Editorial Comment

Family and Friends Test – Is it a Worthless Test?

“I’m not bothered particularly about seeing a doctor or nurse face to face as long as they can and do make a judgement to see me if it warrants it today!”

I am sure you have visited a public convenience and found at the exit a touch screen asking you to vote on your visit with a smiley face or a miserable face. Really the FFT just amounts to a simple similar measure of satisfaction or dissatisfaction that has become elsewhere commonplace in our lives. But does it really measure anything? If there is going to be a simple satisfaction survey doesn’t it need to be a bit more inquisitive?

Consider This…..

I am often reminded of attending a year long management course before practice computing and smartphones took hold. Our project was marketing and I struggled to see the relevance of it working in general practice. The theme of the course was ‘Putting the Customer First’. This was demonstrated by visiting a Rolls Royce sales showroom in Regent Street, where no sales promotion was necessary, they simply kept in touch with clients when a service was needed or an MOT or car insurance needed renewal. We visited a London Transport training centre and a British Airways air crew training centre where customer care was always foremost. We also looked at the way MacDonalds tried to sell one additional product to each customer and then ‘smile’ at the customer. How pleasant!

Limited Promotion

At the time we just had Practice Leaflets providing basic information for our patients which were never in ample supply being printed in quantities of 2,000 by an advertiser. Mobile phones, emails and websites were not even in their infancy. It was down to walking into the surgery or telephoning the surgery to ask for an appointment. My recollection is that an appointment was rarely refused. Most GPs worked full time.

Putting Patients First

Marketing attempts in the 1970’s included a Patients Charter, now the NHS Constitution. We had attempts to improve access for patients with Advanced Access and Doctor First. We now too have Primary Care Networks with their own funding but I wonder whether patients understand what that is all about other than seeing a variety of clinicians replacing or supplementing GPs with prescribing nurses. Is the problem in general practice to do with lack of medical manpower or an increase in patient demand. It might be something else such as the ‘now’ culture. Patients want and expect a better standard and that the service should be available almost straight away, certainly within a day.

Is it to do with marketing and communications?

Move on to the current day and general practice is busier than ever. It has always supposed to be the first port of call for patients seeking treatment and care. It is not an ‘emergency’ service, yet I hear telephone answering messages telling me not to ask for a service after a certain time unless it’s an ‘emergency’. However, general practice is now complex in the way it is provided. It has been seriously affected by the pandemic instilling in Practices the need to provide treatment and care in different ways and at weekends and bank holidays. There are still, however, pressures on out of hours services and A & E. My view is that the idea of signposting patients to other services causes confusion, uncertainty and lack of continuity. Hence, the negative responses to patients surveys.

Is it time to let Practices off the hook?

Yes, I have been faced with over 100 extra patients wanting to be seen on a day. I have been faced with tweaking appointment system to cope with demand. Luckily, I have not been faced with too many slow consulters, and locums who will only do a bare minimum for such high cost. My view has been to ‘keep it simple’. We are in a world now where Practices do need to sift and sort what is thrown at them each day. We have had Covid rammed down our throats for two years. There cannot be many people who are not aware of the recommended preventative measures and how irritating it can be when someone in front of you in a confined space has decided wearing a mask is not for them and they sneeze. Why on earth has each UK nation had different rules other than to make a political point?

Back to the plot

• Do we really need lengthy telephone answering messages rather than a human voice straightaway?
• Do we really need to be told to speak to a pharmacist or ring 111 or look at the NHS web site?
• Do we really need to be waiting two or three weeks for an appointment that we will probably forget, unless we get a text reminder.
• Do we really need to look at a website that has so many links that eats the choices on Netflix.
• Do we really need to be told at 8.05am that there are no appointments today.

So is it really all about how we manage information? Is it the difference between positive and negative marketing?

Just getting through the numbers

A recent experience suggests to me that Practices do need to look at continuity and not have a number of different types of clinician involved in a patients care. A GP told me to take an extra tablet each day. A retail pharmacist also told me to take an extra tablet each day too. However, the Practice Pharmacist told me not to. A few weeks later my GP called me to highlight my confusion, apologised and reaffirmed her advice to take the extra tablet. Three interventions when one would have been sufficient but which one! Maybe that is a prime example as to why patients are critical of current day general practice.

Another example of the serious problems facing general practice was my own observation yesterday of a village surgery with a dispensary normally open at least three days a week. Apart from a visiting physiotherapist the surgery was closed but patients were still rolling up with their repeat prescription requests to find the door locked. They persisted in braying the door which was answered by the physiotherapist who could not help them. There was an explanation on the Practice website. The surgery would open in two days time. Two doctors had suddenly left the Practice as had three Staff. Recruitment had failed. It’s not easy in rural Cumbria. But patients were left on the doorstep of the surgery confused, angry and without their medications. Again, is it down to communication?

Keep it Simple and Clear

So in summary, keep telephone systems simple, short messages and prompt replies . Never say there are no appointments today. Bring back an element of continuity of care, keep websites simple but informative. Is it time to give less prominence to Covid rules? It is all to do with marketing and perhaps if websites are less complicated and telephones simply answered patient surveys like Family and Friends might produce far better and more positive results.

What I’d like to see –

A promptly answered phone and a pleasant voice
No lengthy answering machine messages
Not to be told I’m in a long queue
Not to be told the doctor I usually see only works on Thursday
Not to be told there are no appointments today.
To get an uninvited text asking me to attend an appointment
See the same doctor or nurse practitioner for the continuity of my care

It may seem a bit simplistic but are these the issues patients have with Practices?

Robert Campbell
May 2022


Robert Campbell

By Robert Campbell<br><img src="" alt="Robert Campbell" class="avatar" width='50' height='50'/>

Started work writing medical cards in 1966 at Staffordshire Executive Council. Have worked at Inner London Executive Council, Hertfordshire Executive Council, Lambeth Southwark and Lewisham FPC, Birmingham FPC, Dudley FPC and Wakefield FPC and Family Health Services Authority. I was seconded to the NHS Appeals Unit and have worked as a full time GP practice manager since 1992 until 2010. I was also an AMSPAR trainer at Park Lane College, Leeds. Now I work as a freelance author.