084 Telephone Numbers in the NHS
Government Public Consultation
X-on was asked to contribute an industry perspective to the Government consultation on the use of 084 numbers within the NHS.
Below are some excerpts from X-on's contribution.
The orginal Government document showed a misunderstanding by assigning a functionality to 084 numbers which was seen as inherent. X-on cleared this misunderstanding in several instances, for example:
Consultation Document Page 4:
"However, the Government recognizes that the extra functions offered by an 084 number can improve access to services for patients. We wish to find out how valuable people think the enhanced functions provided by 084 numbers are, and how they might otherwise be provided without patients having to pay more than a local call rate for them."
084 numbers do not in themselves imply the provision of additional functions. Additional functionality is provided by hosted telephony providers or on-site equipment. This functionality is independent of the numbering plan and can be provided on 084, 01, 02 or 03 numbers without technical limitation. Asking a question which links the additional functions to the 084 number creates an incorrect association where there is in fact none. Consequently the answers are less likely to be impartial.
Consultation Document Page 5:
"084 numbers provide several extra functions, including allowing a caller to:
| • | be held in a queue, so ending the problem of getting an engaged tone; |
| • | access a push-button choice of options that can be used to route calls, for example to appointments, repeat prescriptions or a practice nurse; |
| • | be redirected to other locations or other services such as out-of-hours services; or |
| • | access automated booking and appointment systems." |
As previously stated all such functionality is available on 01, 02 or 03 numbers.
"Is there another way to provide the extra functions?
Yes, 03 numbers were introduced by Ofcom in 2007 as an alternative to non-geographical numbers such as 084 numbers. 03 numbers offer the same extra functions as 084 numbers but are charged at the same rate as a call to a local number. However, a charge is levied on the person or organization receiving the call."
It is inaccurate to state that a charge is levied on the person or organization receiving a call on an 03 number. Unlike 084 numbers, 03 do not generate "terminating revenue" which is available to be shared by the person receiving the call and any Service Provider who is providing additional functions. 03 numbers are revenue neutral which means they also do not attract a charge to receive calls, although individual service providers may wish to charge for their services by levying such a charge. This is totally disgressionary by the service provider who may charge for services by a variety of commercial arrangements.
Consultation Document Page 6:
"On average, calls to 084 numbers last marginally longer, not only because the extra functions can mean that a caller may be held in a queue before their call is rerouted or they talk to a receptionist, but also because they can undertake certain tasks, such as booking appointments and ordering repeat prescriptions, via an automated system"
The length of a call does not relate to the numbering plan. The functionality offered by a hosted telephony service may increase or decrease the length of the call depending on the functions offered and configuration of the service. Such functionality can actually considerably decrease the length of the call with careful design. It should be noted that evidence exists in the public domain of instances where call lengths have been unnecessarily extended on 084 numbers through the introduction of superfluous messages with the sole intention of increasing revenue.
Consultation Document Page 7:
"GP Practices and other NHS organizations using 084 numbers do not make a profit from 084 numbers. The money generated by 084 numbers goes towards the cost of providing that number and the functions."
There is no stipulation in the provision of revenue-sharing on 084 numbers that the revenue must be assigned to any cost of providing functionality. It should also be stated that the cost of the number and functions has been artificially inflated in the perception of the purchasers to bring it in line with the considerable revenue share that is available from 084 (particularly 0844) numbers. The market cost of such functionality can only be judged if it is isolated from the revenue-sharing arrangements.
Consultation Document Page 8:However, the premise on page 8 that "It is not an option to leave things as they are" is one that X-on wishes to address in the remainder of this response.
