GP Surgeries: Telephone Numbers
William Hay (DUP)
The Business Committee has agreed to allow up to one hour and 30 minutes for the debate. The proposer will have 10 minutes to propose the motion and 10 minutes to wind. All other Members who wish to speak will have five minutes.
Sue Ramsey (Sinn Féin)
I beg to move
That this Assembly calls on the Minister of Health, Social Services and Public Safety to outline the actions that he will take to bring to an end the practice of GP surgeries using 0844 telephone numbers and the associated high call charges for patients.
Go raibh maith agat, a Cheann Comhairle. I am delighted to move this motion today on behalf of the Committee for Health, Social Services and Public Safety.
For the benefit of Members, the Minister and the Department, I want to provide some background information on 0844 numbers. Such numbers are not linked to a particular town or county. They are used by a wide range of organisations, from businesses and agencies to TV shows, which use them for voting. For 0844 numbers, there is a limit on how much BT can charge for the call. Other providers are not restricted in how much they can charge, but, in many cases, the landline providers set their call charge around BT’s prices. For landline customers, that usually works out at somewhere between 1p and 13p per minute. However, the problem comes when people use a mobile phone to ring an 0844 number. Calls from mobile phones typically range from 20p to 41p per minute.
The main issue in today’s debate is the fact that 23 GP practices are still using 0844 numbers rather than ordinary landline numbers. The issue came to the Committee’s attention because constituents have contacted members to tell them about the high call charges they are racking up when trying to get through to their GP’s surgery on the mobile. The Committee began to dig a bit deeper into the issue, and what we have discovered is very worrying, particularly when one of our key aims is to address health inequalities. As I said, 23 GP practices are still using 0844 numbers. We all know how long it can take to get through to a health centre receptionist. Sometimes, people end up on hold for 20 minutes or more or are asked to go through a number of options before they even get talking to someone. That has resulted in some constituents being charged £8 to make a phone call to their surgery. That is clearly unacceptable.
When we first raised the issue with the Minister, he replied that if people ring an 0844 number from a landline, they will only be charged the local landline rate. However, the point is that many families, particularly in low-income households, may only have a pay-as-you-go mobile. Ironically, they do that to try to ensure that they do not have another bill at the end of the month so that they can deal with their money better.
The response from the Minister and the Department about using landlines just does not wash with us. We live in a time where technology is everywhere, and many mobile-only households use the mobile to call essential services such as councils, utility services and, of course, doctors’ surgeries. Mobile operators are often keen for us to opt for inclusive call plans. Plans can help manage spending on calls and many people take up those offers, but, unlike 01 or 02 numbers, 0844 calls are never included in the inclusive minutes.
We in the Assembly support the principle of a health service being free at the point of use. That has to become a reality, and we cannot have people being charged £8 to make an appointment with their GP. We already know that social deprivation leads to health inequalities, and yet we have a situation where the least able to pay end up paying the most to access a basic health service. The result is that people potentially do not ring their GP and do not get the right treatment at the right time. We talk about early intervention and prevention being the key to transforming our health service, so we cannot have obstacles such as 0844 numbers being put in people’s way.
The Minister also made the point to the Committee that the Health and Social Care Board has written to the GPs who use 0844 numbers to ask them to consider providing a call-back service to patients at the practice’s expense. That is all well and good in theory, but the reality is that patients are often put on hold for long periods before they even speak to a receptionist and, therefore, are already incurring a charge. It also puts the onus on the patient to say that he or she cannot afford to stay on hold, and I do not think that that is fair. It is not what we want in this day and age, when everyone should be treated equally.
Another aspect is that GP practices using 0844 numbers receive 2p per call from the provider. Although that income is ring-fenced and can be used only to support the maintenance of the telephone system and make other improvements to the surgery environment, it is an indirect profit for the GP practice, and the Committee believes that that is totally unacceptable.
The Committee has written to the BMA and the Royal College of General Practitioners to ask what they have done to encourage their members to stop using 0844 numbers. Both replied that they have issued circulars to their members to remind them that they must keep the price of calls for patients to a minimum. The Committee believes that that kind of voluntary approach is not good enough. Therefore, we have brought this motion today for two reasons: first, we want to ask the Minister to outline the further action that he will take; and, secondly, we want to bring the issue to wider public attention. I assume that the Minister will get a copy of the Hansard report of the debate. I do not know whether any departmental officials are in the Officials’ Box, but I would be disappointed if there were not.
