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NHS England to crack down on GP use of 0844 phone numbers

NHS England has announced it will crack down on GPs use of premium phone numbers, and has asked local area teams to identify practices still using them.

Last year MPs called for GPs to stop using 0844 numbers in their practices, after it was found a significant numbers of practices were still using the premium phone number despite new rules introduced by the DH from April 2011 that stated the costs of calls to practices must not exceed those of local calls.

NHS England confirmed the DH guidance on keeping the cost of calls to the practice equivalent to the price of a geographical call still stands. They have asked local area teams to review PCT documents to check which practices are still using 0844 numbers and will ‘act upon’ their findings in due course.

An NHS England spokesman said: ‘NHS England supports guidance from the Department of Health that GP practices should not enter into any new contracts for telephone services that would mean patients pay more than the cost of a geographical call to their practice.

‘GP practices were required to review existing arrangements by 1 April 2011. This remains the case.

‘NHS England was established on 1 April 2013 and as part of our new role we are actively researching the extent of use of 0844 numbers and will act upon our findings as and when this work has been carried out.’

But the GPC said that practices can use 0844 numbers within the rules as they are sometimes cheaper than georgraphical numbers for some patients, and that the local area teams have ‘more important things to do’ than looking for practices using them.

GPC deputy chair Dr Richard Vautrey said: ‘As long as practices are following the guidance, they should not be bullied by anyone. They might want to review their contract when it comes to an end, but local area teams have more important things to do than this.’

He added: ‘We have to remember that the problem is not so much the system practices use but the system providers. These days people have mobile phones and phone contracts which charge more for certain numbers. The system as a whole needs to change. It’s those providers that are ripping people off, not practices.’

Longstanding NHS campaigner Mr David Hickson, who has compiled a database of practices still using premium numbers, said that in September almost a thousand practices were still using 0844 numbers.

He said that the provisions of the 2010 contract amounted to a ban on 0844 numbers, and so practices using them were in direct breach of contract.

He said: ‘0844 numbers are only cheaper for a minority of patients. By contract GPs have to look at the arrangement as a whole for patients. So GPs basing it on a minority of patients who incur a penalty for using geographical numbers isn’t acceptable.

‘NHS England are to be congratulated. They have immediately recognised there is a problem. I’m pleased they have taken serious steps and will take action.’

Readers' comments (12)

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  • David Hickson

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  • It appears to me that Richard Vautrey is either misinformed or has perhaps been misled as to exact wording contained in the GMS Contract and the types of telephone numbers that the contract allows practices to use. The same wording is found both in the April 2010 and April 2013 version, albeit with the clauses renumbered (i.e. 29.B vs. 7.4) so nothing in those requirements has changed in the last three years.

    The GMS contract makes no reference to "local calls" whatsoever, and quite rightly so. There is no concept of a "local rate call" when calling from a mobile phone. Even from landlines, the price difference previously encountered when making a call to a local 01 or 02 number compared to a distant 01 or 02 number was abolished in 2005 or earlier. These days there is a single rate for calling 01 and 02 numbers, and it is called "geographic rate".

    Callers use a variety of devices and a multitude of tariffs and packages when making calls. Some GPs and at least one provider of telephone systems to GPs appear to have attempted to argue that because of these complexities the arrangements of all callers other than those calling from a BT landline should be ignored. However, the GMS regulations do not uniquely cover the needs of patients who happen to be BT customers. The NHS could not possibly be seen to financially favour or penalise certain patients just because they use a particular phone supplier. The Secretary of State for Health confirmed in Parliament in 2012 that the regulations equally cover patients using a mobile phone, a landline or a payphone/callbox, and logically this applies to those taking phone service from any such provider.

    The GMS contract also makes no reference to what phone companies charge for calls. Instead, it concentrates on what callers "pay" when making calls. This is an important distinction.

