It is interesting to note that one party has immediately stepped forward to add comment on the government consultation:

http://www.ofcom.org.uk/media/features/03nhs

I am sure that there is much to criticise about this intervention to the debate, however it seems to be on the "right" side.

My own thoughts after a brief look are, what hope do we have to convert big business from using "local rate" and "national rate" if Ofcom can't stop using it?! Isn't it Ofcom after all that said you shouldn't use those terms...?

I am not in the habit of publishing campaign tactics, however the following may give some impression of my current thoughts and activities. I hope readers will appreciate why I do not offer precise detail.

It is also not my habit to tell people what to do, so please take any comments here as suggestions.

I see the DH consultation as being the wrong way to deal with the situation, but that is what we have.


I believe that it will be necessary to ensure that a very large show of public support for the proposed implementation of a ban on use of 084 numbers is implemented swiftly at the conclusion of the consultation. I hope that members will use whatever resources they have in support of this.

The BBC and other media are actually surprisingly open to suggestions of stories, although one should only generally expect a percentage success rate in single figures. Most TV producers are driven by levels of listener and viewer reaction, so any suggestion of a new angle on what has already be done, noting the reaction to the BBC story, is likely to be well received. What has already been done will not simply be repeated.

Given that there will be three months in the new year before anything will finally be achieved, there is no great rush. Copies of the consultation document will be distributed to every GP surgery and made available for all other NHS organisations to distribute. The Department of Health has no plans to arrange public discussions or events, however it is likely that many such events will occur, both for the public in particular localities and for particular interest groups. Members may wish to consider how such events may be promoted and to get generally involved in recruiting support for a strong response. Those in a position to arrange such events should be targeted.

Conveniently. a new e-petition to the Prime Minister has recently appeared with a closing date early in April - http://petitions.number10.gov.uk/Healthtelephone/. Efforts to ensure that there is an extensive show of support for the simple point of the consultation, through this petition, are already underway. Other members may wish to do what they can to this end.

The NHS.Patient website is in the course of being expanded to provide information specifically relevant to this consultation. Any other efforts in this line, such as a specific properly designed campaign website, would be a great help as a rallying point.


What is also important is for the plans for how the ban will be put into effect to be drawn up. This means that the obstacles presently in place, which led to the consultation rather than an immediate ban, must be removed. I do not see the balance of public opinion as being one of those obstacles, given that there is not a straight choice between not paying more and having a better service. Those who are able to do so, and believe that it is possible, should work on changing the thinking and positions of those who may make a difference.

When considering weight of numbers as a factor in changing public policy, we must remember that over 28.000 people signed the e-petition to the PM and it was thought necessary to hold a public consultation. The number of comments on the BBC website is significant and can be used to advantage in certain ways.

Please understand my reluctance to offer too much detail of strategy and tactics to public view and discussion. The BMA, the DH, Opal Telecom, NEG, BT, NHS Direct and all the other players in this process do not hold their strategy meetings in public, openly assigning tasks to specific individuals so that all can see the strengths and weaknesses of their position and personnel. I do not see any good reason why we should expose ourselves in this way.

This forum should also not be so arrogant as to see itself as the undisputed core of the concern on this issue. I am sure that there are many individuals and groups outside this forum with no less potential for effecting change on this particular issue (i.e. 084 numbers in the NHS).

I have sent this letter to the Consultations Co-ordinator and to Ofcom today by email.



To: The Consultations Coordinator Department of Health, 3E48 Quarry House, Leeds LS2 7UE

This is a criticism and complaint about mistakes and errors within your Consultation Document.   I am very surprised at the number and extent of factual errors within your consultation document and I would appreciate your immediate response on the following points.  

I believe this to be important and urgent as this document is promoting an incorrect understanding to the public.   It also indicates that you do not understand some fundamental aspects of these telephone systems and the use of 084 numbers.

1  On page 4 you state ---
" ...the Government recognises that the extra functions offered by an 084 number can improve access to services for patients."  
These functions are not provided by "the 084 number", they are provided by a "number translation service".   These functions can be equally provided to any number including 01, 02 and 03 numbers.