Our actions seem to be having some effect already. Just yesterday, Ofcom, the communications regulator, contacted me to say that it had seen today’s motion. It has the same view as the Committee on 0844 numbers and believes that the current system does not work. Ofcom’s suggested new approach to the use of 0844 and other numbers went out to consultation last month. Therefore, Ofcom is doing its bit by looking at the call providers. The Minister and Department must now do their bit and take urgent action to stop GP surgeries using 0844 numbers. I urge the Assembly to support the motion.
Paula Bradley (DUP)
As a member of the Health Committee, I support the motion. The NHS was founded on the principle that healthcare should be available to everyone, regardless of their ability to pay. As a former NHS worker, I am very proud of the system that we have here, where no one is turned away from GPs or hospitals because their economic situation means that they lack the ability to pay for their treatment.
Patients contacting GPs want to be able to access their primary care provider in a manner that is timely, easy and without fuss. For many users, the 0844 number represents an additional charge for seeking medical help, whatever that might be.
A number of benefits are associated with using the 0844 phone system. First, it allows GP surgeries to ensure that users do not hear an engaged tone but are placed in a queue. Secondly, the facility to reroute calls to the appropriate department can reduce the stress on doctors’ receptionists and ensure that people are put through to the right department as quickly as possible.
We are all concerned that the most vulnerable are not unduly hurt economically by having to contact any Department. Therefore, it is right that we continue to look at these numbers to assess whether there are better ways for GPs to offer the same benefits while costing users less. It may be better, for example, for GPs to offer a repeat prescription service by e-mail. That would reduce the number of phone calls that the practice has to answer and ensure that those who need repeat prescriptions have an alternative way of requesting them. Most telephone users have some internet package, whether through their mobile or landline.
Using the expanding IT option may be one way to mitigate the cost of phone calls and reduce the time that people have to spend in queues. It is important to note that GP practices that use those numbers are not doing anything wrong. Any revenue that they receive goes directly back into the practice environment, effectively meaning that users get some of that benefit. Of course, that in no way negates the extra cost or helps people, such as those on a low or fixed income, who feel the extra cost more acutely than others.
We should also remember that the Minister is restricted in what he can force GP surgeries to do. In an ideal world, no one should have to pay for the cost of a telephone call to their GP, but, sadly, we live and deal with the realities of the world that we live in.
Telephone systems can be costly, and the GP service is not the only government service that affects some of the poorest. Tax credit offices, for example, use non-local numbers.
I am glad to note that only one surgery in my constituency utilises such a system. In Northern Ireland overall, the use of such numbers is the exception rather than the norm. I also welcome the fact that the Minister has written to those surgeries affected, reminding them of the policy context of telephone systems and their obligations.
Mr Speaker, I support the motion.
Samuel Gardiner (UUP)
I welcome the opportunity to speak on the motion and support it. I agree with other Members that the use of 0844 numbers is not a widespread problem. It occurs in only 23 of the 355 practices, which is just over 6·5%. Nevertheless, no matter how small the number, the fact is that there are still people in Northern Ireland who have no choice but to phone the 0844 number if they want to speak to their local clinic. Although I understand that the figure is likely to decrease over time, especially as the Health and Social Care Board continues in its efforts to persuade practices to adopt a new phone system, it is vital that the Department of Health ensures that people are not taken advantage of unintentionally.
People who phone their local GP clinic will often be too worried about their own health or that of a loved one to think of the price of a phone call. However, those people who, because of their illness, have to phone their local clinic quite often and for long periods are exposed to a potentially clear financial disadvantage. It is not only people who need to phone a lot and for longer periods who may have a problem with 0844 numbers; it also affects those who are signed up to what may seem like a normal telephone package, but one that charges often very high rates for 0844 numbers.
The Department took a positive step in 2005 when it introduced legislation to ban the use of premium rate numbers in GP clinics. However, I have concerns about what exactly the Department can or cannot legislate for in relation to this matter because, in this case, it is unable to enforce the ban.
People expect a service when they phone their local GP. Instead of them being the customer, it is more a case of the National Health Service being the provider. I absolutely agree, and believe that members of the public should not incur unfair costs when compared to the ordinary local rate. Offering advice not to renew, extend or enter into contracts unless practices were certain that patients would not be charged more than a call to a local number would be a very positive step. I am also pleased that the Health and Social Care Board has advised practices that still continue with the 0844 numbers to offer patients the chance of a call-back service, and that that cost should be borne by the practice.