    By seeking to imply that "calls should be charged at the local rate" it appears that you're attempting to make people think in terms of the way things used to work decades ago when "local rate" calls where chargeable and that asking callers to now pay 5p/min to call the doctor is OK - even for callers who currently pay zero for all of their other calls. The wording of the GMS contract is much more specific. It requires that callers pay no more than whatever they pay to call a geographic number. Where callers pay nothing per call when calling 01 and 02 numbers this should ensure they pay nothing per call when calling a GP surgery. If the caller does pay for calls to 01 and 02 numbers, the GMS contract says they should pay no more than that rate for calling their GP. That's a very simple concept, one that should be easy to understand.

    Callers with a BT landline phone may have an arrangement where they pay a per-minute rate for every call made. In this case, callers making calls to 01 and 02 numbers in the day, Monday to Friday, pay in the order of 8p/min whereas they pay 4.1p/min (g11) or 5.1p/min (g6) for calls to the 0844 numbers typically used by GPs. These callers "do not pay more than a call to a geographic number" when calling 0844 numbers. However, less than 15% of the BT customers who make calls during the day, Monday to Friday, have this type of arrangement.

    The vast majority of landline customers who make weekday daytime calls have signed up to the right deal for their pattern of calling. This is an "anytime" package. Callers with this type of deal can make a large number of calls of up to 59 minutes each to 01, 02 or 03 numbers anywhere in the UK, "without paying any more" for each individual call. However, any call to an 07, 084, 087 or 09 number causes the caller to "pay more" in the form of an additional per-minute or per-call charge for the entire duration of that call. For BT and Sky customers calling the 0844 numbers typically used by GPs this is either £2.45 (g11) "more" or £3.06 (g6) "more" per hour. Virgin Media customers with an "anytime" package "pay more than calling a geographic number" to the tune of £4.90 (g11) or £7.45 (g6) per hour when calling the 0844 numbers typically used by GPs.

    A patient with a contract mobile phone pays a fixed amount of perhaps £15 to £30 (there are a variety of deals from each network in this price range) each month for several hundred to many hundreds of inclusive minutes for making calls to 01, 02, 03 and mobile numbers. As long as the requisite amount of inclusive allowance remains, when a call is made to one of those types of number the caller "does not pay any more" for that call. On the other hand, and irrespective of whether any inclusive minutes remain or not, every call to an 070, 076, 080, 084, 087 or 09 number will cause the caller to "pay more" in the form of a per-minute or per-call rate that begins at the start of the call and continues for the entire call. The rate varies from network to network and varies by the prefix and type of number called. For 0844 numbers it ranges from £15 to £27 per hour "more" than for calls to geographic numbers. The price variation depends solely on which mobile network was used to make the call.

    Callers with a pay-as-you-go mobile phone pay around 10p to 35p/min to call 01, 02 and 03 numbers and pay around 25p to 45p/min to call 0844 numbers. Looking at the nine most popular mobile networks, on six of them callers "do pay more" (about 10p to 20p/min more) to call 0844 numbers. On three mobile networks pay-as-you-go callers "do not pay more" to call 0844 numbers than to call geographic numbers, with one network charging the same price for both types of call.

    It is clear that the vast majority of callers "pay more" to call 0844 numbers than to call geographic numbers.

    Richard Vautrey has, in the past, called for phone companies to "charge no more than the local rate" (whatever that means, see above) for 0844 numbers. Perhaps he means "geographic rate"? For a variety of reasons, this cannot be done. Calls to 0844 numbers require the originating telecoms company to pay the terminating telecoms company at least £2.45 (g11) or £3.06 (g6) per hour because these are revenue share numbers. The money that is passed on can be shared between the terminating telecoms company, the service provider and the GP surgery as they see fit.

    Just imagine that BT decided to include 0844 numbers in their "inclusive" call package in addition to the 01, 02 and 03 numbers it currently covers. A caller making just 2 hours of calls to 0844 477 (g6) numbers within the month would invoke a requirement for BT to pass on at least £6.12 to the terminating telecoms company, BT thereby making a loss on the deal. To cover calls to revenue share numbers (e.g. 084, 087 and 09), BT would have to increase the monthly charge for the call package by a substantial percentage.

