Thanks for the compliment. The NHS is established as a national public service, administered locally, now by 50 clustered PCTs in England. It is they who are charged with the public duty of ensuring that its principles are upheld, guided from the centre. As consumerist localism took hold, under the previous government, the degree of central guidance diminished, except in particular narrow areas where the government wished to be (or was thought to be) accountable - i.e. certain arbitrary targets. When these regulations were introduced they were not accompanied by the detailed information necessary for them to be implemented and enforced properly. This was due, in part, to effective negotiation on the part of the BMA, designed to keep them weak, and powerful misrepresentation of the true situation on the part of a leading provider of the systems which are subsidised by patients. Ignorance and misunderstanding of telephone tariffs is widespread - it extends to many within the Department of Health; this is an area that is ripe for exploitation. Some argue that the attempt to run a National Health Service has failed. It is too big to run from the centre and local public bodies are expensive and not as effective as they should be. This is why the present government has been undermining and trimming the resources of the PCTs, prior to their abolition. It suggests that their work is better carried out by GPs, who are accountable only to their individual patients, not to the state and taxpayers. Consumer power is exercised primarily through the consumer's ability to withdraw their custom and take it elsewhere. This is the model which is being advanced for provision of healthcare. (This is not a party Political issue, the previous government spoke of competition between GPs when announcing that these regulations would be introduced.) The opportunity for patients to choose their GP has been extended greatly in recent years and is being extended further. This is unquestionably action in favour of consumerism - that is why I suspect that it may have the support of the CAG. I am in favour of consumer rights in areas where the model of a competitive market is the best way of advancing our society. I believe however that this model is not suited to all areas. The National Health Service stands out as being perhaps the most notable case where a different model applies, although there are other cases where creeping consumerism is undermining that which holds us together as a society. I believe that the area of telecommunications services has, in general, benefitted from privatisation. That is not to say that there are not many ills and issues that need to be addressed, but I make this comment to show that I do not have a blnkered view. Having built up the National Health Service in the way that we have over so many years, I believe that it needs reform to reflect the world as it stands today, but I do not believe that it needs to be replaced with a service based around the private relationships between individual patients and providers. Individual consumer complaints can only address individual issues between consumers and providers. It is indeed very difficult for an individual patient to "get at" clauses of contracts specifically addressing "the arrangement as a whole" to reflect the universal nature of the National Health Service. I continue with my efforts to persuade the Clustered PCTs to perform their statutory duty in the interests of all whom they serve, not individual "consumers". (When the PCTs are abolished the task of administering GP contracts will remain with the same officers, although many fewer in number, as these functions of the 50 clustered PCTs are transferred to the 50 local arms of the NHS Commissioning Board. That is assuming that the present Health Bill, which is necessary for the formal change to the structure of statutory bodies, passes.)

You make a strong personal point about my objectives and methods. I must therefore assume that you disagree with the point you believe that I am trying to make. I am not totally surprised to find myself encountering opposition in a forum named to reflect a dedication to the pursuit of consumerism. I campaign for our National Health Service funded by progressive taxation, whereas I am sure that consumerists will support the present government's efforts to replace it with a "patient focussed" service which will inevitably have to be primarily funded by patients, as consumers. With the highly complex situation of revenue sharing telephone numbers being used as a means to levy charges indirectly, it is not easy to present it honestly and comprehensively but simply. I offer additional information to enable an extended understanding, and must apologise if this, or indeed the way in which I describe the essential points, makes the point unnecessarily difficult to follow. If you believe that this is true, then I can only suggest that you review the published tariffs more closely, and with an awareness of which tariffs apply to callers. If you have suggestions for how the truth of the information could be presented more clearly, then I would be delighted to hear them.