As the provision of primary and secondary healthcare in Northern Ireland continues to change, the Ulster Unionist Party is keen to promote the use of telemedicine and people remaining in the comfort of their own home for as long as it is safe and practical to do so. The use of 0844 numbers may not be a big problem, but it is still something that should be addressed. The Department is working toward this. However, it is vital that it works closely with GPs and their practices to address it.
As a former member of the Health Committee, I support the motion. From my time on the Committee, I know that this was a particular bugbear of Gordon Dunne and of other members whose constituencies are affected.
Healthcare should be free at the point of use but, as Ms Ramsey said, the 0844 numbers place a cost on people getting access. The fact is that those worst affected are those dependent on pay-as-you-go mobiles — generally, those who can least afford it. That is a blatant inequality in our system, and we should move to eradicate it.
The Department of Health in England has changed the GMS regulations to ban 0844 telephone numbers that charge patients more than a standard geographical telephone call. We should follow suit. Ms Ramsey cited a cost of up to £8 for some mobile users to get in touch with their GP. However, I am sure that we have all heard from people who have run out of credit mid-call, resulting in their being not only out of pocket but embarrassed and very anxious, which, in some situations, compounds their medical condition. Fortunately, the problem is not widespread, with just 23 practices still using 0844 numbers, so it should certainly be reasonably easy to solve, if it is the Minister’s will to do so. We support the motion.
Kieran McCarthy (Alliance)
As a member of the Assembly’s Health Committee, I fully support the motion today and fully concur with the sentiments expressed by the Committee Chair, Sue Ramsey, and, indeed, all the Committee members. The issue has been discussed at the Health Committee on several occasions. Quite obviously, the use of the 0844 telephone system by 23 health centres is having a detrimental effect on their patients, who have to find the money to pay shockingly high tariffs. In our opinion, it is high time that practice was ended. I have to say I am deeply disappointed to discover that three of those 23 practices are in Newtownards, which is in my constituency.
We all know that we are living through very challenging times in respect of paying bills and, indeed, have been doing so for the past number of years. However, as yet, there is very little light at the end of the tunnel. In these circumstances, the last thing that local doctors should be doing is supporting high charges for telephone calls by people — their patients — who are sick. There is simply no need for this, and it should stop immediately.
From the information provided by our Research and Information Service, for which we are extremely grateful, I understand that Westminster and the local Assembly, including the Health Minister, have indeed asked that the practice should cease, but they simply cannot force the minority of surgeries to end the use of 0844 numbers. The Assembly is asking the Minister what actions he will take to end these unscrupulous charges. In his response to Gordon Dunne in January 2012, the Minister was certainly on the side of the patient. He said that he had issued letters to 17 Northern Ireland practices stating their obligation to try to ensure that patients do not incur high call charges when contacting GP practices. Then on 15 March, the Minister again wrote to the Health Committee advising that the offending practices were reminded of the need to change to normal BT charging for patients but that there is no legal power to require those practices to stop using 0844 numbers.
On behalf of the Alliance Party, I support the motion and await with interest to see what else the Minister can do and what his next move will be. In the meantime, I appeal to the GP practices concerned, including the three in Newtownards, to stop using the 0844 system in the interests of their patients and our constituents.
Pam Brown (DUP)
As a member of the Health Committee, I also support the motion today. My colleague Gordon Dunne brought the issue to the Committee some time ago. The use of 0844 numbers is now quite common for businesses, providing extra phone functions for customers and increasing efficiency. You can, for example, get put through directly to the person or the department you wish to speak to. Numbers beginning with 0844 provide consumers with a flat call charge rate, which nowadays is, in actual fact, more expensive than calling a telephone number beginning with, for example, 028. Going by the BT business price plan, it is clear that the use of a 0844 telephone number can be cheaper for a business, with savings made on monthly costs. However, calls to 0844 numbers, as we have heard today, are more expensive for customers, especially when dialling the number from a mobile phone, which can cost between 20p and 41p per minute, compared with between 1p and 13p per minute for a customer using a fixed landline.
