To FFT and beyond?
The Friends and Family Test goes live on December 1st and practices will need to ask patients their view about the service they receive in a prescribed way.

The FFT question
“We would like you to think about your recent experiences of our service.

How likely are you to recommend our GP practice to friends and family if they needed similar care or treatment?”

Answers must be scored against the following scale

Extremely likely’; ‘Likely’; ‘Neither likely nor unlikely’; ‘Unlikely’; ‘Extremely unlikely’; or ‘Don’t know’

Asking the questions, collating and submitting the data becomes a contractual requirement

In principle this is a simple but sound piece of market research and it acknowledges and harnesses the power of word of mouth recommendations and also the power of word of mouth to destroy reputations overnight.

It’s worth considering some statistics


We tell 4 or 5 people about a good service and up to 15 about a poor one and as a story spreads it becomes prone to embellishment and exaggeration – the well known Chinese whispers phenomenon

A 2013 survey by the British Standards Institute discovered that 60.9 are influenced in our choice of service by word of mouth and that nearly 50% of us are influenced by customer review sites – the trip advisor mentality

Add to this the opportunities that social media give for spreading the word and we are all vulnerable to criticism that we may never hear directly and are unable to refute

In the BSI survey a staggering 15% of us use Facebook and other social media to complain or comment about poor service.

However 96% of us do not complain to the service provider directly so we only hear from the minority of dissatisfied users.

Given these facts, anything enables us to understand levels of satisfaction or dissatisfaction must be available.

Does FFT go far enough?
In our view no.  It is undoubtedly of value but it is not a substitute for sound market research so the opportunity to ask more questions should be seized.

NHS England is happy that further questions can be asked and best marketing practice would absolutely agree.

Reinforce FFT with 4 further well chosen questions for on the spot surveys
Questionnaires for on the spot real time completion however should be brief, no more that 5 questions in all and should simple and speedy to complete.  A similar approach to the FFT question makes sense.  A statement pinpointing an area of service delivery (appointments, access, waiting, staff attitudes) and asking for simple rating using no more than a 5 point scale

Use an annual 10 question survey to probe further and to seek further improvement
Expand the on the spot information with annual survey to a carefully selected demographically balanced sample of patients – those who do not attend as well as those who do.  250 should be fine as a sample size even for the largest practice.

You may want to run 10 -12 person balance focus groups to understand priorities
Feedback should be shared with staff, patients and patients groups to drive improvements owned by all staff.

Market Intelligence.
As a practice you may want know how you compare
How do you rate yourself, how do patient rate you?  What does NHS choices say and what improvement opportunities does this give you?
In the commercial world companies will build up a profile of themselves and their competitors by undertaking a Competitor Audit.
This would typically covers things like service that are offered, location and ease of access/parking, premises, staff attitude (ever tried called your own surgery – if you were a patient would you be happy with how your call was handle?)
This would provide a baseline to compare yourself and others in the same area.
It would help you understand your strengths and also the areas you needed to improve.

Future proofing
Part of the market research toolkit is also to look into the future and examine demographics and population trends in your area for the next three years.

Are there challenges in the statistics, are there infrastructure opportunities and challenges which impact your practice population.

The combination of these pieces of work will help you map your practices position, reputation and preparedness for the future and should underpin your business planning.

FFT in practice
Practices must submit returns monthly to NHS England and report the following

 the number of responses in each category

 The number of responses collected by each method

NHS England identifies 15 % as a reasonable response level.  We believe you should expect over 30%

Survey overload is a danger so you will need to train staff to offer the opportunity in an appropriate and timely way during their contact with surgery
The process needs to be made easy, large print, a clear explanation of the purpose and what you will do with results.
Confidentiality needs be emphasised and the collection route simple and prominent.

In summary
FFT is a valid tool and has value, so should embraced.  On it’s own its not enough to understand the practices position, rating and value in the eyes of its users and needs to be combined with other market research techniques to give the practice the clarity it needs to thrive and prosper

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