DHM of Chichester, Mr Slade of Manchester, and anyone of similar mind: You are simply wrong...

Despite the obvious pressures on resources that there are and always have been, the NHS principle of free at the point of delivery should be protected by us all as a nation. NHS costs need to be paid for transparently from public taxation and not on an ad-hoc basis by patients needing to contact a GP.

I refer you to Lord Warner's letter to Primary Care Trust (PCT) Chief Executives, 19th December 2006 and I quote:

"consider what actions you need to take locally to ensure that patients telephoning practices do not have to pay more than they would if they called a local geographical telephone number"

Local geographic numbers or "03" numbers are highlighted as being best for patients.

I can call any UK geographic number from my home phone free of charge for up to an hour. Yet, I now have a practice locally on "0844"... Too many PCTs seem to have allowed this to go wrong. Paul

Paul, Wakefield, West Yorkshire

Not only is the cost scandalous but 0844 numbers cannot be accessed from overseas. Therefore if a relative goes into hospital and you are out of the country, you cannot contact the hospital or if you wish to make a doctors appointment for your return then you can't do so. Bearing in mind that around 10% of brits are either living abroad or on holiday/working away at any one time this is a serious issue which has not received much publicity.

Dave Russell, horsham,

We shall not need to continue to 'stuff their mouths with gold' they are obviously busy doing it themselves.

Joyce Brand, Leintwardine Shropshire, UK

its the most scandalous abuse of governmental power ,not only do we pay for the nhs services through our pay packets but are to be charged by secondary means and many other stealth tactics. Gps should also should abide by there oath to serve the community and without profit ,that was what the nhs system was setup for,

David Nottingham, Northampton, northants

And how much money are GPs and NHS clinics having to waste by phoning patients on a mobile number? Many patients now give their mobile number instead of a landline. If the phone isn't answered, NHS personnel are not allowed to leave confidential patient information on an answer phone unless the patient has left a personalised message stating their full name so that you know it is actually their phone-all you can do if leave a vague message asking them to call the surgery or clinic. So then you have to phone again...and again...and again if patients can't be bothered to return calls or switch their phone on and answer it.

It cuts both ways.

Christina Monroe, Belfast, Northern Ireland

If people complain to Ofcom, then something might be done.

Phil Stilliard, TWICKENHAM, MIDDX

This is all terribly 'British' to say that we are happy to accept these charges; ask yourselves this question would you be happy to pay a fee for stationery & a stamp up front to a company to reply a letter that you send them or an entrance fee to your local suoermarket just to enter the store?

Brian McBride, Folkestone,

It's all of a piece with hospitals installing phones by the bedside which cost the earth to access. To make things worse, when you phone your ailing friend you have to listen to, and pay for, a needlessly long spoken introduction. Needless to say, the charges are similar when your friend phones out.

Who invents these schemes? To profiteer from the sick and the isolated is immoral.

I can remember a time (actually within living memory!) when we had a health service to be proud of. Hospitals were clean. Nurses nursed instead of gossipping round a "nursing station." Hospital acquired infections were rare. In hospital, one felt as safe as the technology made possible.

How did it all go so badly wrong?

Michael Bruce, Selby, Yorkshire

My surgery doesn't use an expensive code, it uses our local area code. They also listen to patients' views and have a policy of acting on patients wishes with regard to privacy and surgery availability. I am sure that if they considered an 0844 code, they would ask us beforehand and act accordingly. It couldn't be any better if it tried.

Jennifer Hynes, Plymouth, England

Although BT calls are charged at 3p per minute- BT also charge a 'Call Set Up' fee of 3p. So a one minute call from BT costs 6p, but a one minute call to an 0844 number only costs 5p. It's swings and roundabouts. I would be happy to pay a slightly higher call charge for an improved service like this.
Most places you call nowadays have an 0844/0845 number.

Liz Kerr, Leicester,

To Alan johnson, Leicester,
0844, which charges 5p per minute at all times, is substantially higher than a normal priced phone number. 01 and 02 numbers are free to people with a call package on both landlines and mobiles. Even the basic BT charge rate is much cheaper. So to my mind, 0844 IS a premium rate number -- it is MORE expensive than any normal call whichever way you look at it.
You may have been deceived by the phone industry and regulators. The meaning of Premium in the dictionary -- a sum of money paid in addition to a regular price. So your phone bill has it right. My phone bill describes 0844 as "Premium rate g6".
I don't think there is any confusion, ordinary people know when they are being overcharged!!

