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Restrict friends and family test to hospitals, says DH

The new friends and family patient satisfaction test should initially be largely restricted to acute care settings rather than rolled out universally, according to a Department of Health cost-benefit analysis.

The impact assessment, signed off by officials on 15 November, said the costs of extending the test beyond acute settings and maternity services to areas such as primary and community care were considerable and the benefits were “low”.

The DH’s preferred option is to use the test for adults in accident and emergency and overnight inpatient services before extending the service to maternity episodes.

The assessment said: “Given high levels of satisfaction with GP services in the GP Patient Survey, if the friends and family test were extended to GP services there is a risk that gains in patient wellbeing will not be realised. It will be expensive because of the high number of GP consultations.”

The department estimated rolling out the test in the more limited form − “option 2” − would cost £25m over five years. Extending the test − “option 3” − would see the cost rocket to £399.4m over the same period.

Its assessment concluded: “All things considered, the preferred option is option 2. This is the preferred option because it delivers a high level of net benefit at a relatively low cost (relative to option 3) and without any of the downside risks of option 3. By extending to maternity services it allows patients from an important group to be covered by the friends and family test at an early stage of implementation.”

The impact assessment also concluded the test “may not be compliant with the quality, innovation, productivity and prevention programme”.

“Although the service will support service improvement it is unlikely to yield net cash savings,” it said.

When the prime minister announced plans to roll out the test in May, he spoke about its use in acute care settings.

Neil Bacon, founder of provider iWantGreatCare, which is offering the test free for other trusts through the NHS Confederation, is one of a number of supporters who has called for the test to be rolled out to GPs.

Readers' comments (18)

  • “Given high levels of satisfaction with GP services in the GP Patient Survey"

    Would this be the same survey you get struck off the GP list for if you give the wrong answers?

    I suspect a proper GP survey would reveal high levels of dissatisfaction with inaccessible and geographically determined services - but I suppose HMG doesn't want to rock the GP boat now they need them to co-operate in wasting - sorry - spending - £60 billion of our taxes....

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  • Given that the UK does not have money to slosh about, why in heaven's name would anyone other than a spendthrift even consider rolling this out to GPs? Agree with 11.17's comment!

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  • Sorry, but 11.17 makes untrue assertions.

    The GP patient survey is conducted by post, by Ipsos Mori, and the GP practice can have no idea who has been invited to respond, who has responded, let alone what they have said.

    The survey is backed by loads of published evidence, and is the most reliable opinion survey in the country with millions - yes millions - of responses each year.

    The fact it shows people trust, like and rate their GPs highly may be annoying to some, but it is the truth.

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  • Given the national financial position i'm not sure this is a cost worthy exercise in any setting. This is a significant, resource intensive exercise and once again, it looks like acute providers are kopping for it. As above i agree with 11.7

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  • I am interested to know what the Department of Health's evidence is that the NPS provides a "high level of net benefit" for acute Trusts. It provides no intelligence on why patients might be dissatisfied as a stand alone device. Many Trusts already run much more comprehensive and sophisticated feedback systems which provide rich information to help them improve services

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  • ID

    The GP survey has strengths,granted, but it is highly unlikely it adequately includes patients from the groups who are at increased risk of not having a positive experience and service from their GP.... let's not pretend it is some holy grail of patient experience measure because it's not.

    What worries me is:
    - as the 'F&F' test becomes more and more restricted in both its use and the sample size, and it's already dubious validity and usefulness becomes ever more restricted, is it going to be a hugely wasteful white elephant?
    - if we are not using it in more places than we are using it - what are we going to do instead in these places?

    I note with wry resignation the apparent lack of importance of ' service improvement' versus 'net cash savings' to the DH. Quality anyone?

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  • I hope it will include inpatient mental health services

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  • Interesting to see a cost attached to doing this in primary care. Hospitals don't get paid for doing this in midlands and east. We earn money back from the CQUINs pot, nothing additional

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    I think there is a role for GPs in FFT but it may not be as most view it. We published this last week and it suggests there is a productive role for primary care. The reality is, unsurprisingly, that done well FFT is not automatically expensive and can be highly effective. If implemented poorly it will not be effective and is likely to be poor value for money, whatever the cost. the real issue is going to be how the service uses the information to facilitate improvement and as yet this has received little or no coverage.

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    page 81!

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  • The risk of a less favourable GP patient survey post CCGs is high and so I can see the attraction in not doing it

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  • A specious test to give specous results plus an Impact asseessment drafted to suit and signed by Anon

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  • Although less "statistically robust" it is worth considering customer feedback systems such as the one on travel site tripadvisor. An (admittedly crude) straw poll suggests that this is very widely used, trusted and - importantly - isn't unlikely to be costing several hundred million to maintain.

    Why is the NHS making such heavy weather of this? A couple of million would more than likely be enough to create a very well designed app and accompanying website (giving providers the right of reply). Add a couple of 100k p.a. for moderating - perhaps as a contract provided by CSSs and this could be up and running in short order.

    Not fully inclusive, I admit, but in terms of getting very rapid feedback from service users and their friends/family it wouldn't be a bad start.

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  • Sorry but this is a complete and utter disgraceful waste of money.

    Yes we need feedback but it is absolutely useless unless you do something with it to understand why an experience was good or bad and implement changes based on this understanding. Furthremore, feeding back to respondents regarding what has happened as a result of their feedback is crucial.

    Just collecting spurious data is not going to generate improvement that is sustainable. I can see we are going down that well trodden path of knee jerk reactions that see us run around putting out the fires, but not really doing anything to stop the fires breaking out in the first place.

    When will we learn we need to not just have a system of collecting data, but for really understanding it so that we can make sustainable changes that are meaningful for all to improve the patient experience.

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  • Shurely Shome Mishtake - NHS Choices will have a Friends and Family question up in December. It already gets c20m visits a month. Why not just point every patient to Its moderated and can provided speciality level reports. And that won't cost £25m or £399m. Just the cost of printing business cards and putting them in every ward. Then all you do is make sure every Hospedia terminal has a free link to the form. Put in place a small call centre to take telephone comments £100k pa. Give every hospital and GP surgery a twitter #tag (free) and you're away. Really simple ideas just need to be kept simple.

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  • Sorry, why wouldn't GPs want a F&F type test? It provides really useful additional feedback for them, and given they get paid for every patient they have on their books, and will increasingly be fined for patients choosing to go to A&E instead, it's short-sighted in the extreme for GPs to see the costs and not the benefits. With a bit of foresight and leadership, CCGs will be clamoring to be part of it, or am I just being a bit optimistic?

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  • What about non-NHS services who are taking what used to be secondary care services! Are they excluded, as for FOI and HE'S?

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  • The family and friends test is fine for acute trusts and
    discreet ward areas but much more difficult to collect and analyse in community settings. These are often geographically wide spread with small numbers of staff and not statistically sound and if onsolidated across all sites not helpful to be able to identify where key improvements are needed. Even the five national questions are not all relevant for all services. We need to be able to use locally agreed systems

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