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Friends and Family test guidance for general practice

An overview of the new guidance for implementing the Friends and Family test - and what steps practices should take now.

The Friends and Family test allows patients to provide anonymous feedback (Picture: iStock)
The Friends and Family test allows patients to provide anonymous feedback (Picture: iStock)

Practices in England have to carry out the Friends and Family test from 1 December 2014.

NHS England has recently published guidance setting out how the test should be implemented in general practice. The guidance allows practices a lot of freedom, but there are a number of clear requirements.

The Friends and Family test is continuous – it is not a one off traditional survey. The test is anonymous and it should be a simple process. NHS England will publish the results every month.

Mandatory requirements

According to the guidance, practices must do the following:

  • Provide an opportunity for people who use the practice to give anonymous feedback through Friends and Family test except where it would be inappropriate to do so.
  • Use the standard wording of the Friends and Family test question (see below).
  • Include at least one follow-up question, which allows the opportunity to provide free text.
  • Submit data in the format required to NHS England each month (this is likely to be through CQRS).
  • Publish results locally.

The questions

The initial 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?

The responses:

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

The wording of the Friend and Family test question and responses must be exactly as set out above

The practice can decide what to include as the mandatory follow-up question, providing the overall test remains short and simple. NHS England will not see the responses to these follow-up questions and the results will not be published centrally.  

The guidance suggests the following as possible topics:

  • Questions targeting specific local issues, complaints process or other processes.
  • Questions which follow up on issues raised in traditional patient surveys that run less frequently
  • Demographic questions to ensure that there is feedback from a reasonable spread of the local population and to enable comparisons between the experiences of different groups (although this is not a requirement).  

The initial question can also be used as part of a larger survey but it must be asked first.

Patients must also be able to opt out of any free text comments they make being published.  

Promoting the test

Patients must be able to give feedback after every interaction with the practice – and they need to be aware that they can do so. It is up to practices to decide how they do this. Any registered patient should also have the opportunity to use the Friends and Family test to give feedback at any time.

Collecting responses

There is no target for response rates within a practice, but NHS England will publish data to show the level of participation within every practice, based on list size.

Practices are responsible for how they collect responses. The guidance says these methods must be inclusive – further information on how to make the process inclusive, including obtaining feedback from hard to reach groups and those with disabilities, can be found here.

Where patients are not able to complete the test themselves they can be helped by relatives carers volunteer or staff. The guidance also recognises that there may be times when it is not appropriate or possible to seek feedback through the Friends and Family test.

Where their contract allows, practices can commission a third party supplier to carry out he Friends and Family test on their behalf. If you take this approach you will need to ensure that the supplier is meeting the requirements of the guidance.

Data submission

Practices must submit monthly reports to NHS England that include the number of responses in each category of the initial question and the number of responses collected by each method.

It is expected that CQRS will be the preferred route of data submission, however this has yet to be finalised and guidance will be updated when a final decision has been made. Free text responses and any additional information collected are not submitted to NHS England.


Practices should give feedback to patients on what happens to their responses, particularly where action has been taken as a direct result.  

Practices can decide how they publish their results, which should include results of their supplementary question(s).  As mentioned above, patients must have the opportunity to ‘opt out’ of having any free text comments they make made public (even though it is anonymous).

If you participate in the patient participation enhanced service, you should use the results of the test to inform your work with your PPG.

What should practices do now?

  1. Decide on your supplementary question
  2. Decide whether you want to use a third party supplier or do it yourself,  www.iwantgreatcare.org offers a free online solution,
  3. Consider how will you advertise to patients?
  4. How will you train staff?
  5. What is the process for analysing data feeding back to practice and PPG and taking action?

Read about one of the practices that piloted the Friends and Family test and what they learned from the experience.

  • Fionnuala O'Donnell is a practice manager in Ealing, West London, and a CCG board member.

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