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Practices being given lower positive scores than they deserve under Friends and Family Test

Exclusive GP practices’ positive ratings are being undervalued under the Friends and Family Test because of the way the data is being published by NHS Choices, it has emerged.

Pulse has discovered that patients who answer ‘don’t know’ when asked whether they were likely to recommend a GP practice are being counted negatively, which is distorting the overall picture, GPs say.

NHS England has said that it will continue to publish the data in this way, but will update the explanatory text on NHS Choices to explain the methodology.

But the GPC has said that practices with newer patients are likely to lose out through no fault of their own, and this anomaly was a ‘good example’ of why ‘crude data’ was not a good way to compare GP practices against one another.

When published on NHS Choices, results are presented only as the percentage of all patients surveyed who said they would recommend the practice.

This means that people who answer ‘don’t know’ are lumped in with the people who actively said they were ‘unlikely’ to recommend the practice, giving the impression that they themselves had actively said they were unlikely to recommend the practice.

However, Dr Roger Neal, GP partner at the Surgery in Henlow, Bedfordshire, who first raised the issue, said that the publication for the month of May had indicated only 52% of patients would recommend his practice, despite only one out of 21 patients surveyed saying they were ‘unlikely’ to recommend the practice.

He said this was likely due to ‘extensive new house building’ within the practice’s catchment area, as well as covering a nearby airforce base with a lot of transient patients, who are more likely to say they did not know whether they would recommend the practice.

He told Pulse: ‘Such patients therefore have limited experience of using our practice and are more likely to respond as ‘don’t knows’ to such questioning.

‘But the rub is that NHS Choices appears, worryingly, to use the ‘don’t knows’ within their calculation of recommendation as a negative response. This is a grossly unfair simplification of the statistics. If you exclude the “don’t knows” we would get 68% recommendation.’

Before the FFT launch in practices last December NHS England said the publication of scores ‘should provide morale boosting feedback’, however Dr Neal said: ‘My staff and I are failing to have our “morale boosted” by the FFT.’

The GPC, which criticised the FFT before its rollout due to the added bureaucracy, said this showed the limitations in the Friends and Family Test approach.

GPC chair Dr Chaand Nagpaul said: ‘The FFT and similar surveys have to be looked at in context. One of the greater limitations is simply looking at crude data for comparison purposes is that it lacks context. This is a good example where clearly the results of the FFT is going to be influenced by the fact that a large number of patients have yet to be able to familiarise themselves with the practice, and be able to comment on whether they feel they would recommend it or not.’

In a statement, NHS England said GPs had the opportunity to contextualise their data on their own practice website but it had settled on this ‘simpler presentation’ because many people had found a net promoter score ‘unhelpful’.

However the statement also said NHS England is ‘aware that the explanatory text on NHS Choices needs to be updated to make it clear what the data means’ and that it is ‘working on putting that in place within the coming weeks’.

A spokesperson said: ‘We also show the number of responses that the percentage is based on so patients will get a sense of how representative the numbers are. The number of “don’t knows” is, in most cases, a very small percentage and would not normally make a big difference to the overall perception of a service’s FFT data.

‘By far the majority of patients across the NHS who complete an FFT questionnaire - around 9 out of 10 for GPs - tend to express a positive view. ‘

Readers' comments (19)

  • pure misuse of data

    deliberate malignant and malicious

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  • "Anonymous | Work for a pharmaceutical company | 05 August 2015 9:31am

    deliberate malignant and malicious"
    Neatly summarises Jeremy Hunt, NHS England and DoH.

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  • Why so coy about revealing number of "don't knows" when so much data is being thrown out there "in the interests of transparency"? Alternatively, publish the numbers who would actively not recommend the practice along with those who would and let people apply their own interpretation. Partial data like this potentially worse than none at all.

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  • GPC chair Dr Chaand Nagpaul said: ‘The FFT and similar surveys have to be looked at in context.'

    I'm sorry but why is GPC as ever taking such a soft stance. If a person or commercial organization is publicly criticised unfairly, they would not be saying "it has to be looked at in context". They would be asking for a full apology and claiming for damages.

    Oh well, I suppose receiving honors does mean you'd have be careful what you say. Just remind me who does Dr Nagpaul work for? GPs or Tories?

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  • Why not use the GP survey results, which are conducted with a degree of standardisation, instead of friends and family which have no such process safeguards and low numbers of responses.

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  • The government needs to stop micromanaging. Allow the market rules of supply and demand to take effect and practices will soon sort themselves out or shut. Simples!

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  • IMHO this is quite simply statistical ineptitude.

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  • Allow all those worried-well and demanding patients to rate a surgery and you have a toddler running the household. Really bad.

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  • Why bother to play the stupid game at all? The DH hates the fact that most people think we still do a good job against all the odds. No real life patient makes a decision on the basis of the NHS choices website and most of us have more than enough real work to do. If you must, do the minimum to get whatever trivial money's on offer - if it's worth the time and effort (which I doubt) - and then say sod it.

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  • "Anonymous | GP Partner | 05 August 2015 9:57am

    I think it is clear to the majority, that [Chaand Nagpaul] and the rest of the GPC certainly aren't working for GPs.

    That Chaand can't even see what is so wrong about accepting a reward from the Govt for being a good wee boy shows how totally out of touch and out of their depth the GPC members are. In my opinion his acceptance of the reward should have led to overwhelming calls for his resignation for conflicting interests.

    Bob Crow, the union leader who got such good pay and conditions for tube drivers, was not given a gong for "services to tube drivers". I wonder why? Answer - because he was a pain to the Govt. You only get a reward if you are nice to the Govt.

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