2 On page 4 you state ---
"A local call rate is the amount you pay to make a telephone call within a local geographical area. Each geographical area has a specific area code, for example 0207 for central London. Calls to local numbers from landlines are usually charged at the local rate."  
The practical distinction between local and national call rates was abandoned in 2004.   Since that year all calls to geographic numbers have been at a single rate for all but a tiny minority.    Calls from "for example 0207 for Central London" cost the same whether you are calling within the local area or anywhere else throughout the country including Scotland, Wales and Northern Ireland.   Calls to anywhere in the country from any originating area are at the same cost.   This applies to calls from landlines and mobiles.

3 On page 4 you state ---
"It is common in the NHS to have additional functions attached to 084 numbers. These functions are not generally available with local rate numbers, although it is possible to buy equipment to run alongside a local rate number that enables extra functions to be provided."
This is incorrect where it states  "These functions are not generally available with local rate numbers".   Additional functions can be provided for geographic numbers just as easily as for 084 numbers using a number translation service or locally installed equipment.

4 On page 5 you state: ---
"GP practices and other NHS organisations using 084 numbers do not make a profit from 084 numbers. The money generated by 084 numbers goes towards the cost of providing that number and the functions."
This is being economical with the truth.   It is advertised by the main supplier of these systems, NEG, that doctors do not have to pay anything for their new phone systems and that 1 or 2p per minute of every incoming call is provided by revenue share to pay for the system.   This allows the doctor to obtain the system without any expenditure at all instead of providing funding in the normal way as a capital expenditure.   This means that doctors are effectively allowing this capital to go to their bottom line as profit.   The capital expenditure would of course be treated as an allowable expense by the Revenue.    The point is, you are misleading the public by making this statement.

5 On page 7 you start a table which compares Local Rate, 084 and 03 numbers.    Your comments about the "quality of service" for local rate numbers is inaccurate as all these aspects can be provided or avoided depending on how the system is set up.

I can provide information and evidence to substantiate the statements I have made.   If you wish to see it please let me know.     This may not be an exhaustive list of factual criticisms so there may be some additional points to be made by myself or others.

I feel that these points should receive your urgent attention as it is supremely important that a Government document is seen to be strictly accurate with the facts it is stating and that it does not mislead the public in any way.

I look forward to your early reply,

Yours sincerely,

jrawle wrote on Dec 19^th, 2008 at 10:56am:

Members may like to refer to the information that was collected over a period around a year ago and is published here. As it is all from proper published sources, it suffers from any incompleteness or inaccuracies found there. It has not been updated to reflect the current position, or that at any single point in time. It does however go a very long way towards showing the extent of the problem.

The tables found here can be copied and pasted into a spreadsheet or database (when viewed using IE). They have postcode as a separate column and so are designed to permit geographic analysis, in addition to the PCT breakdown that is provided.

If someone has the necessary postcode data, the time and the skills, I would be delighted to incorporate further summarisation into the published information. If someone could persuade NHS Choices to release the full database of GPs that underlies its website, then the whole job could be done more professionally. This data, along with available (but not for free) postcode tables would allow preparation of up-to-date lists of percentages by town / district and electoral ward / parliamentary constituency. I considered doing this when preparing the information, but my limitations, including an absolute ban on direct expenditure, caused me to stop short.

Source: Daily Mail

http://www.dailymail.co.uk/news/article-1095602/Doctors-banned-charging-patients...

Doctors banned from charging patients to ring surgeries as 0845 numbers are scrapped

By Daniel Martin
Last updated at 7:46 PM on 16th December 2008

Doctors could be banned from charging patients 40p a minute to ring their surgeries, ministers said yesterday.

Around a fifth of the 8,000 practices in England - with ten million patients on their books - flout Government guidance by using 0844 and 0845 numbers.

GPs keep part of the charge patients pay when they call to fix an appointment, obtain test results or get repeat prescriptions.

An official review has been launched into whether surgeries and Health Service organisations should be made to use local-rate numbers, such as those starting 03.

Health minister Ben Bradshaw said: 'We are concerned that some people are paying above the odds to contact the NHS.

'For people on low incomes who need to contact their local doctor or hospital regularly, those costs can soon mount up.

'We know that some people value the extra service that 084 numbers can offer but others object to being charged more than the cost of a local call to access NHS services.

'We receive regular complaints from members of the public and parliamentarians about this.'

