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Practice Telephone Systems
Update 19/02/05: 087 Phone Numbers
Many practices believe that they require a more efficient telephone system and are currently being tempted by special offers to install a brand new telephone
system funded, at least in part by Cable and Wireless, in partnership with Network Europe Group (NEG).
The LMC has been asked whether it is permissible to participate in such a scheme since calls to the surgery would generally cost patients slightly more than the
normal BT rate.
The basis for the funding of these systems is that the service is transferred from BT to Cable and Wireless, with the surgery number being changed to an '0870'
number.
Different companies currently charge different rates for the use of 0870 numbers. From a mobile phone, calls may in fact be the same price or even slightly
cheaper than standard BT costs. However, from a fixed line the cost is usually slightly higher. For example one charges a flat rate of 6.5p per minute from a fixed line, 4.5p of which goes to
Cable and Wireless and 2p to the surgery. Out-going calls from the practice may be slightly cheaper.
The surgery would hopefully generate sufficient income to cover the additional costs of operating the new system. The estimate quoted for one of the
systems was about £500 per month, plus the cost of the BT lines and maintenance from the second year. It is anticipated therefore that the proposed arrangements would produce a cost-neutral
situation.
It has been argued that patients and practices would derive great benefit from a more sophisticated and self-funding system set up by a company with particular
expertise in configuring various options to fulfil specific practice needs. Possible benefits could be;
- callers will no longer get an engaged tone.
- a queuing system for calls could be implemented.
- health information messages may be played while callers are queuing
- callers will be given a selection of alternative routes, such as appointments, results, appointment cancellations etc.
- information can be provided regarding the length of the queue and anticipated waiting time.
- systems may be set up to track all calls.
- it would be possible to record at least some of the calls, although such sophistication may well involve additional charges.
- systems may be configured to give a breakdown of all calls received and how long it has taken to answer at different times of the day.
- if the PCTs seek a detailed analysis of calls as part of their quality initiative care practices would be well placed to provide the data.
The GPC has expressed reservations about practices potentially profiting from patients in this way in possible contravention of part 18 of the new GMS contract
and part 5, regulation 24, of the GMS regulations. It is finalising 'official' advice with their legal department which will be distributed as soon as it becomes available.
A PCT could take the view that GPs were making an illegal charge for advice given over the telephone, in breach of their contract and the
regulations. They could take the view that the cost of installing an efficient telephone system was part of the legitimate expenses that all practices must meet in order to provide their services under a
GMS or PMS contract. However, some PCTs in Kent have taken the view that this is a permissible arrangement and allows practices to implement more efficient systems.
Wessex LMCs would take the view that there is no question of a "charge" being made to patients if a practice chooses to introduce an efficient
telephone system in this way.
There is a new contractual requirement that the practice be connected to a telephone system under GMS2. There is no requirement to provide a particular
telephone service.
If a patient is asked to come to the surgery or to visit a walk-in service the cost of petrol or the bus fare is not considered to be a charge for services and if
the patient uses a mobile phone the additional cost is not considered to be a charge.
There has, however, been some hostile coverage in the national press regarding the very small number of practices that are already using premium telephone
lines. The most sick and vulnerable patients would inevitably need to use the service most and the poorest would find the additional cost most difficult to meet. The negative press associated
with a practice allegedly seeking to profit from their patients could be very damaging and difficult to defend. Practices may wish to take this into account before making a final decision on this
issue.
Any practice that embarks on such an arrangement with a telephone company should set out very clearly in their practice leaflet the advantages in accessing the
practice using a sophisticated telephone system. They should also identify the potential cost to patients who would be obliged to use this premium line. They should stress that any profits would
be ploughed back into the improved system and not used to benefit the GPs financially.
Wessex LMCs would advise that this matter is by no means clear at this stage but we believe that any practice entering into such a contract would be able to
mount a vigorous defence if challenged.
Update 19/02/05: 087 Phone Numbers
Many practices in the Wessex region and around the country have entered into a contract with NEG plc to install a new efficient telephone system that uses an 087
telephone number.
We believe that the government may announce a ban in the very near future and a number of practices have contacted us for advice.
We have now spoken to NEG plc and have been reassured that, in the event of a ban, all of their existing customers will be transferred to an 0844 number, which is
a 'low call' or normal rate number, before the end of April.
The company has assured us that they will honour all existing contracts and there will be no additional cost implications for the practice.
New customers will also enjoy a similar and improved arrangement whereby their telephone system will be updated at no charge to them or to their patients.
This appears to be a win - win situation and should reassure all of our practices and patients who have been very concerned by the recent adverse publicity.
Further Information:
087 Phone Numbers Banned
087 and 084 telephone numbers
CED 31/08/04 (Updated 19/02/05, 27/04/05)
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