Telephony

There are three telephony requirements in the contract

1. The practice telephone number can’t start with 087, 090, 091 or be a mobile number starting on 070. (Calls must not cost the patient more than a normal local call). (Clause 7.3)
2. Patient who calls the patient out of hours should be able to get (via an answerphone message normally) the details of the out of hours service provision.
3. The new requirement that “the contractor must ensure that any new contract or other arrangement relating to telephone services used by—(a)patients to contact the contractor’s practice for a purpose related to the contract; or (b)any other person to contact the contractor’s practice in relation to services provided as part of the health service, is with a supplier specified in the Advanced Telephony Better Purchasing framework.”.

Recording calls

Please find guidance on Londonwide LMC site around the recording of calls

• Informing patients about your practice recording income and outgoing calls

The GMC & MDDUS also have some guidance on recording calls

• GMC – Recording telephone calls
• MDDUS recording patient calls

Internet service/lines

The ICB is currently rolling out SD-WAN and Wi-fi networks across practices.

Once these are in place it will be possible to run your cloud based telephony across these, which will avoid the need for the telephony provider to install an additional internet connection.

We would recommend you liaise with the ICB around this installation and ensure that any telephony provider you engage is aware of their ability to use these. This should save the practice the ongoing costs of an additional line rental.

If you already have a cloud based telephony solution it may be possible for them to move their service to the SD-Wan once it is installed.

Phone numbers

The framework required the providers to be able to port your existing telephony numbers across so your phone numbers should not change and there should be no patient comms required. (Unless you are changing processes because of the additional functionality/capacity.)

Cloud Based Telephony

Cloud based telephony is in its simplest terms a digital phonecall. The VoIP services convert your voice into a digital signal that travels over the internet, instead of down a phone line. There is a real deadline to move to cloud based telephone, separate to your contractual requirement, as analogue lines (PSTN) are being phased out by 2025.

The additional requirement with the GMS contract change is that NHSE have specified that when your contract expires you need to move to a provider on the framework. This means that you can no longer pick any telephony provider, it has to be one from the approved list.

There are currently only a few providers on the framework but this is expected to grow so we would recommend not rushing into a contract change until there is greater choice.

If your contract with your current analogue provider goes past 2025 (or if you want to transfer sooner) then funding from NHSE should be able to assist with any exit fees.

Funding

In the Recovery Plan NHSE promised additional funding to assist with the transition. The ICB have to bid for this funding and are in the process of doing this (June 23). The success of this bid will determine what proportion of costs they can fund.

Currently the Recovery Plan implies that the funding is for the transfer from analogue systems to cloud-based telephony. If you are already on a cloud-based telephony system and want to change suppliers, it is possible you will not be able to access the funding.

The funding should cover: –

• exit fees (or a contribution towards them) if you are looking to change to cloud-based telephony before your current analogue contract expires. Note: there is no contractual requirement to move before your contract ends, and if your contract goes beyond 2025 it is likely your provider will move to some form of digital line when the analogue lines are phased out. However, if they do not join the framework you will need to transfer when your contract expires.
• one off implementation costs of cloud-based telephony (or a proportion of these). This may include any infrastructure costs around upgrading cabling or installing lines, as well as any handsets required. As there is no server required there is less infrastrucutre than analogue systems.
  • Please note companies take different approaches to their charging. Some charging a one-off set up fee, others incorporating any set-up costs into the lifetime of the contract with a higher monthly fee. If you are looking to take advantage of NHSE funding, you should ask the companies to separate the costs so that you can take advantage of the funding offer.

As the funding is only expected to cover one-off set up fees it is unlikely that it will cover the adding of any additonal functionality to existing contracts as these are likely to be ongoing monthly charges.

Please do not rush into any new contracts until the funding has been agreed as the ICB have been told by NHSE that the funding cannot be used to retrospectively reimburse costs for any practice who have already entered into a new contract.

Specifications on the Framework

The framework looks to provide suppliers which can provide “advanced GP telephony systems built around cloud-hosted Voiceover Ip (VoIP) systems, which include clinical system integration, remote access and peak demand management capabilities.”

The framework will be built around the following Capabilities:

• Auto-attendant and interactive voice response (IVR)
• Call reporting and forecasting
• Call recording
• Office telephony
• Rule-based call routing.
• Integration with the clinical system
• Call-back options

(See page 14-19 of the Support pack for the full list)

However, as long as practices use someone on the framework, they are free to select which of the functionalities they wish to utilise.

There are benefits to each of the functions but not all may be suitable for your practice.

Also bear in mind that although there is NHSE funding to assist with the one-off set up costs of setting up cloud-based telephony the ongoing monthly costs will be the responsibility of the practice, so consider the ongoing costs of additional functionality. (The ongoing costs of telephony are felt to be covered with your global sum funding).

Take into account how any new system may enable greater home working, the flexibility of call routing to deal with peaks and troughs in demand, and the ability for any number of clinicians to be making outgoing calls without tying up the incoming lines. Think through how your workflow within the practice could be changed to be more effective and plan the phone system around where you want to be rather than where you are now.

The NHSE support pack details some of the considerations to be reviewed when determining what specifications you need. (Support Pack on NHS Futures)

Recovery Plan Ambitions

The features detailed in the recovery plan are from the analysis of a pilot. It is not contractually required to have all of these. The providers on the framework should be able to support these features but your only requirement is to use a provider on the framework, not to utilise all possible features.

The features mentioned in the recovery plan are:-

• queuing: enables practices to manage multiple calls, patients are notified of queue position and wait time, and never get an engaged tone
• call-back: patients have the option to be called back when they are higher in the queue
• call-routing: supports directing patients to the right person or team (eg a medicines team serving the whole PCN)
• integration with clinical systems: allows practice staff to quickly identify patients and find relevant information with less searching.

Business Continuity

Do ensure you consider business continuity and how calls will be routed if the practice loses power or internet connection. There need to be processes in place to avoid patients queueing when no one can answer the calls.

PCN considerations

Practices should talk to the rest of their PCN and consider if, or how, they may wish to work together to manage phone calls across the PCN, or direct calls to ARRS staff based at other sites. If the PCN has any ideas about managing calls across the PCN then they may wish to consider all using the same provider to enable this.

The Recovery Plan references the Fuller Stocktake action to look at how urgent care is managed and they recommend that PCN’s use the same provider and states that ICB’s may want places or whole systems to do so. Currently our ICB has not voiced any plans to manage urgent care calls in a way that involves general practice, and they are not stating that you should all be with the same provider.

They are currently supporting the WaveNet roll-out but you can choose another provider. (Please see Telephony Procurement channel in the All Staff NW Primary Care team)

Currently telephony contracts are individually held by each practice and therefore they cannot dictate which provider you use (beyond your contractual requirement to use someone on the framework).

Benefits

Cloud-based telephony does bring many advantages, in call-direction and call-queuing etc. (detailed in the support pack Annex D) However, it is just one tool and on its own will not change demand or capacity, you still need staff to answer the calls and appointments to give them.

The data the reporting tools provide may assist you in flexing your resources to enable more people to answer phone calls during peak periods. It may also allow you to have incoming calls ring through to more staff during peak times by utilising the benefits of a cloud-based system which is not tied to specific incoming lines.

References

Modernising Primary Care Telephony – Health Innovation network

Advanced Telephony Better Purchasing framework

Advanced Cloud Based Telephony for General Practice Specification Commissioning Support Pack on NHS Futures