There is no single answer to the question. It depends on the tariff and the time and duration of the call. In some cases, it also depends on the type of 0844 number. I provide links to published tariffs, so that one may look at whatever examples one feels may be relevant. I offer some examples in a table to illustrate the point that GPs may not use 084 numbers if certain listed examples apply to those who call them. Of the 0844 numbers used by NHS GPs: 1,042 are type "g6", 91 are type "g11", 3 are type "g10" and 2 are type "g8". I only show the charges (in all cases) for the first two types. (This information about call types may be of help to those following the previous suggestion to consult only the BT tariff tables. It should however be noted that BT only originates around 40% of residential landline calls = less that 25% of all non-business calls.) Assuming a five minute daytime call by a caller who already makes daytime calls to geographic numbers, and would not change their package if their GP offered a geographic number, the relative call costs, in cases where callers pay more to call a 0844 (g6) number, are as follows: Landlines BT: Unlimited Anytime - 39p vs. 0p BT: Basic - 29p vs. 0p Talk Talk: Talk Anytime - 39p vs. 0p Virgin Media: Talk Unlimited - 76p vs. 0p Virgin Media: Talk Weekends - 76p vs. 57p Mobiles Orange: Pay Monthly - £0.62 vs. £0.00 Orange: PAYG - £2.00 vs. £1.25 Vodafone: Pay Monthly - £1.75 vs. £0.00 T-Mobile: Pay Monthly - £2.05 vs. £0.00 T-Mobile: PAYG - £2.00 vs. £1.00 Payphones BT: Public Payphone - £1.40 vs. £0.60 These figures expand the differences shown in my table. Unless a GP has no callers who incur these additional costs, it may not use a 0844 (g6) number. That is the essential point which has to be made with reference to the terms of the NHS GP contract. For completeness, the table also shows those cases where callers pay less because of the penalty charge incurred for calling a geographic number outside the terms of their plan. The regulations do not require one to perform a balancing exercise based on the aggregated duration of calls made under each type of arrangement, so there is no need to consider the other cases. So long as a significant number of callers pay more, the number cannot be used. I recognise that some will be keen to explore the wider picture. I am not aware of any statistics which show how many callers choose to incur a penalty charge by making daytime calls under the terms of plans covering only evenings / weekend calls, as against those who make such calls under the terms of plans that cover them. In the case of BT, the Unlimited Anytime Plan has more subscribers than either of the others. I do accept that this does not prove that all callers select the correct plan for their needs; it would however be remarkable if this were not generally true. Ofcom's proposal for "unbundled tariffs", on which a firmer announcement is expected in the coming days, is intended to clear up a lot of the confusion in this area. Perhaps the most significant aspect of these forthcoming announcements will be the removal of the present regulatory restrictions on BT. BT alone is currently prohibited from adding anything of its own to the rates for calls to "NTS" numbers (e.g. 084, 087, 070, 09), whereas it is now free to charge whatever it wishes for calls to geographic numbers. This is what creates the perverse effect of a "out of plan" call to a geographic number costing more than calls to all 084 and some 087 (Premium Rate Service) numbers. BT is still the largest single provider of call services, however the effect of legacy regulations on it alone, dating back to when it had a near monopoly, make it a poor case to use as a model, because it is not representative of the situation as a whole. As stated above, Ofcom figures show that BT originates less than 25% of non-business telephone calls. (P.S. To confirm a point made in a previous posting. Since Ofcom regulation of BT prices ended in 2006, all BT residential subscribers have been on "Call Plans". This includes the social tariff "BT Basic" which is sometimes referred to as being a Call Plan. The former "BT Standard" tariff, which was that regulated by Ofcom, is now obsolete.)

I have published a table which primarily provides links to published tariffs (so it can be verified), but aims to offer a simple summary. This is found via (apologies for the textual representation) h t t p : / / tiny.cc/GP084Costs. This is simply intended to demonstrate that a GP is unlikely to be able to comply with its contractual requirements by using a 084 number. Because it is prohibited from using a number that is more expensive to call than an equivalent call to a geographic number, "having regard to the arrangement as a whole", it would have to show that none of its callers were subject to the tariffs which caused them to pay more. As BT Unlimited Anytime is the most widely used landline tariff, this could be difficult. The recent DH "Further Guidance" confirms that the costs incurred when calling from mobile phones, public payphones and landlines contracts other than those which impose an "out of plan" penalty charge for calling geographic numbers during the daytime cannot be disregarded. The NHS is a universal service, available to all on equal terms - there is no obligation to have a telephone contract which does not cover calls to geographic numbers before 7pm on weekdays so as to not pay more to call one's GP.

