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Mr Ainsworth
If my hon. Friend can wait, I will try to give way later. A number of Members want to intervene.
The GPs argue that they have entered into contracts that give them enhanced telephony solutions, and that they cannot get out of them. That is the kind of thing that they say to justify their non-compliance, but none of it is true. All the arguments are flawed, and there is the simple solution of migrating to an 034 number, which provides the same supposedly enhanced telephony services. As an aside, I will say that what we mean by such services is call queuing and call diversion options. When in the middle ages people fell foul of the inquisition, they were shown the instruments of torture but not made to pay for them, but people are now being made to pay for these supposedly enhanced telephony solutions.
The Minister of State, Department of Health (Mr Simon Burns)
Will the right hon. Gentleman give way?
Mr Ainsworth
We can do that only if the Department of Health is determined, right up to ministerial level, to enforce the contract. The terms of the contract are clear, as I hope the Minister will say when he responds. No one should pay enhanced charges to access their GP.
Mr Ainsworth
The Minister is nodding. Let us hope that he says that and that, for heaven’s sake, we do not have non-Government and that, having made a decision, they make sure that it is complied with across the board. I look forward to hearing the Minister’s response.
The Minister of State, Department of Health (Mr Simon Burns)
I congratulate the right hon. Member for Coventry North East (Mr Ainsworth) on securing this debate on the use of 084 telephone numbers in the NHS. The Government’s position is extremely clear—when patients contact their GP or anyone else in the NHS, they should not be charged more than they would be to call their next-door neighbour’s landline. Those are the rules. That is why we have retained the previous Government’s directions, published in December 2009, and regulations, passed in April 2010, which make it a contractual requirement for GP surgeries to ensure that that is the case.
Under the directions and the amendments to the general medical services and primary medical services regulations, it became compulsory for GP practices and NHS bodies to review how much it cost patients to call them. If they found that patients were being charged more than a standard local landline call, they had one year to take all reasonable steps, which could include varying the terms of their telephony contract, cancelling the contract, or offering an alternative number to call, such as an 03 number, which charges callers at a local rate. GP practices should not, in any case, enter into, extend or renew their contracts with their telephone supplier if patients are being charged more than a local call.
This legislation was the result of a lengthy consultation by the Department in 2009, to which there were about 3,000 responses. The vast majority agreed that patients should not be charged additional costs to contact their GP. However, many also valued the enhanced services they receive when calling their GP, such as queuing and additional booking options, but we are clear that that should not cost patients any more than a local landline call.
Mr Burns
I will not at the moment, because I do not have much time to answer all the points raised by the right hon. Member for Coventry North East. [Interruption.] I might give way in a moment, although hon. Members should remember that the right hon. Gentleman did not give way to me either.
We must also be clear that the additional services can also be offered on other number ranges—such as 01, 02 and 03—and GP practices should feel able to choose the number that is most suitable for their patients, provided that it does not cost them any more to call.
Many people ask why we do not simply ban 084 numbers outright. I fear that that would not solve the real problem, which is that some patients continue to be, or believe that they are being, charged too much to contact their GP.
Mr Andrew Smith
Given that the Minister has said that practices should not charge more than the cost of a landline call to a neighbour, if a patient can demonstrate from their bill that they have been so charged, will they be able to get the money back, and how would they go about that?
Mr Burns
The right hon. Gentleman has anticipated something that I will deal with shortly, namely the 1,300 GP practices mentioned by his right hon. Friend the Member for Coventry North East that have allegedly been abusing the system.
As I have said, I fear that banning 084 numbers would not be the panacea that Opposition Members might believe it to be. The Department, to its credit, banned the use of premium-rate telephone numbers beginning 087 and 09 in 2005, but new number ranges with additional costs began to appear. Although it seems to be a simple solution, I do not think that it will be over the medium and longer term, because people will seek to avoid it. That is why it is crucial that the previous Government rightly sought to tackle the problem at source and why we have continued the policy that they introduced in the dying days of their regime. The 2010 regulations make it clear that patients must not be charged more to contact their GP than they would be if they called a local number.
Since the rules came into force, I understand that there has been confusion in the NHS about what the regulations and the directions include. I am grateful for this opportunity to clarify some of those misconceptions in the NHS and elsewhere. There have been claims that mobile phones are not covered by the 2010 regulations, but that is not true. The regulations cover landlines, mobiles and payphones equally. The legislation is absolutely clear that if a person calls a GP surgery with an 084 number from a mobile, landline or payphone, they should not pay more than they would if they called a local landline number from the same phone.
That is very important, because more and more people now use mobile phones as their primary form of communication, as has been mentioned by the right hon. Member for Coventry North East. That is particularly true of the less well-off—the right hon. Gentleman also made this point—where 25% of households only have access to mobile phones, and for young people, where a third of people under 25 only use mobile phones for communications purposes. In 2011, for the first time, the majority of call minutes originated from mobile phones.
Questions have also been raised about how a patient can challenge their GP practice or PCT if they believe that they are being charged more than the cost of an equivalent local call. Any action taken should be on the basis of robust evidence. GP practices and their PCTs should look at evidence of call costs to determine whether their patients are being charged more than they should be. Such evidence could include cost-per-call information from providers, such as O2, Vodafone and BT. A suitable sample should be considered, bearing in mind the different contracts that patients can choose to sign up to.
A practice can also look at cost-per-call information that is provided by patients. Using that information, it would be possible to compare directly the cost of calling a GP practice’s 084 number with the cost of calling a local land-line number. If the evidence suggests that using a specific number is not costing patients more than it should, the GP practice should be free to continue using 084 numbers. If patients are being charged more than they should be, they should take the steps that I have already mentioned to rectify the situation.
