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The Government must not ignore the CQC's criticism of the Friends and Family Test

Like the introduction of the 111 phone line and telecare services, the Government’s bullish attitude to the Net Promoter Score seems to be an example of ‘policy-based evidence’ rather than ‘evidence-based policy’, writes Dr David Jenner.

It is extraordinary that the Government has chosen to ignore research conclusions commissioned by the CQC, over the inappropriateness of the net promoter score (popularly known as the ‘Friends and Family Test’) for rating NHS services.

Despite a clear consensus from the research work against using the test which patients found confusing, and the suggestion of a more suitable alternative as defined by cognitive testing, the government intends to proceed with the implementation of the net promoter score across the NHS, and even align financial incentives to it in the CCG quality premium.

The study’s authors found that the term “recommend’ was not favoured by patients in relation to NHS services, and as the net promoter score relies on this key word, it could not be seen as advisable to use it to rate NHS services.

This again, like the introduction of the 111 phone line and telecare services, seems to be an example of ‘policy-based evidence’ rather than ‘evidence-based policy’.

It also raises serious concerns if the Government chooses to ignore recommendations from its own appointed regulator of services - the CQC - as to how they should be measured, and indeed feedback from patients themselves as to who they would like to be involved in rating their NHS services.

The problem with feedback

There is a real problem with patient’s surveys. Unless they are constructed correctly, the answers they produce will be invalid and there will be “rubbish in, rubbish out”, with any subsequent errors being further compounded by aligning financial premiums to the results.

The chief medical officer and chief nursing officer should give a clear narrative as to whether and why they support the use of the net promoter score, otherwise healthcare professionals who continually strive to follow evidence based guidelines might be disenfranchised from owning and responding to the results of this test.

But if they have doubts about the test they should say so - it is their professional duty to do so.

After all, I don’t think it can ever be that simple to rely on one test to measure patient’s satisfaction or experience. More detailed surveys and structured interviews will be needed in the future to give a description of the patient’s experience of services and how they can be improved.

Dr David Jenner is a GP in Devon and the general practice network lead at the NHS Alliance. He is also chair of the eastern locality board of Devon CCG but this article does not reflect the view of the CCG.

Readers' comments (2)

  • The research referred to did not test the Friends and Family Test as it now stands, which has been improved from the original Net Promoter Score in three ways: (1) Adding the term "if they needed similar care or treatment"; (2) Adding a framing statement; (3) change from 11-point uncategorised response scale to 6-point categorised response scale.
    The guidance also makes very clear that users should add follow-up questions. In my view these should include severity, because more ill patients report having poorer experience, as well as promptness, communication, kindness and organisation. In large volume free text can become very time-consuming to analyse.

    Tim Benson, Routine Health Outcomes Ltd.

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  • Tosh!

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