Experience suggests that the reply will perhaps include a copy of a letter, identical, or similar, to this circular letter [*1] (there is also a January 2010 version). This is an expression of opinion from an interested party - it has little to do with the reality of the situation which the contractual requirements demand be addressed. It is confirmed as being misleading by recently issued "Further Guidance" from the Department of Health [*2], which includes the following comment in a FAQ: I hope it is considered acceptable for me to provide the links in text form, rather than making some unnecessary postings in order to meet the post count required for comments to be supported by external references: *1 - h t t p : / / w w w . thornhillsmedical.nhs.uk/userfiles/docs/0844-number.pdf *2 - h t t p : / / w w w . dh.gov.uk/health/2012/02/084-numbers/

Conniff If your surgery claimed that calls to 0844 numbers were charged at "local rate" in 2008, then there is little point asking it about the cost of telephone calls, because it clearly knows nothing (or was deliberately seeking to mislead its patients). The distinction between local rate and national rate was abolished in 2004. Calls to 0844 numbers were never charged at "local rate" by any telephone service provider. GPs have no control whatsoever over the charges for calls to any number - unless they themselves provide telephone service to their patients. Every GP that uses a 0844 number is benefiting (indirectly) from the "revenue share" that is passed between the telephone company used by the caller and their own telephone service provider. The cost of this is passed on to the caller. NHS providers may not levy charges on NHS patients, who have the right to access NHS services "free at the point of need". The regulations in place address this by prohibiting use of a number that costs patients (considering all cases) more than the cost of a call to a geographic number. There are examples of callers who incur a "penalty charge" for making a daytime call to a geographic number after selecting a Call Plan that only covers calls made at Weekends or in the Evening, which may exceed the cost of even calls to some Premium Rate Service numbers. If it could be shown that all patients of a practice are in this odd position, then use of a 0844 number could be justified on a technicality. At present, practices are succeeding in misleading patients and PCTs with nonsense such as that referred to.

If you were tempted … to suggest that this does not lead invariably to the practice changing its number, apologising to the patient in question and sending a circular letter to all patients promising never to do the same again - then you would have been correct. Pressure is however building to overcome the fierce resistance which has been put up by both the BMA (protecting the financial interests of its members) and the provider of the systems which are funded by this mechanism. They have so far prevented many of the PCTs from properly getting to grips with the issue, but the tide is turning. My attempt to comment on the politics of this matter (the meaning of "consumerism") has been deemed unsuitable for this forum, but there is plenty of the Politics to read on my blog. Most of it simply factual, with quotes from Hansard, leaving the reader to draw their own conclusions.

Since my comment (#23) above the situation has moved on dramatically, although, as birdieboys comment shows, implementation of the new regulations has not been effective. Changes to the contracts held by NHS GPs were introduced with effect from 1 April 2010, prohibiting use of telephone numbers which caused callers to pay more than the cost of an equivalent call to a geographic number. In effect, this amounts to a ban on the use of all 084 numbers at present. With doubt surrounding possible future regulatory changes by Ofcom, the regulations themselves do not specify which number ranges this applies to. Those using 084 numbers in April 2010 were given 12 months to change their arrangements. In most cases the preferred option is to migrate to the equivalent 034 number, as this enables retention of the features of non-geographic numbers and existing contracts for provision of telephone service from a particular provider. Calls to 03 numbers are charged at no greater cost than that of calling a geographic number - for all types of service and all types of contract. Up to date information on the campaign may be best found via my "NHS Patient blog", which has links to other campaign sites. (Unfortunately I am prohibited from providing a direct link to my blog here - however it is not difficult to find using a search engine.) ----- Edited to remove political statements ----- Notwithstanding what could simply be a matter of semantics, I have welcomed Which? as a partner in the campaign and would be happy to welcome CAG also.

Many MPs have signed Early Day Motions as a way of expressing concern about this matter. EDM 108 in the current session EDM 1989 in the previous session The issue was also covered in a debate last Thursday. There are links to the relevant contributions and some personal comments here - Debate on access to primary care 16 Oct 2008 There is a wealth of information on the NHS Patient Web Page

Contributors to this thread may be interested to note that Ofcom has caught UCS making Silent Telephone Calls and issued a Notification of Persistent Misuse of the telephone network. Details are on the Ofcom website at /bulletins/comp_bull_index/comp_bull_ocases/open_all/cw_905/

There is much campaigning activity already underway on this specific issue and many discussion threads in the saynoto0870 Government and Public sector forum There are useful resources for campaigners and others at the resource web site I have given with my registration. (As a visitor/new member, I cannot add a hyperlink) Government action to address this could be said to be pending, following an evidence gathering exercise. I will be happy to help with further information.