The Friends and Family Test will be a contractual requirement from October 2014. The test question will be: ‘How likely are you to recommend our practice to friends and family if they needed similar care or treatment?’
It looks simple and straightforward. But it isn’t.
It comes from the corporate world as a measure of brand loyalty, and is not actually designed to enable organisations to improve the care they offer to patients. In fact, of course, it isn’t designed for the NHS at all.
It is not useful for the NHS as it doesn’t tell us much about quality of care, nor is it helpful to inform patients.
Hospitals currently using it might have thousands of replies, but the test doesn’t actually advise them on how to improve the system based on this feedback. It looks them blankly in the face if the score is low.
The dangers for general practice in a worst case scenario are, if we just use the FFT as it is currently imposed, loss of GP morale, poor advice to patients about the quality of local GP care, misrepresentation of GPs, and loss of income following loss of reputation (or unworkable numbers of patients joining a practice that apparently performs well). We are not B&Bs – bad reviews affect NHS patients as well as NHS surgeries.
Rapid honest and clear feedback to practices should and could be an important driver for improving care and making life better for patients and practices. But only if the feedback is useful and shows the direction in which we need to travel.
The FFT should not be used on its own in a GP setting, and adding one original question to the questionnaire is not likely to transform the exercise into a useful one. Additional questions may be poorly-designed, or shaped to obtain a predictable response – making the test a meaningless waste of GP time.
NHS Alliance has worked with iWantGreatCare to develop a supplement of validated questions to provide meaningful feedback, and the questions are already available. Patient responses are logged and published anonymously on a website that covers all local GP practices. Feedback on individual GPs from the validated questions can be used to meet development, appraisal and revalidation needs. All feedback is monitored to prevent gaming and system abuse
But ultimately, the BMA should renegotiate the obligation to do the FFT. GPs deserve better. We need to embrace the idea of rapid clear feedback – but in a way that we can understand and harness for better care. The BMA should renegotiate to ensure a more relevant and appropriate approach.
Dr Brian Fisher is a GP in south east London, and the patient and public involvement lead for NHS Alliance.