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GP mythbuster 16: The Friends and Family Test

  • Organisations we regulate,
  • GP and GP out-of-hours services

The NHS is a huge organisation with around 1 million patient contacts every 36 hours. Giving patients an opportunity to provide feedback on the care that they have received seems to me a great idea on a number of fronts.

Ensuring CQC hears directly from people about their experiences of care is central to our regulatory approach, helping us to decide when, where and what to expect. We encourage people to share their experiences with us through videos, leaflets and posters displayed in GP practices and we ask practices to ensure they have a culture which supports people to speak up about their experiences of care.

Alongside this, the Friends and Family Test (FFT) will soon be implemented in General Practice and practices must publish their own results. I very much welcome this and thought it would be helpful to provide a brief update to describe how the FFT will be used in general practice and some tips to make the best use of the FFT to help in your CQC inspection.

This guidance has been written with the help of colleagues in the Patients and Information Directorate at NHS England.

From 1 December 2014, it is a contractual requirement for every GP practice in England to offer patients the FFT.

The FFT has already been operating in hospitals for over a year. Over 4 million pieces of feedback have been received so far – the bulk of which has been positive. There are of course areas that can be improved and the FFT has already led to many hundreds of improvements in hospitals. The FFT has also boosted morale in many instances as staff now receive near real time feedback which reinforces that most of the time they are giving great care.

There are some points about FFT that I think it is important to emphasise.

A flexible approach

Firstly, the intention is for FFT to be as low burden as possible – both for practices and for patients. The FFT is a quick and simple feedback tool which enables patients to indicate how likely they would be to recommend services to their friends and family if they required similar care or treatment. Patients can also provide a free text comment to explain why they have scored as they have.

Every patient needs to have the opportunity to complete the FFT at any point in their treatment pathway. This does not mean that every patient needs to be physically asked, however practices do have a responsibility to make patients aware of their right to complete the FFT and provide the means to do so. NHS England has developed a range of FFT resources which practices can adapt and print for local use. In addition, a 90 second animated film has been produced which can be used in practice waiting rooms. All resources are available online:

There is flexibility in how practices offer the FFT. There are many options available which include completion of a postcard, utilisation of a text messaging service, online solutions or kiosks.  Different methods will work better in different practices – by allowing local flexibility it is hoped that FFT will fit in with other patient engagement activities already underway.

Accessible to all

Secondly, it is important that all patients are provided with the opportunity to provide feedback via the FFT regardless of their needs. The guidance that was published by NHS England in July contains a wealth of resources and materials to assist practices make the FFT accessible for patients with different needs e.g. dementia, hearing loss, children and young people. In addition, the FFT question has been translated into 20 of the most commonly spoken languages.

There is a summary version of the guidance for GP practices which clearly describes the requirement:

Value of FFT

I believe that it is important to emphasise that the greatest 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 website. 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. As with all datasets, the more that different sources of information that can be triangulated in arriving at an assessment of care quality, the better. I would, however, encourage practices to look at their FFT results along side other sources of data (such as the GPPS results) 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.

If practices have queries on any element of the Friends and Family Test, they can contact the NHS England helpline on 0113 824 9494 or email

Last updated:
28 April 2021