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Friends and Family test – time for change?

by in Friends and Family Test, Resources, Surveys

It seems hard to believe, but the NHS Friends and Family Test (FFT) patient feedback tool is five years old. Incredibly, the short feedback request has, over that time, pulled together more than 50 million responses from patients. As it stands, the FFT is one of the largest collections of patient voice in the world.

While numbers like this are clearly impressive, it becomes nothing more than a vanity project unless the collected data is acted upon – something that Clare Enston, NHS England’s Head of Insight and Feedback, says is happening.

“Feedback is more complex than 50 million ticked boxes,” Clare says. “We know now that the act of giving feedback can be a hugely complex step for patients, depending on how well a person is, the timing of when they might give feedback, what they want to say, whether it reflects a good or bad experience, how continuous their relationship is with the doctors and nurses, and whether they want to be identifiable or not. Given all that, not listening to what’s really being said – even if only said by one person – is to miss the point.”

Clare goes on to say that the FFT really comes into its own when it’s embraced at all levels of the NHS. Within practices, the feedback is being used to successfully drive conversations with partners, within teams, with patients and with wider service partners as there’s more integration of care across multiple providers.

“FFT, for us, is not a tick box exercise – it has been a game changer, particularly when staff have seen it as more than a data collection activity,” explains Clare. “Over the past five years we’ve seen great examples of how teams across the country have made real and impactful change by the simple and respectful act of listening to what their patients have told them and taking action.”

Clare also suggests that practice managers should be making the most of the patient voice, for multiple reasons: “The staff recognition awards that have sprung from the celebratory and thankful comments about individuals and teams also points to the potential of the patient voice when it is intricately linked to how the NHS goes about things. We could do more of this. We should do more of this.”


Of course, the FFT hasn’t been free from criticism. News from time-to-time has highlighted falling response rates, which critics say is because the questions are poorly thought-out and, in many cases, irrelevant. Others point to the cost of bringing in third-party firms to manage the feedback.

Nigel Sparrow, the Senior National GP Advisor and Responsible Officer at the Care Quality Commission, addressed the issue in number 16 of the CQC mythbuster series. He said: “I believe that it is important to emphasise that the value in the FFT lies in the free-text comments that are provided by patients. This provides practices with real-time feedback which can be actioned.

“FFT results in the form of the percentage of patients recommending a practice will be published transparently on the NHS England website and on NHS Choices. This data is not statistically comparable in the same way as the GP Patient Survey data. So please use FFT to inform lines of enquiry and judgements, while being mindful of its limitations as well as its benefits.”

“I would, however, encourage practices to look at their FFT results alongside other sources of data and to look at how their results change over time. By acting on the feedback provided by patients, the FFT results should of course improve.”


Not least because the true value of the FFT comes from the free comments, many practice managers are self-managing the test.

One PM, writing on the Practice Index Forum said: “We use slips on reception, text messages and it’s on our website. It takes me no more than a few minutes each month to compile the results so it never crossed my mind to pay someone else to do it, the only time it takes longer if someone has left further feedback and their details as then I will follow it up with them directly. I keep the slips for 12 months but have a spreadsheet of everything too should we ever need evidence.”

Various software and toolkits are available to make collating FFT responses easier – including the new FFT Collator [PLUS], which is available free of charge to all Practice Index PLUS members.

FFT collator enables practices to easily pull together feedback, add details up, produce a summary for CQRS – it collates all of the data for you – and build an easy to read month-by-month analysis. In a nutshell, it helps you tot up the responses for each month’s friends and family test in an easy-to-use pop-up window. It makes a nice pie chart too! Further information can be found here and in the video below.

Better questions

Further good news on the FFT front is that the NHS is taking a look at the future of the FFT.

“We know we have a job to do now to make FFT more effective to see what we can do to support local teams to listen and respond to patients, keeping the patient experience high on the agenda and to take it beyond 50 million ticked boxes,” says Clare.

“We are starting by reviewing the questions, and reviewing the timing. We already have a bank of views from patients and staff across the NHS who have amassed five years’ experience of working with and responding to FFT. We also have research reports, evaluations and academic contributions. We are working with those who have said they’d like to help us in our bid to improve and evolve the FFT, as evolve it must.”

Further information on this can be found on the FFT development project page where there’s also the opportunity to share your experiences of using the FFT and help shape this national feedback tool for the future.

Clare’s words point to the fact that the FFT is here to stay. Hopefully the planned changes will improve the question sets but, in the meantime, as one PM told us, “we might as well try to embrace it and get as much out of it as possible. Otherwise it’s just another unnecessary admin task.”

What are your views on the Friends & Family Test? Have you gathered some helpful feedback that has helped you to shape your service delivery and practice management? Let us know by commenting below or head to the Practice Index Forum.


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