Mike Kelly, Reading,

My wife & I have been dismissed from our previous surgery, because I had the "audacity" to complain concerning this matter.And not only that, the surgery was being run on strictly military lines , with one only being able to make an appointment by phone Monday,Wednesday & Friday only at 8 AM, so everyone was waiting to get through at the same time. I never was able to make an appointment by phone and had to get in the car to drive to the surgery for 8 AM. If that isn't a rediculous state of affairs, I don't know what is, and have made an official complaint through the proper channels. This has occurred only recently, and am awaiting further developements.

Benjamin Sefton, Leeds, West Yorkshire

My gp surgery uses a 0844, i think through a company based in Basildon, and actually used to have a 0870 number. The 0870 number did cost me quite a bit more to call, but it was better than not being able to get through at all. Now they have a 0844, and it costs me about the same, so i have no problem with that.

We need easy access to our gp due to my partner's ill health. We seem to be connected straight away and then we can press an emergency option if we need to get straight through. Before it was ALWAYS engaged.

Leigh Healey, Huddersfield,

We recently had a 3rd party conduct a survey to the general public - findings showed that 66% had experienced problems contacting their GP, 71% said they would prefer to be placed in a queue rather than hearing the engaged tone all the time and 69% said they were frustrated when they were ill and could not contact their GP.
As regards to the cost of the call, only 3% said that they knew that 0844 was less than 5ppm (interesting, it is 4.2p + VAT), and the average cost of a call to a surgery with 0844 is just 9p. When asked if this was a reasonable charge 82% said it was, and they had no problem with it. More to the point, EVERY single call is answered first time every time and patients always know what is happening and can make informed choices. Surgeryline was designed very much from the patients perspective. One installation every day, for the last 3 years, proves this.

Jason Slade, Manchester, UK

To Alan Johnson, Leicester, I would say that the improvement in access to your surgery could easily have been achieved without using 0844. All it requires is a well organised telephone system which many other companies can supply. Ultimately someone still has to answer the call for you to make your appointment!
A normal 01 or 02 could number could still be used. The problem is that your doctor decided to go with NEG, who promote 0844, because your doctor then has no capital outlay and other revenue, while his patients are paying through the nose, via the phone, for his new system (and for NEG's excessive profits). This is a very expensive solution but it is the patients who are footing the bill.
You may not see what the fuss is all about but for some people, old and sick, it can cost them many pounds per month which they cannot afford. While if they use a call plan their doctor calls could cost them nothing (all call plans exclude 0844). 0870, 0845 etc,

Mike Kelly, Reading,

To clarify the position when patients are abroad.

The consultation is deemed to be at the place where the patient originates the phonecall. As this call is abroad, the UK GP will not be registered with the medical regulatory authorities in that country and would be giving medical advice illegally.

Also, GPs will not be covered by medical indemnity and could be disciplined by the GMC for not registering as a working doctor in another country.

UK doctors when abroad are essentially lay, and have no medical privileges.

For their own protection, patients should not phone their home surgery when abroad and in all circumstances must contact local registered practising doctors for their medical care, and ensure they have appropriate travel medical insurance.

Dr C, Wales,

Dr Burrill says that he is not responsible for his patients' health while abroad, implying that he doesn't care if local doctors treating his patients are unable to get through to him on his 0844 number for details of medical history, drugs prescribed, etc. Has Dr Burrill forgoten his Hyppochratic Oath, or more recently (2006) the description by the General Medical Council of a doctor's duties:
Make the care of your patient your first concern;
Protect and promote the health of patients

A Schwartz, London, UK

Our surgey now has an 0844 number and finally I can get throught to make an appointment. I don't call up to make an appointment often, but before they were always engaged. For the price of a few pence a year for a better service I just don't understand what the full is about! Perhaps the confuion is that 0844 numbers are listed in the 'premium calls' rate section of my phone bill, but I know that premium rate calls start at 10p or more so this might confuse people. I'm happy to pay 5p a minute to get a better service from my GP.

alan johnson, Leicester, Leicestershire

My thoughts exactly. DHM.

Ken, Halifax,

Its about time the public realised that GP surgeries are private businesses whose primary objective is to make profits for the partners, the GP's themselves.
Remember that when you cannot get through to your GP on the phone it is because the practice decided to allocate the funding from the NHS in the way it choose. Look at the car your GP is driving next time you are at the surgery and you will see where much of the increase in funding to Primary Care has gone.