Such phone numbers are regularly used by banks, credit card companies, internet providers and any other major business with a customer service department. As fixed landlines are becoming less common, and as more people adopt mobile phones, those costs can therefore build up significantly, in addition to the cost of monthly price plans.
In a letter from the Health Minister dated 15 March 2012, Mr Poots informed the Chair of the Committee that approximately 6% of practices in Northern Ireland used 0844 telephone numbers. The Minister also stated that his Department had informed GP practices three times since September 2011 that patients should not incur charges above the equivalent of a local call when contacting their GP practice; that, having taken responsible steps to ensure that excessive costs are not passed on to the patient when contacting their local GP practice, all practices should bring into being a callback system whereby the caller can ask to be called back at the expense of the practice; and that a practice should not enter into long-term or extended contracts with telecommunications firms if that results in additional costs being passed on to the patients that are greater than the cost of a local call.
The Minister also informed the Chair that his Department had no power to stop GP practices using 0844 numbers, but he did ask his Department to look into what can be done to raise awareness of the issue and limit additional costs being passed on to patients when they contact their local practice.
In a public consultation by the Department of Health in GB in 2008, stakeholders were consulted on the use of 0844 numbers. The Department stated that it wished to hear people’s views on the issue, but understood that 0844 numbers offer patients and users additional functions, including, as we have heard, the use of call waiting, ending the engaged tone, push-button choices, redirection services or access to automated booking and appointment systems. Benefits therefore can exist for the patient and the GP practice in bringing about efficiency and easy access. However, as a result, the consumer ultimately ends up footing the bill.
Eighty-seven per cent of respondents to the consultation believed that patients should not be charged more than the local rate, and we fully agree with that. No person accessing healthcare should be charged more than a local rate, so I am pleased to support the motion.
Mickey Brady (Sinn Féin)
Go raibh maith agat, a LeasCheann Comhairle. I also support the motion. It demonstrates a proactive approach by the Committee, and shows that it is taking steps to address a number of problems raised by Committee members and constituents. I know that Gordon Dunne raised this particular issue in Committee on several occasions, and it is good to see that it has now been brought to fruition in the motion by the Committee.
I apologise for missing the start of the debate; I was in another meeting, but I think most of the stuff has been covered by other Members. I think it is accepted that only a small number of GP practices continue to use those particular numbers. As has been mentioned, the Minister, in reply to the Chair, stated that it was 23 out of 355, or approximately 6% of practices. Obviously, the reason why there is a continuing problem is because patients who use the 0844 numbers are paying more than the equivalent cost of a local rate call.
If the services offered by those numbers were not more expensive, people would have no particular problem using them. There may be benefits of being held in a queue and accessing push-button choices. They may be good and effective to some degree, but if the patient did not have to pay more for them, it would be even better. People who use those services are often on benefits and on low incomes. The GPs who continue to use those numbers may argue that they provide a better service, but they cost more. If someone is using a mobile, as a lot of people do now, it costs a lot more to access those numbers than it should. I know that social security offices had the same problem. They were offering free calls, but if someone was using a mobile and not a landline to contact them, it was costing a huge amount of money. I know of one case where it cost a woman £17 to call a local office while she was held waiting. That was out of a £20 top-up card. It is expensive to access these numbers, and it is something that needs to be addressed urgently.
The bottom line is that patients need to access their GPs. Such access should be efficient and not costly. It has been mentioned, as it was in the letter that the Minister sent to the Chairperson, that people can order prescriptions online, and so on; but if you do not have access to a computer and cannot get online, it becomes more expensive to use these particular numbers. Patients should be given the opportunity to have quick, low-cost telephone contact. As far as I know, Ofcom supports the motion. I am sure that the Minister will give his views on how he will deal with this issue.
Ross Hussey (UUP)
I apologise to the proposer and to other Members for my late arrival. Unfortunately, I was on the phone, but not to an 0844 number.
When I saw the motion on the Order Paper, I felt that I had to come down and get involved. Many people have referred to the fact that it applies to only 23 out of 355 GP clinics. The use of 0844 numbers in GP clinics may have come as a surprise to some in this House, but it is no surprise to me in Omagh. My GP’s telephone number is 08444773513; the sort of number that rolls off the tongue. If you are an elderly person, will that number resonate with you and will you remember it always? You will not; it is far too long and too complicated.
