by PSTN suppliers, this means that a caller can dial the 0845 number from anywhere in the country and know that they will only be paying a fixed amount, typically 5 pence per minute.  The network can be set to deliver (route) calls made to a 0845 number to a permanent exchange line or DDI number. Call plans can also be set up to provide time of day options or divert on busy/no answer to ensure calls are delivered to another number if required.  This service would appear beneficial to callers if they were previously making National Rate calls, with the NHS paying for the service.

It should be noted however that should other NHS Trust users call the published 0845 number then the call costs are at a higher rate than for a normal PSTN local calls, typically 5pence per minute, and not included within any pre-paid call bundling or call option “deals”.  This would erode savings made by the reductions in current PSTN service tariffs.  
Most suppliers provide a 0845 number service and typically they all charge a similar amount to the calling customer, some suppliers will offer a refund to the called customer, but this is not as prevalent as it is with 0844.

Some NHS organisations have attempted to get round the above problem by utilising the unpublished geographic numbers - that is they dial the exchange number/DDI number that the 0845 is pointed to, this has usually resulted in loss of routing functionality and other problems.

2.4      0844 Redirection

This service is similar in operation to the 0845 service but the tariff structure is different and is not fixed to the PSTN local charge.  The supplier charges a higher tariff to the caller and, in most circumstances, makes a refund to the called customer (typically around 1pence per minute).  Some suppliers are offering this service free to NHS customers but retaining any customer rebate. Redirected calls to a mobile attract particularly high tariffs on the caller.

Calls from within the NHS to the published 0844 will attract a higher tariff than that for a PSTN call of similar duration and distance thus reducing savings.

2.5      087x Redirection

Whilst this service is similar in operation to the 0845 service the tariff structure is different and is not fixed to the PSTN local charge but the national charge.  The supplier charges a higher tariff to the caller and in some circumstances recompense the called customer. This compensation may be used to pay for the costs involved in publishing the number change, usually motivated by a service or functionality improvement. Some suppliers have offered this service as part of a package to NHS customers which can include provision of telephony equipment. More generally the caller paid for the national rate call even if the called number terminated locally, higher tariffs to mobiles applied and generally the NHS organisation received financial compensation based on the number of minutes the supplier’s network is in use.

Calls from within the NHS to the published 0870 will attract higher charges than for PSTN calls of similar duration and distance made to geographic numbers.

...


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Re: BT/NHS - Working together to deliver N3
Reply #3 - Oct 3rd, 2007 at 2:09am
 
...

There has been much attention in the national media with regards to patients paying high charges when calling their local GP’s who had deployed 0870 services. In the aftermath of this the Secretary of State issued new guidelines with regard to ‘premium rate’ numbers and their use within the NHS, an extract of which is below:

“. From 1 April 2005, NHS organisations providing local services will not be able to adopt national or premium rate numbers.  This will be achieved through:
· GP practices – amendments to GMS regulations
· APMS and PCTMS practices, including out of hours providers – amendments to directions
· NHS Trusts and PCTs – directions
GP practices currently using national rate telephone lines will be expected to change these to ‘lo-call’ numbers, under an arrangement between the Department of Health and the principal supplier.  The department will make funding of around £500 per practice available for them to switch from national rate to lo-call numbers.  The department will be working with PCTs to identify which practices will be entitled to the additional funding.
National rate telephone numbers start with an '087' prefix.  Premium rate telephone numbers start with the digits '09'.  The only special service numbers the NHS will be able to use in future are ‘free phone’ numbers or those that offer patients a guaranteed low rate call, such as '0845' or '0844' numbers.
Around 290 GP practices have established national rate lines, which charge up to 7.5p per minute, for taking patient appointments and for requesting repeat prescriptions. “
More information can be found on the Department of Health Web page at

http://www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleasesNotice...

3      Additional Considerations
3.1      CLI

When incorporating “NHS Direct” into the Out of Hours (OOH) call direction regime, the passing onwards of the originators Calling Line Identity should be considered. “NHS Direct” currently use CLI to route calls to the appropriate call centre serving that callers area.  If the “true” CLI is unavailable then the re-routed calls would need to be treated in a similar way to calls from a mobile telephone.
3.2      Publishing New Telephone Numbers

The costs and timescales of publishing any changes of contact numbers must be considered and any implementation of new numbers must ensure that they are widely known and in-use before any superseded number or system is closed.

3.3      Interim Service Costs

When a new number/ system is to be used, the old number for that service or contact must be closed in a managed way. If the old number is well known or well published then an interim regime should be put into place to ensure that the caller is given, or redirected to, the new number.  Ideally, the caller should be redirected without having to re-dial – this is implied if adopting the Carson Recommendation in full. The costs of transferring the caller to the new number must be fully considered along with the required duration of the redirection system – this would typically be one year but will depend on printing schedules for directories.  Any re-direction method mentioned in this paper could be utilised but all stated caveats will apply. If a recorded message system is utilised which requires the caller to make a new call (with an additional call charge) then the cost to the public must be considered.

4      Comment

It can be seen that where a 08XX service (other than 0800) is utilised, the caller does not have direct visibility of the actual cost of the call and may pay more than an equivalent call at their prevailing “local” rate. The actual cost of the call will have been determined by the service supplier and whatever local agreement has been made with the NHS body.  The ethical issues associated with services that either deliver an income stream to the NHS or cost more to the caller than they did before any changes must be fully understood and considered by those responsible for such ethical judgements i.e. this is not just the Telecom Manager’s decision.

