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CCG leaders doubtful over extending Friends and Family Test to GPs

CCG leaders are sceptical about the Government’s plans to roll out the controversial Friends and Family Test to primary care, warning that its findings could be used to ‘beat up NHS staff’.

The test, which asks patients whether they would recommend the care they receive to family and friends and is already in use for hospitals, is to be rolled out to all GPs by the end of next year and could form part of a future GP contract.

It will also form the basis of 12.5% of the quality premium payments to CCGs, who will have to demonstrate what action they have taken as a consequence of the feedback.

The first results for hospitals, published this week, suggest patients on 36 of 4,500 hospital wards in England would not recommend them to relatives. However, the test has been criticised for a lack of methodological rigour and NHS England has itself warned that low response rates may have undermined the test’s value as a way of measuring feedback.

The chief methodological flaw, according to critics, is that the test does not take into account differences in types of patients or the treatments offered between organisations.

GP commissioning leaders told Pulse they had doubts over the test.

Dr Huw Charles-Jones, chair of West Cheshire CCG said: ‘I do share the concerns that are being raised about the sampling methodology and whether it is an accurate way of gauging patient experience. Having said that, the fact it is being carried at all may improve “customer” service.’

‘The methodology may be better for general practice where patients will not just be rating a one-off experience, close in time to that experience, but will be influenced by their longer term perceptions of the care they receive.’

‘The test might be simple but it is not the complete answer. I worry that politicians will get hold of it and use it to beat up NHS staff when what they actually need is more support, praise and resources.’

Dr John Ribchester, Canterbury and Coastal CCG’s GP commissioning lead and a GP in Whitstable, said he thought the Friends and Family Test should be treated with caution: ‘It’s a bit black and white. For instance, what if the patient’s expectations were unreasonable in the first place? What if staff illness or medical emergencies meant a patient had an unusually poor experience.’

‘A bad day in a general practice does not imply the practice itself is bad. However it may lead to a “not recommended” comment from someone whose only attendance that year was during a difficult spell.’

He added: ‘A lot of complaints about general practices do not revolve around the medical care, but around the access.’

Dr Elizabeth Johnston, chair of South Reading CCG, said getting patients’ views of their experience was a good thing: ‘When looking at quality, we want to use multisource feedback, so the Friends and Family Test will a useful tool in this.’

But on rolling the scheme out to GPs she said: ‘We already have a patient survey - which we use to develop and improve services. I’m not certain if the Friends and Family Test will replace this.’

Dr Niti Pall, a member of the governing body of Sandwell and West Birmingham CCG and a GP in Smethwick, said the Friends and Family Test - if used “correctly” - could be a useful tool, especially at a local level.

But she was sceptical about rolling it out nationally to GPs: ‘The Secretary of State is implying that GPs aren´t doing this kind of work and effectively that he is a knight in shining armour. But the fact is that a lot of GPs are already doing this and no one has asked us. I don´t know if it´s going to be very useful done at a national level.’

Dr Michael Dixon interim president of NHS Clinical Commisioners said the basic concept of the test was good, but the implementation was ‘flawed’.

He said: ‘The test doesn´t give enough detail or granularity. What patients think is only part of the picture. For example, they might tend to judge badly - and unfairly - practices that don’t give them what they want. So there have to be caveats and provisos.

‘I have no fears about it being rolled out into general practice provided we get the questions right - and they’re not right at the moment. They need to be not only: “Would you recommend this practice?” That´s quite useful - but only as one question among others. We need to know whether it´s the car parking or the clinical competence they like or dislike about a surgery.

‘The NHS Alliance is working on an improved version that should give a more complete picture. CCGs are an entirely reasonable choice to monitor the results because they are best placed to work out whether they suggest a practice is really failing or whether the results don’t fairly reflect the practice´s performance.’

 

Readers' comments (1)

  • I am still struggling with the "explanation" given by spokesman from King's Fund the other day that only "strongly agree" counts as a recommendation. "Slightly agree" counts as neutral and "no opinion" (which in the real world I would class as neutral) is lumped in with slightly or strongly disagree and interpreted as a negative comment.
    Patients are likely to be using language in the generally accepted sense when answering the questions - why should results not be interpreted in the same way?

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