The number is used whenever you contact the health centre, and when you do so, you contact it immediately; it is not engaged, that is quite true. You get to choose an option, 1, 2, 3 or 4; you will then get other options, and you will eventually get through to sort out whatever you need to do. If you are using a mobile phone, the cost is excessive. I have to use the mobile phone to sort out prescriptions and various things for my mother, so I know the cost. Many sitting around will say; “you can well afford that”. Maybe I can, but there are many who use their mobile phone who cannot afford it, and a lot of people have a mobile phone as their only source of contact.
You can also use the internet to contact your health centre. Again, that is a wonderful system, but how many older people can use the internet, have access to it or understand it? A lot of older people depend on their families to make the calls for them. We have to have a situation in which health centres must use a local number. Most people will remember a local number, and I think that the time has come to do away with 0844 numbers for good. The cost of using them is excessive and they do not work. Older people do not remember the numbers, and we have talked about this issue for too long. Maybe I am being charged too much for the call, I do not know, but I think the time has come for 0844 numbers to disappear.
Edwin Poots (DUP)
I am grateful for the opportunity to hear Members’ views on this issue. I fully appreciate their concerns about the cost of telephoning those GP practices that continue to use 0844 numbers. High telephone call charges impact on the most vulnerable members of society; the elderly, the disabled and those on low incomes. For many patients, calling their local GP surgery can be very stressful and worrying; concerns about high call charges only serve to add further stress.
We fully appreciate that, out of the 355 GP practices in Northern Ireland, only 23 use 0844 numbers. That represents approximately 6% of practices. Nonetheless, telephone systems used by GPs should not place undue financial burdens on patients. The cost of telephoning 0844 numbers can be very expensive for patients whose landline telephone packages do not treat calls to 0844 numbers as local calls. It can be even more expensive for those patients who use their mobile phones to telephone 0844 numbers. The use of mobile phones in our everyday lives has increased, and for many, they have replaced landlines.
In the industry, 0844 telephone numbers are known as non-geographical numbers or number translation services. When the call reaches the network, the number dialled by the caller is translated by the network to a geographical number to deliver the call to its destination. In 2008, the use of 0844 numbers was examined by way of a consultation exercise by the Department of Health in England. Although the consultation demonstrated that there was overwhelming support for the banning of 0844 numbers, the Department of Health concluded that banning the numbers would not necessarily solve the real issue; that some patients are paying more than the cost of calling a normal geographical number to contact the NHS.
The lessons learnt in relation to 087 numbers were that banning a specific number range simply led to the use of other number ranges and the same issues persisted. The Department of Health decided that, rather than banning 0844 numbers, it would put in place a legislative framework to prohibit the use of any number or tariff that resulted in patients paying more than a geographical number to contact health service providers. The legislative framework that the Department of Health put in place included the issue of directions in December 2009 and the amendment of its National Health Service (General Medical Services Contracts) Regulations 2004, which came into effect on 1 April last year.
The directions and the amendments to the regulations directed NHS organisations and GPs not to enter into, renew or extend a contract or other arrangements for telephone services unless it is satisfied that, having regard to the arrangement as a whole, persons will not pay more to make relevant calls to the NHS body than they would to make an equivalent call to a geographical number. They were also directed to review their existing contract and consider whether, having regard to the arrangement, the patient would pay more than they would to make a relevant call to a geographical number. If they would, the body was required to consider introducing a system under which, if the caller asked to be called back, the body would do so at its own expense.
Action taken by the Welsh and Scottish Departments and my Department in September 2010 mirrors that taken by the Department of Health. On 5 September last year, my Department issued policy guidance regarding the use of 0844 numbers. The policy directed that patients should not incur charges above the equivalent of a local call when contacting their GP practice. Having taken all reasonable steps to ensure that a patient will pay no more than they would to call a local geographical number, the practice must consider introducing a system under which, if a caller asks to be called back, the GP practice will do so at its own expense. The policy also stated that GP practices should not enter into new contracts or renew or extend contracts for telephone services unless they are satisfied that patients will not pay more than they would to call a local geographical number.
Telephone operator tariffs include many different options. They are very difficult to understand, and they change regularly. Many variables contribute to the cost of a call, including the telephony supplier, the tariff, the length of the call, the time of day at which a call is made and whether the call is made from a landline or a mobile. Given the number of variables, it is not possible to give a definitive estimate of the cost of phoning an 0844 number. The cost of telephoning an 0844 number is determined by the patient’s telephone provider, not by the 0844 service provider. The 0844 service provider gets the equivalent fee that a geographical provider would receive for an equivalent call.