Mike Reading, Lowestoft,

I must say that those who use 999 to "provoke the authorities " would be irresponsible Mr Falconer.This would result in true emergencies being delayed or denied access to the service and may result in loss of life.
The Drs have, for improved patient care,upgraded their phone systems .This has cost the surgeries money, with no profits to be made, now or ever.It's far cheaper having only one line in and out.There is some offsetting of cost of phone calls out against those coming in, but the cost of providing more than one line to patients, is in the thousands of pounds per year.
A patient survey highlighted how difficult it was to contact the surgery by phone, as the line was "constantly engaged."After the phone system was changed ,it showed a greater satisfaction at the ease with which patients could contact the surgery.This therefore results in faster access especially when you are ill.It is a falicy that holding on the line in a cuing system costs money it doesn't.

Mrs Baker, Brighton, UK

Please why are to get away with this. Something should me done abou it.

Kofi, Swindon, Wiltshire

It's quite clear why companies or anyone switches to 084 and 087 numbers. It is so that the callers to these numbers are ultimately going to pay the ongoing costs such as rental etc. for them. I think It's daylight robbery that these people should be allowed to get away with it, because mark my words, when the funds need building up, the time that you are kept waiting will get longer and longer.

Terry, West Midlands,

Beware if they have both 08xx and landline, they will not pick up the landline. Recently, I had experience with Virgin Train. I used the landline to call the company, my queue was No5, then No4, then No5, No5, ..., all the time, I was in No5. I changed to use 0870, I got through very fast.

Xiaohong, Reading , UK

In response to Mr Gee of Bournemouth GP's income was not increased in advance of inflation. In fact they got one pay rise in 2004 with their new contract which was 9 per cent.This was also after an income cut by taking services out of general practice and given them to the private sector.
This is after no previous pay increases for years and with no pay increases with inflation thereafter.
Therefore 9% of a reduced income makes the pay rise to date less than 3%per annum = less than inflation.
GPs are not getting inflationary pay rises but their staff are thus GPs are getting a wage cut and they are not getting any further inflationary up lifts to their income.
So maybe you're right, they should not have spent money out of their own pockets to improves patient services and just kept the old system?Good idea keep complaining and that's what will happen and it will cost the surgery less,GPs will be financially better off and less busy as patients wont be able to get through.

Mrs Baker, Brighton, UK

It is a disgrace the greedy GPs are allowed to make money this way. Surely Ofcom must do some thing about this and get them to change back to 01/02 numbers.

R.Vipul, Chippenham. Wilts,

The best thing to do is vote with your feet. I changed surgeries and was also plesently surprised to also find a far superior doctor and far better reception staff. It was win win win and I recomend it. If a sugery pulls strokes like rip off phone lines they most likely are not very good on many fronts, this was my experiance.

D Case, Newquay,

To answer Dr Borrill

If someone is taken ill overseas the doctor may need medical history and exact current medication. This could be vital. I know of someone whose foreign attending doctor couldnt get thro to the surgery in UK on a 0844 number, therefore denying patient best care.

BT has ringback service for 15p. If line is engaged then you will get ringback. Much better than holding on a 5p a min 0844 number.
Surgeries deliberately disconnect their 01/02 number on insistence of NEG to maximise income. Absolute disgrace.

alan, middlesex,

I'd just like to say how gratefull I am that I am not one of Dr Borill's patients. Having had the experience of being injured abroad it was reassuring to be able to discuss the issues ( local op in 3rd World / fly home for private op / fly home and attend A&E) with my local GP on a regular BT landline.

Steve, Long Crendon, UK

I do hope that no-one would be quite so irrepsonsible as to adopt Giles Falconer's suggestion above.

James Booth, Chelmsford,

Given the free call packages offered by reputable providers - such as TelecomPlus or Utility Warehouse, dialling the normal surgery numbers doesn't cost the patient a penny. Now with the 0844 number, it costs money because it's not classed as a free number. How can they say it costs less because you're on the phone less??? Ridiculous, and another stealth cost. Not only do I now pay to ring my surgery, where I didn't pay before, I'm now in a heightened state of anxiety and worry over increased expenditure. Given GPs now earn over £200,000 a year, and still opt out of the 'Out of Hours' service, they earn far too much.