    Likewise, consider a mobile user with 200 minutes of calls for £15 per month. If mobile networks suddenly made 0844 numbers inclusive and callers used all 200 minutes of the allowance for making calls to 0844 numbers the mobile network would have to pass on at least £10.21 of the £15 line rental to the terminating telecoms company. The only way mobile networks would be able to include 200 minutes of 084 numbers in call packages would be to raise the line rental price by at least £10 per month.

    The GPs initial choice of phone number controls how much callers pay to call the surgery. While GPs don't set the actual price they do control the overall pattern, especially as to whether the call will be inclusive or not.

    If GPs were to use a phone number beginning 0907 687 they would force all callers to pay £1.19 per minute or more. Mobile users would pay substantially more. By choosing a number that begins 0844 477 they force all callers to pay at least 5.1p/min and force mobile users to pay substantially more.

    If GPs use a number beginning 01, 02 or 03 they ensure that all callers pay no more than they would to call a geographic number and that includes being able to use the inclusive minutes within their call package to phone the doctor. By coincidence, that is exactly what is specified in the GMS Contract.

    Practices continuing to use revenue sharing numbers are tarnishing the reputation of all GPs. Users of 084 numbers were required to take action in 2010, but many failed to do so. Several hundred more have joined this scheme since the ban was put in place. The public rightly want to know both why they are being ripped off and why it is continuing.

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  • David Hickson

    I understand that a previously published comment may have caused personal offence, and so I re-submit it with all references to named parties removed. The comment is quite long enough as it is, but I will be happy to provide evidence to support any remarks that may be challenged on the basis of fact


    The statement “ … said that practices can use 0844 numbers within the rules as they are sometimes cheaper than geographical numbers for some patients” misrepresents the terms of the contract which was agreed by representatives of those subject to the contract.

    “sometimes … for some patients” does not meet the condition of “having regard to the arrangement as a whole” which contractors are required to consider, in the context of their statutory duty “to have regard to the NHS Constitution”.

    Surgery telephone system providers may recommend practices to consider only the case of the small minority of landline users who incur unregulated penalty charges for calling geographic numbers outside the terms of their chosen Call Plan, which are greater than the regulated premium charge for calling 0844 numbers. They may even have been successful in persuading the local bodies with whom the contracts were held until recently that all other cases (the overwhelming majority of patients) may be disregarded. It has even been suggested that if a, wholly unaccountable, system provider is successful in convincing a practice of a falsehood, then this provides a satisfactory means of demonstrating compliance.

    Many practices failed to properly review their arrangements between April 2010 and April 2011, when required to do so, because they failed to recognise that all users of 0844 numbers may migrate to the equivalent 0344 number at no disadvantage to their provider. This modest variation simply ends the subsidy of their system costs by patients and other callers. Such a move has no effect on the terms of their arrangement with the system provider, and so the much vaunted issue of “contract termination penalties” need not arise.

    The “system as a whole” is changing, as suggested. The statutory regulator for communications has now announced the details of the “unbundled tariff”. Users of a typical surgery telephone system on 0844 numbers will have to declare “calls will cost 5p per minute plus your telephone company’s access charge”, wherever their 0844 number is given. Whatever may be the level of access charge added by the caller’s telAephone call service provider, the term “rip-off” is not adequate to describe the imposition of a 5p per minute “Service Charge” for a telephone call by, and to the benefit of, a NHS provider. Furthermore, this change simply makes the present situation transparent (indeed 7p per minute would be a more accurate figure for most users of a typical surgery telephone system).

    I do hope that the body representing contractors will support the new statutory body with whom contracts are now held in achieving much belated compliance with the terms of the contract which it agreed. There are always more important issues, but I hope that a senior representative of the body which negotiated the contract was not suggesting that breaches of the contract terms negotiated by itself should be overlooked.

    There is lots more on this topic on the website of an organisation that campaigns for fairness in telecommunications. This covers use of 084 numbers throughout the NHS and the public and private sectors in general, as well as other telecoms issues.

