Patients who wish to provide feedback through FFT should get in touch with the NHS organisation directly (for example, by contacting their NHS trust or GP practice). NHS England is unable to process FFT feedback directly from patients about their healthcare experience.

For more information about how to feedback or make a complaint about any aspect of NHS care, see feedback and complaints about NHS services.

Providers are not required to proactively ask patients to give feedback at times specified in the guidance, but they should ensure that patients know that if they want to use the FFT to give feedback they can.

Providers can use any collection methodology that meets the requirements, for example they can use SMS texts, a webpage, pen and paper, tablets and so forth, but should ensure that all patients can find a way to give feedback if they want to – so the provider may wish to use a combination of methods. To be inclusive, the provider might want to have feedback forms on the reception desk as well as send an SMS message to patients that have had an appointment.

If the provider finds it useful, it can continue to carry out a routine collection at a time that suits them and their patients, for example, at discharge, at some given time post discharge, or at specific appointments.

NHS England offers support by providing a range of promotional resources. These range from films – both animated introductions to the FFT and examples of how it is working in some healthcare services – to a range of posters and leaflets suitable for different services.

You can find a range of digital FFT promotional resources on the Campaign Resource Centre website. This includes a variety of posters, leaflets and feedback forms for different care settings.

We have also published a set of case studies that show good practice in carrying out the FFT, making it accessible to a range of service users and using the feedback.

The mandatory standard question is:

“Thinking about [setting]…

Overall, how was your experience of our service?”

And the response scale to use is:

• Very good
• Good
• Neither good nor poor
• Poor
• Very poor
• Don’t know

Providers should choose the most appropriate one of the following, or something similar, to describe the setting or experience being asked about:

• your GP practice
• your stay in the hospital
• your dental practice
• your recent visit to A&E
• this maternity service
• our antenatal service
• our labour ward
• our birthing unit
• our homebirth service
• our postnatal ward
• our postnatal community service
• your recent appointment
• your recent visit
• our recent visit
• the service we provide

The new question has been cognitively tested to make it as widely accessible as possible. However, providers are encouraged to add text or graphics to the question to make it easier for patients to respond where appropriate. NHS England provides examples of easy read, British Sign Language and foreign language versions but providers should also feel free to develop their own. We would be happy to receive examples and make them available online to other providers.

We know that the free-text feedback is the most important part of the FFT. There is a requirement to ask at least one free-text question alongside the mandatory question.

Providers are encouraged to use free-text questions that work for them and their patients, for example seeking feedback on something that has been identified as needing further examination.

During our development project, we tested several free-text questions. We found the following questions were well understood and encouraged good quality feedback:

• Please can you tell us why you gave your answer?
• Please tell us about anything that we could have done better

We do not specify what your free-text question asks. You might choose to ask more than one. We encourage you to test that your free-text question works well and update it as often as is helpful for your needs.

Our FFT-related case studies include examples of how the free-text data is used to identify opportunities for improvements.

The FFT is a continuous feedback tool, designed to be quick and easy for patients to use and for staff to implement and collect. It is not intended to provide data that can be used to compare different organisations.

Unlike the national surveys:

• all people who use services should be able to use the FFT to give feedback if they want to; there is no sampling of patients and no requirements around response numbers or rates
• there is no single method of collecting data; providers can use any method that works for them and the people that use their services
• providers have the flexibility to ask additional questions alongside the mandatory overall experience question; these is also flexibility in what free-text question is asked by providers

The published data is not subjected to routine analytical processes and is not:

• case-mix adjusted to reflect the different kinds of treatment patients are receiving in different providers
• adjusted to reflect demographic characteristics (such as age, ethnicity, or sex)

Using the FFT data to compare providers can have a detrimental effect on how it is collected and used. Providers would, understandably, focus on trying to get a high score (for example by being selective in which patients are asked to give feedback) rather than collecting good quality feedback and using it to identify good practice and opportunities for improvement.

The guidance encourages providers and commissioners to focus on what the feedback is telling them and how it can be used to make improvements.

The national requirements related to response rate were removed in April 2015 to discourage of a disproportionate focus on achieving very high response rates which led to providers thinking about the FFT as a tick-box exercise. We encourage a focus on ensuring that all patients have the opportunity to feed back through the FFT and how this feedback is used, rather than on response rates.

The monthly numbers we publish include data that can help commissioners get an overview of how the provider is doing in gathering patient experience insight, in the context of the number of people using the service. The numbers are not a performance measure – and from April 2020 we stopped be calculating ‘response rates’.

We are keen that providers use the wording and the response options we have set out in the guidance – these have been cognitively tested with a wide range of people that use services and we are confident that they are much more accessible than the old question and response options.

Having said that, we do acknowledge that not everyone has the same cognitive ability and some people may still find it difficult to respond to the question as it stands. That is why we have said in the guidance that locally providers can add any supplementary wording and graphics to the question that they need to, to help people understand what they are being asked to do. The most important thing is to enable people to give feedback if they want to.

We have made examples of easy read-designs available for people that want to use them. These are not mandatory, and providers should feel free to design their own versions, using the standard question wording, if they prefer to do so. These are available on the Campaign Resource Centre website.

While it’s not mandatory to collect demographic information, we think it can be useful for identifying:

• whether there are any demographic groups that are not engaging through the FFT, and may therefore require an alternative approach
• whether any demographic groups are reporting better or worse experiences than others

If you do collect demographic information you should think about collecting the most useful for you and the demographic makeup of your patients.

We recognise that there are ongoing debates about the best way to collect and record sex or gender information, and at this stage we are not able to make a firm recommendation on how to word the question or the response options.

We provide translations of the new standard FFT question and response options in the following languages:

These are available on the Campaign Resource Centre website.

All providers should now be meeting the new guidance. You might find it useful to look at the checklist on page 36 of the guidance to assess whether your organisation’s approach is aligned fully.

For more information, see Friends and Family Test development project 2018-19.

If you are unsure about what you need to do to meet the guidance you can contact us by emailing: england.insight-queries@nhs.net.