NRC, Oldham,

What a lot of fuss over so little. I remember a time when I could never get through to my doctor an dhad to wait minutes on the phone. Now I dial 0844 and I know my call is going to be answered. If I have any sense and the call is not urgent then I call later in the morning. I almost always get through and complete the call in 2-3 minutes - though I appreciate there may be occasional exceptions. This costs me 10-15p instead of 6-9p. Hardly a concern for most of the population. Also why do people never consider their own reponsibilites? "immoral". What nonsense. Do people really beleive their GPs sit down to squeeze money from their phone calls. I know of many patients who refuse to give landline numbers and insist on call backs to mobiles. I am sure these patients never think of the costs they impose on the NHS. Sending a letter is so much more expensive. Most patients may call their GP 2-3 times a year. I do this more often but retain my perspective. Do a report on abuse of services!

J Sahota, London,

immoral and unprincipalled

Edna, Blandford, Dorset

The massive rise in GPs salaries - no strings attached - has not resulted in a rise in productivity. No surprise there - anyone who has ever run a business could have told the government that simply paying someone up to or over their 'comfort level' is a strategy that only ever results in the recipient wanting to do less, not more work, to enjoy their new-found wealth. Our doctors see themselves as office workers: they do no out-of- hours work - that's given to locums - and home visits are virtually unheard of. If they also start charging the patients to make appointments, that will simply fit in perfectly with the general, offhand attitude we've come to expect. There was a time when doctors were much respected for their dedication and commitment, but there's little sign of that, now they're on their way to the Rich List.

sarah m, bournemouth,

0845, 0844 and 087 numbers are being used by many companies and now by GP's to rip the public off. I wrote a letter about these numbers to BBC working lunch ( consumers ) programm but they did not even bother to reply. I think Government must authorise OFCOM to enforce the ban of the use of all these numbers by all public bodies and all other private companies. These days we have to use 087 number even to get a spare part for an appliance. Why consumer protection agencies do not staret a campaign against these numbers?

M.Aslam, Harrow, United Kingdom

That is absolutely disgusting behaviour. Patients don't ring the doctor unless they absolutely have to.

ARK, Norwich, UK

If you're really sick, go to the hospital. If you're not really sick, go to work. If you're in between, go to bed.

Frank Upton, Solihull,

I'm thinking of getting an 0845 number installed at home. Registering the number with all my banks, building societies, do a load of online insurance quotes and quote my phone number.
When the phone starts ringing, and all their call centres start mithering me with products they wish to sell, I'll answer and tell them to hang on a second...
and watch the money roll in.

Richard Garland, Manchester, Greater Manchester

Not so long ago we could turn up for an appointment without booking, and therefore without any cost to the patient....!
At least we should be given the choice; to call a local number at less cost to the patient.

Rosalind Lister, London,

I have today spent 19 minutes on hold to the 0844 number of my doctor's surgery. This is on top of the 8 minutes I spent on hold last Monday and the 7 minutes I spent on hold last Wednesday. I then spent between 1 and 2 minutes making my arrangements. This huge telephony expense shows lack of consideration of the patients at a time when GPs are handsomely rewarded.

Felicity B, Cheltenham, Gloucestershire

Many surgeries have tried very hard to make to make it easier for patients to contact their doctors during their opening hours - i.e. 0800 to 1830 (monday to friday). Not every one needs to make an appointment, some need to speak to the secretaries some need results, some need to cancel their appointment "out of hours". Some practices also now allow Internet booking of appointments both in hours and out of hours. There is no income from these systems for GPs merely a chance to fund the extra service that the phone system provides. Many public sector services use these numbers. Instead of bashing GPs AGAIN consider asking why the phone companies charge so much for your calls.

Those taken ill abroad may have difficulty contacting the doctor back home on an 0844 number, as many foreign networks will not connect to them. We are not responsible for your health when you are on holiday in another country you are meant to call the local doctor, we also don't do international visits.

Dr Borrill, Midlands, UK

Rip off Britain at work again using the smokescreen which phone companies have used by quoting huge amounts of variable information about different charges. It works for the phone companies now it will work for the GPs. I detect the work of "managers" put in place to run a business and damn the patient.. Note the comment by DHM: If hospitals can fleece the patients why shouldnt the GP. These people are in the "care" industry, remuneration for GPs has gone up in advance of inflation but greed still drives some of them to further excess.

mike gee, bournemouth, uk

I have come to aconclusion that this country has become a nation of price whingers who donot want to spend asingle penny to help get an improved service. In our GP surgery we have had 0844 no. for over a year and I find the system works very well and i donot feel that I am being ripped off or taxed. I agree with DHM of chester. It is high time that these moaning minnies devoted their time to something constructive.

