Every NHS service now has an online score — but you are better off ignoring it

    4 August 2015

    How does your GP surgery compare? In this age of information, any patient can readily go the website to see how their GP compares to others. Or can they? For each practice, a ‘Key facts’ box is given, containing the number of registered patients and the percentage of patients that would recommend the practice.

    The latter per cent is called the ‘friends and family test’ (FFT) score, which supposedly gives you an impression of how other patients feel about the service. At first glance, it would seem pretty useful to know if other people wouldn’t recommend the service; if it’s dismal, then you might as well find a new one.

    But the per cent given is not that simple or fair. Nor is it the only percentage score rating NHS services online — another measure, in fact, is much more reliable. (I will explain that later.)

    The FFT is a statistic updated monthly; each GP surgery is responsible for collecting the data and submitting it to NHS England. They are ‘allowed flexibility’ in how they make the FFT question available to patients, be it handwritten, by telephone calls, by text message, or even ‘other’.

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    So what is the FFT question and how is the FFT score calculated? Patients are asked: “How likely are you to recommend our GP practice to friends and family if they needed similar care or treatment?”, and must answer either:

    • Extremely likely
    • Likely
    • Neither likely nor unlikely
    • Extremely unlikely
    • Don’t know

    The FFT is then calculated by dividing the number of people that responded ‘extremely likely’ or ‘likely’ to the question by the total number of respondents. But here’s my issue: if you respond ‘don’t know’, can you really be assumed to be saying that you would not recommend the service? What happens if this is your first time at the practice? What happens if you are fit and healthy, and haven’t been to see your GP for years?

    Let’s say three respond extremely likely, three respond likely, one responds unlikely and five say they don’t know. Looking at the raw data, you can’t tell much, but on balance it seems lots of people haven’t made up their mind (for reasons we don’t know) but those who have are generally positive about the service. According to the FFT score, this practice would be given 50 per cent. If we eliminate the assumption that the five ‘don’t know’-ers would not recommend the service, the FFT score actually goes up to 86 per cent.

    In actual fact, the number of responders is often dismal compared to the number of registered patients, and ought not to be used to reflect the entire patient population. Moreover, the GP surgery itself must submit the data. What’s to say they couldn’t lose a couple of ‘don’t knows’ or, at worst, ‘extremely unlikely’ slips on the way?

    GP surgeries have another online percentage score, taken from the GP Patient Survey. This is sent out to a million people, ignores ‘don’t know’ and ‘does not apply’ answers, and is much more useful.

    The disparities between the two scores show that the FFT is, for now, a load of nonsense. A surgery in south-east London, for instance, has a 93.6 per cent score on the GP survey, but an FFT score of 36 per cent – very, very confusing for its patients.

    So next time you check out your practice on and, in the Key facts box you see the percentage of patients who would apparently recommend it to their friends, ignore it. It is a redundant measure.