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Should the government abandon the Friends and Family Test?

August 5, 2013

Without online reviews and patient stories the Friends and Family Test will die…and maybe should do.

 According to the British Media, “the TripAdvisor of Health” is now becoming a reality: it is not the future, it is now.

But when Sky News coined this term last week, it was used not to describe the hugely expensive and unfathomable NHSChoices (a relic of the last Government’s wish to control all information about the NHS in a way that “managed the story, rather than the patient”?), but rather the independent business I founded five years ago, an innovative British start-up, already working across the UK and in 17 other countries.

Any member of the public can now rate and review their GP, hospital specialist, surgeon, dentist, and pharmacy, and in the next few months iWantGreatCare will be adding every UK physiotherapist.

All the reviews are fully, openly shared on the web, for the first time ever making information available to enable patients to make informed decisions about who looks after them, which GP will care for their child, which hospital they want to have their operation in.

This is not just great for patients and the public, but is superb news for truly great healthcare professionals. Each week, hundreds more doctors start using iWantGreatCare, asking all their patients to provide feedback – and then sharing that openly on the web for the benefit of the next patient. Each month more nurses, midwives and physiotherapists set up their personal profile pages and ask those they care for to help improve services for the next patient by “rating and reviewing” their experience.

What we thought would be a “patient revolution” is rapidly turning into a “healthcare revolution” bringing patients and those who care for them closer together, building trust, increasing understanding, and sharing knowledge to drive up quality and standards. Whilst there will always be a small group of doctors fearful and worried about what their patients might reveal, the majority want to understand the experiences of all their patients, not just in a small survey once a year, but rather they know they can learn and improve from every patient, from the youngest to the oldest.

Transparency has turned out to be great not just for patients, but to be a powerful tool for improved morale for those who deliver great care day in, day out, and to help NHS organisations across the UK deliver better, safer care.


As opposed to the rather primitive first version of the friends and family test, managed and controlled by the NHS itself (imagine a TripAdvisor without reviews – whose idea was that?!), it is now absolutely clear what is necessary if real-time feedback is to become the incredible tool in healthcare that it is in so many other parts of society:

  • It’s about the reviews, stupid! It is the stories and experiences of patients and their families that other patients want to read, and that make such a difference to engaging staff. Every single one of these needs to be published on the web in real time – unedited and not controlled/filtered by hospitals or the NHS. This is simple and easy to do.
  • Single, standard system – the same questions asked in the same way in every provider (whether large hospital, small GP practice, dentist, NHS or private sector).
  • Much higher target response rate – over 60% of patients respond in the best NHS hospitals (giving reviews as well as a rating). There is no excuse for any hospital not to get at least 40%, and this gives so much more information and insight.
  • Remove the easy chances to game the system – this is where the NHS really has the chance to make a difference. At the moment it is known that providers can and are gaming the NHS’ own FFT process (largely because the NHS has set a ridiculously low target for response rate, and actually allows some hospitals to run their own process!). The NHS needs to admit this is an issue and solve it quickly. Until they do, I and other doctors, will be unable to recommend patients use FFT to inform their choice of care.
  • Present the information in a way that the public understands. For some reason that no one even tries to explain, the NHS made up a new scale to present the feedback from patients. Rather than use a simple five star rating (the obvious web-standard from Amazon, eBay, TripAdvisor etc), they calculate a number from -100 to +100. No one understands this, and it has merely served to confuse. I’m sure it wasn’t devised to bury bad news, but when only a few dozen wards of more than 4,500 are reported as “not recommended”, you have to wonder who thought that was a good idea. Could someone there stand up and take the responsibility for this communications disaster, and change it?
  • Launch a real-time ratings and reviews system for General Practice. This is where most people get their care, it is the heart of the NHS and it needs to be done properly. Why the delay?

It won’t surprise many to hear that it is unlikely that the NHS can do all of the above themselves, rather that it needs to be done independently and in a way that is clear and trusted by the public. That is of course why a group of us from the NHS created iWantGreatCare 5 years ago. No one at the heart of government or the NHS really believes the NHS can – or indeed should – try to become an internet operation. Apart from anything else, after the scandals of Mid-Staffordshire, the chaos that was the NHS introduction of 111, and the damp-squib that was “surgeons’ league tables” (not a single outlier amongst all surgeons? Come on, do they take the public for idiots?!) – the NHS has more than enough to concentrate on.

The great news is that the cat is well and truly out of the bag, the best NHS Hospitals have shown that it is not just possible to collect ratings and reviews from most of their patients, but that doing so properly is popular with staff and patients, and drives better, safer care. There is no going back – the TripAdvisor of Health is here to stay: every patient in the UK can now rate and review their care.

(This is the first of a series of postings to celebrate the launch of real time ratings and reviews of every GP and GP practice across the country. Working closely with NHS GPs, iWantGreatCare has created a free service which will give the public – for the first time ever – the ability to read and write comments about individual doctors, and to use this information to choose the sort of doctor most suited to their needs. To see if your doctor has been reviewed already – or to add your feedback – simply go to iWantGreatCare.)

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