Unlike BT, other telephone providers, including mobile phone providers, are unregulated and, therefore, free to levy charges without approval from the regulator. Neither GP practices nor the 0844 service provider has any control over the charges that the telephone and mobile providers levy.
Jim Wells (DUP)
Although the Minister is right in saying that we cannot be definitive, it is absolutely clear that, from a landline, it can cost anything from 2p to 4p a minute to ring an 0844 number, and, from a mobile, the range is 25p to 41p. We cannot be specific, but that clearly indicates the quantum of the problem. If you pay 41p, which, I understand, is an Orange pay-as-you-go tariff, to ring an 0844 number, you can see why somebody like Mr Brady’s constituent could rattle up — to use the slang — a bill of £17.
Edwin Poots (DUP)
Yes. Evidently, a higher cost of the calls generates increased income for the telephony service provider. For example, the current local BT tariff is approximately 8p a minute plus a 13·1p connection charge. In general, that charge will apply unless the caller’s BT package specifically includes free calls to 0844 numbers. That rate applies only to BT landlines. It is possible — indeed, probable — that other landline providers may charge more for calling 0844 numbers.
My attention has been drawn to the fact that GP practices that use 0844 numbers receive 2p for each call that is made to the practice. However, I have been advised that the revenue is held in an escrow account, which means that GP practices do not have access to it and it is used to fund the rental cost and maintenance of the system. I am, nevertheless, concerned that patients of GP practices that have an 0844 number are essentially, through their phone calls to the practice, part funding the practice telephony system. That, to me, is unacceptable.
At present, neither the board nor the Department has the legal power to instruct GPs to stop using 0844 numbers. Under the relevant legislation, the GMS contract regulations, GPs are required to provide a telephone number in their practice leaflet, and that is the only reference to telephony in the General Medical Services contract regulations.
When the practices entered into the telephony contracts with the service provider, the use of 0844 numbers was not banned, and 0844 numbers were not considered premium rate numbers. The menu facility that the service offered was deemed to be innovative and offering a good service for patients. Practices have reported that one of the reasons that they selected the 0844 service was to try to ensure that patients were able to get through to the surgery, because patients had often complained about constantly getting an engaged tone.
As GPs are self-employed independent contractors, to stop practices using 0844 numbers, the Department would have to amend the General Medical Services contract regulations, which would require consultation. As there were no restrictions on practices using 0844 numbers when they entered into their contracts with the service provider, and given that the practices will incur substantial termination fees, a proposed date for stopping the use of 0844 numbers would have to be flexible to accommodate practices whose telephony contracts have some time to run.
As Members have said, on 15 March I advised the Health Committee that I had asked Department officials to examine what action had been taken to heighten patient awareness on requesting their GP practice to phone them back, as well as ensuring that patients are fully aware of all other options for contacting their practice, including the use of the internet in seeking repeat prescriptions or making appointments. To help inform my Department what action could be taken to heighten patient awareness, officials wrote to the 24 practices on 21 April asking them to provide the following information: the date that their practice’s telephone contract with the 0844 service provider is due to expire; the estimated cost of terminating their 0844 contract; confirmation that members of their practice staff are aware of the Department’s policy on the use of 0844 numbers and are adhering to it; and confirmation that their practice has not renewed its 0844 contract with the service provider in contravention of the Department’s policy.
Seventeen practices have so far provided the requested information. They confirmed that they are adhering to the Department’s policy on telephoning patients back if requested to do so. They also confirmed that they have not renewed their 0844 telephone contract. Three of those practices’ contracts expire in 2013, in June, September and October; four expire in 2014, in January, June, September and November; six expire in 2015, in May, August, September and December; and four expire in 2016, in February and April. Early termination of contract payments range from £9,500 to £31,000.
I understand that the service provider has offered the 23 practices the option of having a local number that would run alongside their existing 0844 number. It has also offered the option of a call-back facility. If practices were to avail themselves of those options, it would certainly help to resolve the issue of expensive telephone calls for many of their patients. It remains the case that practices cannot be required to sign up to those options, but it is good to know that they are available, and public pressure should be applied on GP practices to respond.
Telephone calls to GP practices should not cost more than an equivalent call to a local geographical number. A proposed date for stopping the use of 0844 numbers would have to be flexible to accommodate practices whose telephony contracts have some time to run.