Gidwani, Maidenhead, Berkshire

They now have an answer machine at my surgery, so instead of a engaged tone, the call is connected only to inform you that the lines are too busy and to try again. So I am paying for the privilege of being told I cannot speak to anybody. It's a farce!

Dan, London,

Can we please put this in perspective, Firstly if you are call in your doctor from a mobile and your mobile phone company charges you 35 pence per minute for the call then it is the mobile company who are gaining to the tune of about 30 pence per minute as the charges to them for the call are still 5p. The same is true if BT charge you 13.95 pence from a payphone. It may be true that calls are shorter, it is true that for those with national inclusive call packages are excluded from having these calls free. However do any of those people who have these packages and object to calling their GP at 5 pence per minute think twice before calling their friends mobiles at 12.5 pence per minute (with Talk Talk for example). Also how much are we talking about 50 mabey 100 pence per month i'll bet if you work it out you loose more on your inclusive minutes package each month by noy using your minutes.

Edward, Suffolk,

Just another way to rip off the longsuffering taxpayer - GPs are extremely well rewarded for doing less work that they have in the past.

Now we are to be charged more...so much for... 'free at the point of access'...

Anton Muller, Wakefield,

What old days you could never get through, I have never rung my Doctors without taking half a day to get through and then you are always put on hold I spent so long on the telephone thet B.T.suggested it for my family and friends numbers. What B.T. also forgot to mention is the minimum amount per call I can call anyone for an hour for 5p on evening and weekends (when Doctors are closed) but If I talk for 20 seconds it cost 5p and don't for get the VAT. What it does is penalize the sick. Who has tried to live on sickness benefit, I think they think because you are sick you do not need everyday thinks like Gas, electric Water and a house to live in, you know what most of your money goes on!

June Hart, Hockley Essex, U.K.

08xx numbers are a racket. The so called 0845 local access numbers to 'save' money for callers is a nonsense for those with mobiles. Companies and organisations should be required by law to offer a national landline number if they have an 08xx number . To get through to my bank I have to use the international number on my mobile should I wish to call without charge. Does the bank know the issues this creates? Most definitely, but it is not in their financial interest to do anything about it.

Alan, Luton, UK

You can get around this problem by using the website "Say No to 0870" . This publishes the normal numbers that you can dial instead of the non-geographic premium numbers.

The link to the website is :
http://www.saynoto0870.co.uk/

Richard Wyld, Effingham, UK

If the calls last 2 minutes on average, that's a average of 10p.
How much does a second-class stamp cost?

Try and keep some perspective!

AF, Potters Bar, Herts

Probably the biggest user of these "revenue sharing" numbers, and certainly the one with the longest calls is NHS Direct.

With calls averaging 25 minutes it could cost 75p to call which will not be included in any calling plan

GJ, Swindon, UK

It's simple really....patients should have to give a landline number to be contacted by their surgery. Then the surgery won't be paying out as much on calls and won't need to go down the line of 0844 numbers.
Maybe they should also start charging for missed appointments but that's another issue for another discussion.

Helen, Midlothian, Scotland

Surely Ofcom must do something about this scandal. Doctors should not be forcing patients to pay for their new phone systems. By doing this using NEG doctors are forcing patients to pay many thousands more than the true cost and this is no doubt amounting to millions of pounds nationally. This is nothing more than a rip-off perpetrated by NEG and their doctors. It is a disgrace to the medical profession.

Mike Kelly, Reading,

No patient should have to pay a premium line to phone a doctor and no public service should have to phone a mobile (premium rate) number to contact a customer. The standard land line service is all that should be used.

jj, Cambs, uk

GPs and the iniquitous company NEG ARE "out to fleece their patients". NEG are out to make excessive profits out of sick people who are calling a health service. Calls to 0844 are always more costly. The public should be able to choose whether to call a premium rate or a normal number when calling an essential service such as a doctor.

Mike Kelly, Reading,

If I call a doctor’s surgery that uses normal telephone numbers (01 or 02) it usually costs 3p/min, but as I pay my phone company an extra £10 a month, all my 01 and 02 calls are “free”.
If my doctor was using one of those dreadful 0844 numbers, the call would cost me 5p/min at all times, and they would receive about half of my call charges as a extra fee.