Hosted Telephony
Hosted telephony is a managed service to provide the functions that are discussed in the consultation document, including:
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Call queuing |
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Push button choice of options to self-route calls |
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Out of hours call routing and redirection to other services |
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Access automated booking and appointment systems |
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Call management information (reports on inbound calls) |
Hosted telephony can also provide additional functionality not discussed in the consultation document including:
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Call Recording |
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Real time displays of queue status (wallboards) |
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Queue position and expected wait information messages to patients |
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Integration with inbound and outbound SMS services to patients |
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Reduction in outbound call costs through use of VOIP telephony |
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'Call Back When Free' to reduce call queuing |
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Voice information services |
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Voice mail and other voice messaging services |
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Business Continuity through delivery of calls to alternative locations |
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Self service access to configuration through secure Internet portal (for example to redirect calls in an emergency, or to change timers and messages) |
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Multi-lingual message services or prompts to meet access obligations |
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The use of VOIP call delivery to site allowing reduction or elimination of outbound and inter-site call costs |
Benefits of Functionality
X-on would strongly feel that the benefits to patients and NHS of the functionality offered through the technology of a hosted telephony system considerably enhances the patient experience and the efficiency of the health organization. A typical case in point is the fairness in call queuing experienced with a hosted system during early morning peaks in appointment bookings. We do not believe that patients will wish to return to the engaged tone lottery provided by practices with limited call handling capacity.
We will address the challenges and solutions on the basis that the NHS is in agreement that a solution to providing these benefits without compromising the principle of "free at the point of access" is desirable.
Challenges and Solutions
The challenges to be addressed are in our opinion:
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How to make the functionality available to NHS organizations who do not currently offer it while retaining value for money |
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How to commercially make the functionality available to GP Practices who have entered into long contracts for 084 solutions |
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How to market to the public the benefits and cost structure of 03 numbers if these are to be used in preference to 01 or 02 |
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How to recover from public disquiet or confidence issues caused by the introduction of 084 based services |
We will address each of these in turn.
Making Functionality available to NHS Organizations with no 084 Solution
Solutions exist off the shelf for provision of 01, 02 and 03 numbers with hosted telephony functions. There are proven commercial models that can offer these at low fixed monthly rentals without the need for revenue-share offset or transaction charges.
The NHS can offer functionality while retaining value for money by making informed supplier choices, either autonomously or at national level. The requirements for stable proven technology, carrier grade solutions with multi-site resilience and a future development path do not need to be associated with exorbitant price tags or punitive contracts.
Solving Existing 084 Contractual Arrangements
It is possible that it will be necessary to cancel existing contractual arrangements at a cost, or to leave them in place and run parallel solutions if 084 numbers are to be banned. Assuming such contracts are subject to legal scrutiny and have been sold with clarity of the facts above, absorbing this cost will be necessary to move forward. The cost effectiveness of replacement solutions will therefore be of paramount importance.
Public Confidence
In order that the public perceives a policy change has been made, an understanding of the replacement tariffs such as 03 needs to be communicated. This is normally a slow process and knowledge of the cost of calling 03 is currently limited. The possibility of providing hosted solutions on 01 and 02 may overcome short term problems in this area.
In addition, the perception that there is collusion between service providers and the healthcare profession in trying to raise revenue from patients through 084 numbers is being promoted by certain interest groups which could promote a damaging lack of trust. In order to rectify this the benefits to the patients of improved call handling systems must be promoted alongside clarity in the call tariffs and this must be dissociated with previous 084 based systems.
Marketing 03 Numbers
In the longer term, a government marketing campaign explaining the reason for 03 numbers and the costs associated with dialing them will increase public awareness and confidence in the NHS telephone interface.
084 Consultation Summary
X-on believes that the NHS has an opportunity to rectify the damage to public trust created by 084 by implementing feature rich hosted services on 01, 02 and 03 numbers. The government will gain credence by the promotion of such services and the associated tariffs. Through careful supplier selection, the cost of the undertaking can be moderate. Maintaining the current postcode lottery of tariffs with associated concerns over revenue-sharing would be politically damaging at a time when public susceptibility to doubts on corporate responsibility is at an all-time high.
For further information on the 03 Alternative to 084 please call 0333 332 0000 or contact X-on.