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  • Please fix two minor typos near the end of the article. :)

    The errors: "aptients who occur"

    The fixes: "patients who incur"

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  • Many thanks for pointing this out

  • The Lilliput Surgery in Poole still has an 0844 phone number. Recently I was charged 24p for a 2 minute call, and 19p for a l minute call. What can we do about this please?

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  • Hi, the above makes interesting reading but the issue relating to 0844 in the GP surgeries could easily be rectified quickly and with little impact. Simple: just delete rebates on the 0844 477 xxxx range which would cover most, if not all surgeries. This can be achieved without affecting the overall G6 rebate structure.

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  • @Lilliput

    You should point out to the surgery that calls are costing you "more than calling a geographic number" and refer them to their GMS contract which says they cannot use a number which costs "more than calling a geographic number".

    The cost of calling a geographic number is zero for most people as they use the inclusive minutes found within their call package. 0844 numbers cost "more" to call. The ban on 084 numbers has been in place since April 2010.

    You could also raise the issue with your local newspaper, many have covered similar stories in the past.


    @Noel

    Simply "deleting rebates on the 0844 477 xxxx range" will have little or NO effect on what callers PAY for calls. Virgin Media add a 9p/min Access Charge and mobile networks add a 20p to 40p/min Access Charge when calling these numbers. BT is currently regulated to not add an Access Charge, but that regulation "the NTS Condition" (dating from the days when BT had a monopoly) ends soon, whereafter BT will be able to add an Access Charge to all calls to 084, 087 and 09 numbers.

    0844 477 numbers impose a 5.1p/min (inc. VAT) Service Charge on all callers. This charge is "hidden" within the total call price. Currently, this charge is not separately declared by the user of the 0844 number, nor by your phone network in their price list. Of the 5p/min Service Charge you are paying, about 2p/min of this is available to GPs as a "revenue share" which they use to offset the cost of their new telephone equipment. Callers are paying up to 45p/min for calls to 0844 numbers just so 2p/min can be extracted by GPs.

    GPs are not allowed to use a number where callers "pay more than calling a geographic number". The problem is that GPs seem to have been told that "0844 numbers are local rate calls" when this is patently NOT true. Unfortunately, many seem to have believed it. Patients are out of pocket to the tune of hundreds of millions of pounds since this started in 2002 (originally on 0870 numbers, and on 0844 numbers from 2005 onwards).

    NHS England should be taking action to ensure that all GPs are in compliance. GPs were supposed to move to 01, 02 or 03 numbers by April 2011, but many seem to be holding on until the end of their long phone services contract before making that change. This nonsense has gone on long enough.

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  • In my experience All non-free 08 and 03 numbers are a ripoff and 0844 numbers particularly are a disgraceful, profiteering scourge, which reflects very badly on the NHS.

    As a retiree on a fixed income (unlike the quids-in doctors I need to consult!), I budget my costs and have an all inclusive package which surprise, surprise excludes 0844. In June it cost me 0.75 and 0.65 pence on one day to call regarding an appointment.

    The worst thing about this practice is the way in which the original "normal" telephone numbers to which most of these numbers are actually linked (which used to be traceable via web site saynoto0870.com) have been magically blocked presumably so that the medical practice maximises their cut from the number provider. And in a lot of places they still have signs saying "We have set up a Lo-Call number for your convenience". Convenience? Aaaaargh!

    All users of 08' numbers should be required by law to provide a normal direct dial number thus at least giving the customer or patient the choice. No ifs or buts - it should be a legal requirement.

    It's bad enough for commercial businesses to use these "nice little earners" for pre-sales and support but it really is another unacceptable face of capitalism when the medical profession and government departments rip off people who need their services.

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  • Practices are required to supply an 01, 02 or 03 number to contact the surgery.. This has been part of the GMS Contract since April 2010.

    03 numbers are always charged at the same rate as 01 and 02 numbers and always count towards inclusive allowances from mobiles and landlines.

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