I would change my doctor.

kevin kearney, Liverpool,

To say that the 0844 number gives the advantage of a single contact number is disingenuous. The same can be achieved with an 01 or 02 number.

PaulK, Thornton,

I think it is terrible that the GPs surgeries telephone area code will cease and we will need to use 0844 numbers which are more expensive. It is already hard for pensioners to manage on their limited income and they are the ones who need the doctors most. Not fair on the other people who live on shoestring budgets either. It should not be allowed.

Lee To, Swindon, UK

It is shocking that even GP's are now ripping off consumers by using these types of numbers. It certainly isn't fair !!

JB, Manchester,

Can I echo the earlier contributor and ask when the Times is going to do a story about the vast cost to the NHS of mobile calls?

Patients lack of a fixed line is costing the NHS millions as hospital secretaries, midwives, distict nurses and family doctors are forced to phone mobile numbers a huge costs compared to a local call.

I am also a GP and the costs of phone bills has risen more than any other cost in the last few years, mainly due to the large number of calls we have to make to mobiles.

Perhaps patients who do not have a fixed line should not expect to be phoned by their health care workers

Dr Trefor Roscoe, Sheffield,

My landline calls are free as I subscribe to Option 3. I pay 2p per minute to call one daughter in Hong Kong and 1 p to call another in Canada. It seems ridiculous to have to pay more to call my doctor down the road.

Stephanie McKenzie-Hill, Uckfield,

I pay a flat rate of £23.49 a month which gives me all 01 and 02 numbers 24/7 and includes the phone line rental. It used to be a good deal. Now more and more companies use 0870, and 084 numbers, and I have to pay for these calls on top. Why do they do it? There is only one answer. Greed.
Doctors should not be allowed to use these 0844 numbers. If I phone my surgery, which is an hour's walk away, it is only because I have to. There is no bus going there, and I don't own a car. Incidentally my surgery hasn't treated me in the past 3 years at all. Do they refuse to collect the allowance they get for having me on their List?

Beryl, WINDSOR, England

Sorry, but I couldn't understand why the change of numbers have occurred: were the doctors offered new mobile phones with the new prefix?

Bernardo, QUELUZ, Portugal

So why do GPs do it?
As the article states, the GPs pay for the installation of the system. This will run to thousands, so any suggestion of GPs profiteering from this system seems misplaced.
Maybe, just maybe, they are trying to provide their patients with better access to the surgery by phone.
I guess we could always go back to the old days when you could never get through. I suspect the same people moaning now were moaning equally vociferously then.

Simon, Poole,

The use of 0844 without providing a geographic alternative number is truly a scandal. It significant that Ofcom say "that use of the numbers by public sector bodies was “not appropriate” and there were cheaper options".
Surely, doctors must be compelled to provide an alternative geographic number to 0844 - otherwise this is another stealth tax on the public and a tax on the old and sick in particular!!

Mike Kelly, Reading,

Absolutely unacceptable.

Michael Harding, Tenterden, Kent

"Scott Russell, of NEG, said that patients calling the Surgery Line system spent two minutes on average on each call, compared with 5½ minutes before."

It will be of interest to have the full explanation for this reasoning. Many surgeries will only take appointment bookings at certain times of day and it it takes many attempts before a connection can be made. I cannot see that patients will spend any less time on these calls because of the prefix change.

Alan Challoner, Llanerchymedd, Wales UK

My surgery uses a normal local call telephone number. However the greatest rise in practice utilities over the last 5 years has been telephone calls because patients increasingly use mobile phones instead of land lines. GP's are paying premium rate to call patients on mobiles. Ofcom says that public sector shouldn't use 0844 numbers, but
GP's are encouraged by the Department of Health through the quality and outcomes framework to have a single access number for emergencies. The 0844 system allows this as calls can be automatically diverted out of hours to the out of hours provider without the need for an answering machine and the patient making a second call. Having just spent £12000 on a new phone system and an annual phone bill of similar size I resent the portrayal that GPs are out to fleece their patients. If hospitals can charge premium patient phone and car parking rates why shouldn't GPs be able to marginally offset the costs of a single access number which improves safety

DHM, chichester,

One way to get action taken over this immoral practice would be for all those whose surgeries adopt 0844 numbers to use the (free) 999 number instead - my guess is that a determined campaign along these lines would provoke the authorities to ensure all surgeries used normal, cheaper, numbers instead.

Giles Falconer, Sleaford, Lincolnshire