By Dr Adrian Midgley, GP in Exeter. 1999.
A new service about to be generally available on telephones could lead to problems for GPs. Practices and co-ops need to act now to avoid them.
Anonymous Call Rejection (ACR) is an offshoot of Caller Line Information (CLI) which is generally well-known and used, and has some potential to both save and cause effort itself.
ACR takes the information that CLI gives the exchange about what telephone is calling, and allows a customer who chooses it to reject all calls where the CLI is withheld. Very useful for anyone plagued by nuisance calls, since this will stop many of them, and identify the others.
Many surgeries and Co-ops block CLI on all their outgoing calls, by arrangement with their Telephone Service Provider (TSP). In this case they can release it for an individual call by dialling 1470 before the phone number.
Some larger organisations have their own switchboard and have set the switch up to block CLI on all calls. This may not allow telephone extensions to over-ride the block.
ACR is intended to reduce nuisance calls, by allowing the recipient to only receive calls that declare where they come from, and therefore being able to trace directly back. "Would you open your door to a man in a balaclava?" ask it's proponents.
Perfectly legitimate reasons for blocking CLI include where a line is for outgoing calls only, so anyone calling back on it would not be answered.
John Clegg, practice manager in Nailsea near Bristol said "after CLI was introduced, we soon began to get people who had dialled 1471 when they came home calling the front desk and saying they had been rung while they were out, who was it? There are 50 people in the surgery, it could have been any one of them. We disabled CLI. The chaos and confusion it caused were most unwelcome".
Having heard about ACR he says "I shall hold out with CLI withheld until it is withdrawn. "
Similar arguments apply to co-ops.
GPs calling from home are likely to dial 141 to block CLI on calls to many patients. They might also choose to use ACR when it is available.
The most obvious potential problem arises when a patient calls and is told the doctor will call back - common among co-ops. If the co-op has CLI blocked and the patient has ACR enabled, then they will not connect. A synthesised voice will give the message "The subscriber does not accept calls where the originating number has been withheld". Among the choices available are redialling with CLI released, or making a call placed by the operator at additional expense. Or of course releasing CLI on all lines and mobiles to avoid this. It might cause a doctor in a hurry with a patient who appeared to be seriously ill a lot of stress.
Releasing CLI on all lines can lead to real problems, however another service is due for introduction,
By arrangement with the TSP it is possible for a telephone line to send as CLI another number. This would allow a co-op for instance to release CLI on all the phones used by doctors or triage nurses to call patients, but send the main Co-op phone number, thus routing return calls to where they should be.
No TSP in the UK is known to advertise presentation numbers yet, and LMCs might consider lobbying for GPs to be allowed to use the surgery number as a presentation number for their home phone or mobile.
In the near future mobile phones capable of using two of the SIM cards that give them their identity, including their line number will appear. One SIM could be for on-call, and another for normal daily use.
GPs who conclude that they must release CLI on their home lines might take this as a prompt to install that second line, using one as outgoing only, and even setting up with the TSP an announcement that the line dose not accept incoming calls. Installing Home Highway ISDN and using one line mainly for Internet surfing and logging on to the practice seems almost tempting.
Another service in the offing is the ability to instruct the exchange never to accept any call from a particular number. BT envisage this being used for double-glazing salesmen, and perhaps for other nuisance callers. It means that one has to take the first call, but can then dial a code that tells the exchange to add the last number that called to a list to be rejected in future. BT appear to only be planning to offer 10 places on the list, and perhaps this would need to be increased.
There are obvious pitfalls for doctors, in that however abusive a caller was and even if they are removed from the practice list, there is no guarantee that there is not now, or will not be in the future a patient at the same number who has a reasonable expectation that their call will be answered. However, several firms will go straight on the rejection list for my home when I get the facility. I do not think GPs can really use it at the Practice.
Published in Doctor, put up as acr1.htm in Sept 1999
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