On-net redirection, where available, is the most acceptable redirection method to callers as their costs remain at (usually) local rates.  Additionally, calls from within the NHS to those numbers, continue to benefit from endorsed N3 tariffs.   (Especially if the GPs and Health centres use it to get benefit on any redirected call charges). With the continuing deployment of VoIP systems within various Local Voice Communities, the use of On-net Forwarding should increase as time progresses.

...
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Re: BT/NHS - Working together to deliver N3
Reply #4 - Oct 3rd, 2007 at 2:11am
 
...

5      Ofcom Comment

Ofcom today (28/9/05) published new proposals to increase consumer protection measures governing the use of 0870/1 and 0844/5 numbers.
0870/1 and 0844/5 numbers (known as Number Translation Services or NTS) were introduced in 1996. Calls made to these numbers, which are not geographic numbers, have been priced at a level that has enabled businesses to share the revenue generated by per-minute call charges.
These numbers benefit consumers and businesses by enabling access to a range of services, including dial-up pay-as-you-go internet access, travel enquiries, tele-voting, telephone banking and many others. However, the growth and spread of usage of these non-geographic numbers in recent years has generated high levels of consumer concern about the lack of clarity in the pricing and marketing of these services.

Ofcom's initial proposals, published last October, prompted a range of responses from consumers and industry, including some significant disagreement.
Ofcom is now consulting on its new proposals. The key points include:
1.      0870: End to revenue sharing. Ofcom proposes that all calls to 0870 numbers should cost the same as calls to national-rate geographic numbers. This change would bring the cost of calling 0870 numbers down significantly. This price reduction would effectively end revenue sharing on 0870 when combined with other proposed changes to NTS call regulation.
Communications providers wishing to charge more than the rate for calls to national-rate geographic numbers would be required to provide a pre-announcement informing the caller of the cost of the call.
Ofcom proposes that providers should have up to 12 months to implement these changes. In the interim Ofcom proposes that 0870 call prices should not increase beyond their current levels.
2.      0871: Re-classified as premium rate. Companies using 0871 numbers would be regulated by the premium rate services regulator, ICSTIS, and would be subject to the same requirements as companies using 09 numbers.
3.      0845: No changes for the next two years. Many Internet Service Providers (ISPs) currently rely on 0845 numbers to offer dial-up pay-as-you-go internet services. Maintaining the current arrangements would protect these services for more than 5 million UK dial-up internet users. At present it is also often more cost effective for more than 1 million consumers on low incomes using BT's Light User scheme to dial an 0845 number than to make a national-rate call to a geographic number.
4.      0844: Increased price transparency. Changes to current prices (up to 5p per minute, with a 5p minimum charge, for BT customers) are not proposed at this time. However, Ofcom is proposing that providers should be required to publish more comprehensive and accurate pricing information. Ofcom plans to monitor the types of service offered on 0844 very carefully and will consider taking action if providers start to offer services on 0844 which are better suited to other number ranges.
5.      Improved consumer information. Ofcom proposes to require providers to give consumers better information about the cost of calling 087/084 numbers. To implement this, Ofcom is consulting separately on changes to General Condition 14, set under the EU Telecommunications Framework.
6.      Advertising and marketing. Ofcom will continue to provide support to the Advertising Standards Authority/Committee of Advertising Practice ('ASA/CAP'), whose guidance requires advertisers to provide consumers with pricing information for calls to NTS numbers. The guidance currently states that advertisers should not refer to 087 or 084 numbers as being charged at the "national" or "local" call rates.
7.      Use of NTS numbers by public bodies. Ofcom has already stated that, in its view, it is inappropriate for public bodies to use NTS numbers exclusively (i.e. without giving equal prominence to a geographic alternative) when dealing with people on low incomes or other vulnerable groups. Ofcom has also contributed to the Government's Central Office of Information (COI) best practice guidance on how NTS numbers should be used. Ofcom would like to see greater compliance with the COI's guidelines.
These measures aim to give consumers improved confidence in services using 0870/1 or 0844/5 numbers. Ofcom believes that the new proposals will prevent inappropriate use of these numbers and deliver clarity for consumers without disrupting important existing services such as dial-up internet access. Ofcom also believes that this approach will deliver greater certainty for telecoms companies carrying NTS calls.

...
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Re: BT/NHS - Working together to deliver N3
Reply #5 - Oct 3rd, 2007 at 2:12am
 
...

6      Recommendation

At a local NHS level, there are many different types of systems and services in use. This, together with the sometimes confusing array of options and tariffs available from various telecoms suppliers, makes it impossible to identify a single ‘one solution fits all’ type of recommendation.

The aim of this briefing paper is to raise awareness and help identify general areas which need to be considered in complying with The Carson Recommendation. Where further bespoke assistance is required in selecting the most appropriate method, supplier and tariff, the N3SP Voice and Data Consultancy can be contacted to discuss particulars on Tel: 0800 085 1707.

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Re: BT/NHS - Working together to deliver N3
Reply #6 - Oct 3rd, 2007 at 11:48am
 
idb wrote on Oct 3rd, 2007 at 2:09am:
...
4      Comment

It can be seen that where a 08XX service (other than 0800) is utilised, the caller does not have direct visibility of the actual cost of the call and may pay more than an equivalent call at their prevailing “local” rate. The actual cost of the call will have been determined by the service supplier and whatever local agreement has been made with the NHS body.  The ethical issues associated with services that either deliver an income stream to the NHS or cost more to the caller than they did before any changes must be fully understood and considered by those responsible for such ethical judgements i.e. this is not just the Telecom Manager’s decision.

...

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