Mr Ainsworth
Although I welcome a lot of what the Minister has said, I am not at all sure that we can afford to leave this problem to the individual. There is deference towards doctors and people are loth to offend or upset their doctor. The Department and the local PCT must be prepared to take action to ensure compliance, and they should not expect individual patients to do so.
Mr Burns
The right hon. Gentleman anticipates a point that I was about to make. As a preface to that point, however, I must say that patients can be extremely helpful in providing evidence that can help to prove if this practice of overcharging, which is in defiance of the regulations and directions, is going on.
I now come on to the point that the right hon. Gentleman made about the figure that is in the public domain and that is used a lot, namely that there are 1,300 GP practices that are—in effect—defying the regulations and charging patients more than they should. I have made inquiries and I can find no evidence to support that figure. People say that there are 1,300 GP practices that charge more than they should; what they do not say is which practices they are, and they do not provide the robust proof that overcharging is happening.
I say to the right hon. Gentleman, and to anyone else who has an interest in this important subject, “Please send us the evidence”, because we cannot find concrete evidence that overcharging is going on. If it is going on, we want to see the evidence and we want to see which GP practices are engaged in it, so that the PCTs, which enforce these regulations, can take action. I assure the right hon. Gentleman that if we get the evidence and if it is proven that overcharging is happening, the PCTs and—after the modernisation of the NHS—the NHS Commissioning Board, which will have responsibility in this area, will also vigorously pursue the matter because, like his Government, we believe that such overcharging is unacceptable.
However, I must reiterate that we need the evidence. We do not need anecdote or the “friend of a friend”, who has said this or that. We need precise, concrete evidence, to be able to pursue this matter.
As I have said, PCTs are currently responsible for ensuring that GP practices meet the terms of their contracts, including ensuring compliance with these regulations. The Department will soon clarify the existing guidance, which I hope will help GP practices and PCTs to understand this issue more fully and to dispel some of the myths and misunderstandings about the use of 084 numbers.
This Government are committed to creating a patient-focused NHS, as the right hon. Gentleman said we were planning to do; I can confirm that he was accurate when he said that. One of the key elements of that process is ensuring that patients find it easy to access the services they need, when they need them. Using an 084 number can help a GP practice to offer additional services that improve patients’ access to care. It is right that GPs remain responsible for their own access arrangements, including their telephone number, opening hours and booking arrangements. Those arrangements will be different for different practices, and the ability of GPs to be locally responsive is something that we know patients value. Primary care is the cornerstone of the NHS. Around 90% of patient contact with the NHS takes place in a primary care setting, with around 300 million consultations per year, so it is essential that patients can easily access care, and have a choice about how to do so.
One way that we are improving access to care is through the roll-out of the NHS 111 service, which will be available to everyone in England by April 2013. That service will give the public a phone number that is easy to remember and free to call when they need help urgently but do not know where to turn. Callers will be quickly assessed, and sent to the right service on the first point of contact. The primary aim of NHS 111 is to ensure that patients get to the right service, and quickly, at any time of the day or night. In most areas, patients can also expect to be able to see their out-of-hours GP through NHS 111, which will simplify how patients access NHS services and improve patient experiences.
NHS 111 will replace NHS Direct’s 0845 4647 service, which obviously uses an 084 number. NHS Direct was exempted by the last Government from the directions and regulations, and rightly so. That is because the Department had already begun considering plans to implement NHS 111, and it would have been confusing to the public to change NHS Direct’s number shortly before introducing a new number for patients to call that will be free to the user.
By April 2013, there will be a simple system in place, whereby patients can access care quickly and easily. If there is an emergency they should dial 999, but if people do not know where to go they should dial 111, and otherwise they should continue to use their GP as usual.
I give an assurance that we take these directions and regulations very seriously indeed. We expect them to be adhered to and obeyed. I can assure Opposition Members who raised this issue that PCTs carefully monitor the situation to ensure that, when there are complaints about 084 numbers, GP practices are adhering to the regulations and not costing patients more than they should. The PCTs vigorously enforce the regulations. I also reconfirm that we are issuing clarification guidance to GPs, which I hope addresses another point that the right hon. Gentleman made.
I cannot emphasise strongly enough, however, that despite the numbers that are bandied around—as I said earlier, 1,300 is the number that is most commonly used to describe the number of GP practices that are not adhering to the regulations—we cannot find any evidence to establish the accuracy of that figure. Nevertheless, we are anxious that the regulations are enforced. So, if there is any concrete information, proof or evidence that GPs are abusing the system and not abiding by the regulations, it is important that that it is provided to the PCT, which acts as the enforcement officer. If the right hon. Gentleman himself has concrete evidence— following the research that he has conducted to secure this debate and then take part in it—and wants to send it to me, I would be more than happy to accept it and I will direct it to the appropriate body, whichever PCT it is, so that the allegation can be investigated.
In conclusion, the use of 084 numbers is controversial but we are very clear that patients should not be charged more than they would be to make an equivalent call to a local number. That is the belief and principle that underlies the policy, one that we are continuing from the last Government’s term in office. However, we also believe that we should not restrict the freedom that GPs have to improve access arrangements for their patients, provided that they are complying with the regulations. I hope that this debate has not only clarified the situation but has set a challenge to the right hon. Gentleman and others to provide evidence if they have it or come across it, so that if there are any abuses we can put an end to them.