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Does the Friends and Family Test offer any tangible benefits to GPs?

Dr Emma Lees


Last week I got my laptop fixed. A dashboard by the exit of the store flashed up three smiley-face buttons, with the words ‘How did you rate your customer experience today?’. I hit the green smiley face and left, feeling genuinely pleased that I had the opportunity to give positive feedback. Consumer evaluation is commonplace in the commercial world, but as much as I value patient satisfaction, I don’t want any smiley face buttons outside my consulting room.

The Friends and Family Test (FFT) can easily be seen as yet another irritating contractual requirement, but the optimist in me is searching for a silver lining. Most practices already exercise service improvement by reviewing complaints and feedback, through patient participation groups or with good old-fashioned comments boxes – surely this isn’t so different.

Compared to other contractual requirements, doing the FFT, is relatively low-effort. There is no minimum threshold for the number of completed tests submitted and no punitive measures for those performing less well. Practices are provided with the opportunity to take note of the feedback and try to improve.

The real value of the test, however, seems to be in the free-text box that follows, where patients can make suggestions or voice complaints. Feedback collected from the test is a more accurate reflection of quality than some other measures such as a CQC inspection. Practices are urged to reach out to the full spectrum of their population, which should give a more inclusive measure of our work than traditional methods measure.

In addition, despite the relentlessly negative portrayal of our profession in the media, most patients value and appreciate their GPs and this positive feedback may well boost morale among practice staff.

It may also become the impetus for change that matters more. Since it was launched in inpatient and A&E departments last April 2013, lots of cheap and simple ideas suggested by patients in the free text section of the test (such as having Marmite on the breakfast trolley or soft-close bins on wards to reduce noise at night) have made dozens of hospitals better.

And whether we like it or not, the test will soon be upon us. It could be worse: at least there are no smiley-face buttons involved.

Dr Emma Lees is an honorary clinical research fellow at Imperial College London and a GP registrar in Surbiton.


Dr Tracey Vell 330x330 online


The requirement for us to do the Friends and Family Test lacks evidence, needs a revised format and will be unhelpful to both patient and GP.

Since the FFT went live in April 2013, it has had no statistical significance and is merely an opinion of a user at a particular point in time. Yet we are told it will assist decision-making about services in a practice.

The question itself is totally unreasonable. How likely are you to recommend our GP practice to friends and family if they needed similar care or treatment? commands possible answers including ‘Extremely likely’ and five other options. But GPs know as well as anyone thatsome parts of the population will never answer ‘extremely’ anything. It is weighted so that three negative answers count against you.

Patients currently have much more effective pathways to share their opinion via PPG, dialogue with practices, Healthwatch, local CCGs and boards where they are represented. 

The publication of results of poor-quality monitoring processes does disservice to the general public. We also see the un-vetted personal opinions of patients displayed on NHS Choices and they serve to remind me of the conflict of patient want and demand.

But perhaps the most important problem with it, is that it sits at the heart of the conflict between opinion and evidence. For many years, GPs have tactfully fulfilled gate-keeping roles and patient relationships have been maintained. But there is now a pendulum swing, due in one part to the Government unleashing the desire to yield to patient want.

GPs are increasingly pressed to avoid unnecessary admissions, to take on more work and be more accessible. In these daily situations we know we balance demands of the patient and their increasing abilities to complain against the needs of the evidence. But a weighted ‘evidence’ of public opinion against the practice, however small in numbers, will have its voice heard.

The FFT offers no tangible benefit to GPs, and having a decision of ‘Extremely Likely’ or ‘Likely’ dictating the future of a practice has bound us on a path of destruction. Can we hold on to the principles of our practice or should we now consider a smiling mediocrity? Surrender our job satisfaction for job security?

These decisions are set to destroy the health economy as they lead us down a path of patient want, leading to increased referral, investigation and prescribing.

Dr Tracey Vell is the honorary secretary of Manchester LMC and a GP in Rushholme.