Jim Wells (DUP)
That line was in a response to the Committee from the Minister, but the reality is that, for the vast majority of BT customers in Northern Ireland, the cost of a local call to a landline number is nil, because the package that they are in gives free calls of less than one hour to any landline number. So, it is not much use to those customers to say that it should be the equivalent to the cost of a local call, which is 8p or 9p a minute, when, in fact, it is nothing. That point has been missed by the GPs.
Edwin Poots (DUP)
People certainly pay more to get their calls free for up to an hour, and many are on such contracts. I fully understand what the Member is saying. What I said earlier was that GP practices could offer the local number alongside the 0844 number so that patients would not be paying more in that instance. It is important that we maintain pressure on GPs to respond to this particular issue.
My Department will examine the possibility of amending the general medical services contract regulations, making it a requirement that GP practices use geographical numbers. We will also explore with practices the option of installing a geographical line that patients could use as the alternative to the 0844 number until such times as those contracts expire. We will also explore with them the option of introducing the call-back facility, which the service provider can set up.
I trust that this information is useful to the House and that we can advance this over the course the coming months and years.
Jim Wells (DUP)
I had two teenage daughters. For many years, our phone bill was quite small until it suddenly rocketed, and I learned that my daughters had become friendly with just about every boy in the neighbourhood and felt duty-bound to ring them on a regular basis for very long periods. I did not object to this, but the phone bill mounted dramatically. Then I discovered that British Telecom had a package that allowed you to ring an unlimited amount of landline numbers for up to one hour, free of charge. That was a bargain. I signed up immediately, my phone bill plummeted and I did not mind how many boys my daughters phoned, because as long as I could limit them to 59 minutes the calls were effectively for nothing.
That is the reality for the vast majority of people in Northern Ireland who are on that package, be it with BT or any of the other providers. Equally, many people in Northern Ireland do not have a landline at all. Indeed, for young people, the concept of a landline is almost foreign to them because they are so used to mobile phone calls. Therefore, when they settle down and get married and have a home together, often they will simply continue to use mobile phone numbers.
Many of us have mobile phones — everyone in this Chamber has one — and we have inclusive minutes. In my case, it is 300 minutes for the grand sum of £10 a month and I think that I got a bargain. Therefore, if I phone a landline number as part of that inclusive package I effectively pay very little for the call. GP surgeries throughout Northern Ireland know that, but 6% of them, as Pam Brown quite rightly pointed out, have decided to opt for 0844 numbers. This is called revenue sharing.
If you ring an 0844 number from a mobile, as many Members, including Mr Gardiner, Mr Hussey and Mr Brady pointed out, you are in trouble. The minimum rate that I could discover, trawling the internet, was 25p, because those numbers are not included in the landline package. My 300 minutes, or whatever packages other Members may have, do not include calls to 0844, 0845, 0870 or even 0800 numbers. Therefore, when you call your surgery — unfortunately, three of those surgeries are in South Down, in Dundrum, Downpatrick and Newcastle —
Ross Hussey (UUP)
The Member is quite right about the rates that are charged, but those of us who live in the likes of West Tyrone incur international charges when we approach the border, which costs us an awful lot more.
Jim Wells (DUP)
Every time I drive from Kilkeel to Newry I get several text messages from Eircell or Eircom or whatever welcoming me to the Irish Republic, but I have not set foot in foreign soil. I suspect that they are deliberately beaming signals into the North to pick up the roaming charges. In Rostrevor, you can be on O2 in your sitting room and on Eircell in your upstairs bedroom. That is the complexity of roaming charges, which is a problem even for folk in Portstewart or Portrush.
The lowest rate that I could find for a mobile phone call to an 0844 number was 25p, and the highest on a pay-as-you-go phone was 41p.
Therefore, I am not surprised to hear Mr Brady’s story of a constituent who clocked up a bill of £17, because, on ringing an 0844 number, you often get ‘Greensleeves’. You get the first verse and the second and the third — it goes on and on. While that is happening, because you have got a connection you are paying the full 25p or 41p a minute.