Calls to 084 numbers cost 5p a minute from a landline - more than the cost of a local call - and 40p from a mobile.

The Department of Health has tried repeatedly to stop GPs using high-cost numbers.

In 2005, it issued guidance over complaints that GPs were using 0870 numbers which are even more expensive.

But doctors moved on to 084 numbers - either 0844 or 0845 - which, although not technically premium rate, are still much dearer than a local call.

Two years ago, ministers issued further guidance, saying GPs could charge no more than the local call rate of 3.25p a minute.

But because family doctors are private operators, ministers have until now been reluctant to force them to change.

Phone campaigner David Hickson told the BBC's Today programme that use of costly numbers was completely unacceptable. He said: 'The NHS is supposed to be free at the point of need.

'The difference in each call may only be a few pence for some people, but the costs can really mount up for others - especially for people who are using mobiles because they don't have a landline.'

Network Europe Group, a telecoms company, says it has installed 0844 numbers in 1,200 surgeries and believes rivals have signed up 300 more for 084 services.

The company claims that patients gain because instead of hearing an engaged tone their call goes into a queue.

Laurence Buckman, chairman of the British Medical Association's GP committee, said: 'Telephone systems should make accessing a GP easier and also be cost effective for patients.

'We therefore welcome this consultation on how to improve the current system.

'The best way forward is for the Government to work with the telephone industry to make sure the companies that supply these systems move to local rate call arrangements with NHS organisations.'

Dr Buckman added that many surgeries were tied into long-term contracts, some of which can last seven years.

The telephone advice service NHS Direct also uses the higher-rate 0845 number and Mr Bradshaw said this policy would be reviewed. Some hospitals and primary care trusts also use the numbers.

GPs earn an average of £118,000 a year - up more than 50 per cent in four years.

They are also taking a higher proportion of the money they receive from the Government rather than investing in staff and services.

Source: Pulse

http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4121502&c=2

GP surgeries could be forced to ditch 084 numbers

16 Dec 08

By Steve Nowottny

GP surgeries could be banned from using more expensive 0844 and 0845 telephone numbers, it was announced today.

Ministers have launched an England-wide public consultation on the use of the numbers, which can cost patients up to 20p a minute to call from mobile phones – and warned ‘it is not an option to leave things as they are.’

At least 800 practices in England are thought to use the numbers – with as many as one in three surgeries doing so in some parts of the country. Numbers beginning with 084 are also used by some hospitals and primary care trusts.

GPs using the numbers argue that it enables them to provide patients with a better service, and cuts down the time taken to contact surgeries by routing calls more effectively. But ministers fear patients are being unfairly over-charged.

Health minister Ben Bradshaw said: ‘We are concerned that some people are paying above the odds to contact the NHS. For people on low incomes who need to contact their local doctor or hospital regularly, these costs can soon mount up.’

‘We know that some people value the additional service that 084 numbers can offer, but others object to being charged more than the cost of a local call to access NHS services. We receive regular complaints from members of the public and parliamentarians about this.’

The Department of Health had originally been due to rule on the issue in March, but delayed the publication of its report pending ‘information gathering’.

The BMA welcomed the consultation - but defended the use of 084 numbers.

Dr Laurence Buckman, GPC chair, said: 'Where 084 numbers are used by the NHS there is good evidence that patient satisfaction has improved, with better and quicker access to services because of the additional functions within the telephone system.'

'We believe the best way forward is for the government to work with the telephone industry to make sure the companies that supply these systems move to local-rate call arrangements with NHS organisations. After all it was the government that encouraged many GPs to move to 084 numbers in the first place to help meet their access targets, and many surgeries will now be tied into long-term contracts.'

But consumer lobbyists expressed impatience at the further delay.

Campaigner David Hickson said: ‘It is intolerable that three months is being wasted getting the obvious answer to this silly question about one tiny aspect of the NHS.’

‘For the NHS to be ‘free at the point of need’ all of these bodies must be required to cease using numbers beginning 0844 or 0845, because part of the payment made by patients when calling these numbers is provided as income or subsidy to the service provider.’

The public consultation seeks views from patients, GPs, NHS bodies, the telecommunications industry and other interested parties, and closes on 31 March 2009.