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Blog: Friends and Family test will ‘do more harm than good’

1 August 2013

Although the Friends and Family test is a simple way to gain feedback from patients, Dr Brian Fisher, NHS Alliance‘s personal and public involvement lead believes it’s not the best way. He offers ideas on how it can be improved

This week saw the release of the first friends and family results. I don’t deny that the test does sound like a good idea; a simple score to rate an NHS organisation by patient feedback. But this is one of those attractive ideas that will do more harm than good.

Designed by industry for the private sector

The Friends and Family is a measure of brand loyalty. Would you use Adidas rather than Nike?  If patients really do have choice, it may only apply in cities. As Roy Lilley says: “In industry the FFT is seen as useless unless accompanied by a good ‘voice of the customer’ programme and the ability to dig into customer experience dynamics.  Something the NHS does not have.”

It asks the wrong question in the wrong kind of system.

Relying on a single measure is dangerous

We now have ample experience that NHS organisations are excellent at many things. Treating patients is their forte, but gaming measurements is another hard-won skill. The set-up for the test makes it rather easy to manipulate. As it is taken close to the hospital stay, or even while the patient is still in hospital, opinions are likely to be positive – and there may well be ways to make it even more so.

Results are likely to become increasingly unreliable.

We need nuanced feedback

A single inappropriate score imposed from above tells us very little. It will look as though we can compare wards or hospitals, but the data has very limited value. For patient feedback to be useful, we shall need to supplement the FFT with more information.

Patient feedback to the NHS needs to become its lifeblood

Finding a way to do this well is vital to the health of the NHS. We have seen time and again that listening, understanding and responding to patients’ voices results in more appropriate, safer and more compassionate care. We do not need yet another disaster to remind us. We need proactive dialogue with our patients now and in the future.

We can do this better with less demand on staff

Reports from around the country tell us that managing the FFT is taking up a great deal of valuable time. The FFT will be coming to primary care soon and we need to ensure that good data is collected simply and efficiently. We can do this by using our sophisticated electronic base and ensuring that we add some simple but searching and relevant questions to the FFT. And making sure that we have an opportunity for the patient to tell us things in their own words – a space for free text.

Place within QOF

We can ditch many of the QOF questions – we are not practice automatons. Make patient feedback central to general practice quality in a simple and effective way.

We can make this work for practices, hospitals and patients if we take a little time to think this through. Let’s take this opportunity.

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