Mr Hussey said, quite rightly, that we can afford it, and that is probably true. However, the large majority of people who contact their GP surgery are pensioners, people on income support or people on low incomes, and they cannot afford to clock up large bills that serve as a deterrent. If someone is genuinely ill and trying to get through to their GP surgery, the last thing that is needed is to discourage people from ringing. So I am glad that the honourable Member for North Down, Mr Dunne, who, unfortunately, is not with us today, has raised this important issue and has ensured that the Committee has sufficient information to write to the Department.
As I said in my interjection to the Minister, the response from the GPs was inadequate because they do not understand the way that the packages work. Therefore, they do not realise that calls that should be free for most people, when in fact they are paying an extra 2p or 4p a minute. It is important that we try to eliminate that process as quickly as possible.
When I approached my local GPs in south Down, they made the point — as the Minister rightly did — that they had got themselves into a contract and that buying out of that contract would be extremely expensive. So, we will have to wait until that situation unwinds. Mind you, I congratulate the GPs in Dundrum, because when they moved to a new practice in Clough, which I am glad to say the Minister is coming to open, they agreed not to install 0844 numbers in the new surgery: it will use a standard landline rate, and that is welcomed by the community.
I also accept, of course, that the money generated by 0844 numbers does not go into the pockets of individual clinicians or staff; it is used for the benefit of the surgery. I accept that that provides new facilities, perhaps in waiting rooms or in the form of a play facility for children within the surgery, and that is to be welcomed. The problem is that it is probably those who can least afford to make such a contribution who are buying the new facilities. The vulnerable, the poor and those on income support should not be paying extra money for no good reason.
The Minister and other Members made the point that there is a halfway house. Granted, these GPs cannot drop out of their 0844 contracts at the moment without incurring prohibitive penalty clauses, but they should at least provide an alternative landline number for those who find the cost of ringing 0844 prohibitive. Ms Brown and Mrs Bradley made the point that the 0844 numbers gives flexibility to reroute calls, etc. You can get exactly the same facility on a standard landline number. Of course, no income is generated for the surgery by doing that. Therefore, there is always the tendency to go for the more expensive option, which, in this case, can rake up quite a large amount of money.
I would love to know — and, because of the unique relationship between GPs and the Department, I do not think that the Minister is in a position — how much money in total is being generated by the use of these numbers. It would be fascinating to see how much money is generated by the thousands of people who ring surgeries every day, and where it is going. However, I understand that GPs negotiated separate, very generous, contracts through the BMA in 2005, with which the Department is stuck. The contracts were negotiated under direct rule and, frankly, there is little chance of them being changed, certainly not by the GPs’ side. Therefore, in this situation, the Minister’s power is limited. I certainly hope that what he has said to us today will see the gradual phasing out of this practice.
In the real world, SayNoTo0870 is a useful website that I use all the time, on which you look up the expensive phone number and you get a landline alternative. Sadly, it is not possible to use it to look up an alternative number for a GP surgery in Northern Ireland; it is only for the big insurance companies etc.
I have no objection to the principle of 0844 numbers. If I watch ‘Britain’s Got Talent’ or a similar television programme, and I am impressed by Pudsey the walking dog — which I was; I was actually very impressed by Pudsey the walking dog — and I wish to spend my hard-earned money to vote for that dog to win by ringing in on a premium rate number, that is fine. However, if I am a 70-year-old pensioner who constantly rings my GP because I have a heart condition, I do not think that I should be worried about the size of my bill for doing so. That is the difference. There is no objection in principle to 0844 numbers, but they need to be phased out.
Sam Gardiner is on a good run. I notice that he has been asking some very interesting questions of the Minister. He was the first to point that only 6% of all GP practices in Northern Ireland — 23 out of 355 — use this facility. I would like to think that, by 2016, none of the 355 will be using it. Mark Durkan, who is no longer in the Chamber, made the point that the people who are least able to pay are the ones who bear the brunt of the cost, and he also said that the vast majority of GP surgeries have opted not to go down this route. I will be very careful what I say about Mr McCarthy. Appropriately, he appealed to GP practices to end the situation voluntarily, and I agree with him. Pam Brown brought up a very useful piece of information. A consultation by the Department of Health in Great Britain found that 87% of respondents agreed that the use of these numbers was not acceptable. A survey in Northern Ireland would show similar results, and the practice needs to end as soon as possible.
Question put and agreed to.
That this Assembly calls on the Minister of Health, Social Services and Public Safety to outline the actions that he will take to bring to an end the practice of GP surgeries using 0844 telephone numbers and the associated high call charges for patients.