Patient experience desk researchNHS Friends and Family Test
Fast, continuous feedback for local action
The NHS Friends and Family Test (FFT) is a national continuous-feedback mechanism for local service improvement. It gives people a quick way to describe their experience and explain it in their own words.
Best question it answersHow can patients shape their care experience through fast feedback while it still matters?
What it teachesContinuous-feedback discipline: use always-available feedback and free text for fast local improvement, without treating it as a fair benchmark.
The problem it was built to solve
Periodic, sample-based surveys cannot show a service quickly what is working or going wrong for people using it now. FFT was designed as a simple, open feedback route that can reach staff quickly and support local action. NHS England Friends and Family Test and NHS England guidance on using the Friends and Family Test to improve patient experience
How it works
FFT has one mandatory overall-experience question, with a fixed response scale, and at least one free-text question. Providers offer quick feedback when people want to give it, submit monthly numerical data for national publication, publish results locally, and can collect feedback during care, at discharge, or afterwards. NHS England guidance on using the Friends and Family Test to improve patient experience
What it teaches us
Fair comparison
FFT is the clearest warning against mistaking common wording for a fair league table. NHS England states that its results are not statistically comparable across organisations because collection methods vary. NHS England Friends and Family Test
Programme design and architecture
FFT uses a national minimum standard with local implementation flexibility: a required core question and free-text route, monthly national data submission, and local publication and action. This is a different architecture from a controlled benchmark survey, and it is deliberately so. NHS England guidance on using the Friends and Family Test to improve patient experience
Scope of measurement
FFT usually measures a service touchpoint or a care episode, depending on the local collection point. It can reveal frustrations at handovers or discharge, but it is not designed to create a coherent cross-provider pathway measure or to assess the longer-term impact of care on health or life. NHS England guidance on using the Friends and Family Test to improve patient experience
Question design
The fixed question asks about overall experience, while free text explains why the person gave that answer and what could have been better. The guidance calls free text central to improvement, not an optional extra. NHS England guidance on using the Friends and Family Test to improve patient experience
Since April 2020, FFT's mandatory overall-experience question has been: “Thinking about [your appointment at the outpatient cardiology clinic], overall how was your experience of our service?" The response scale: Very good; Good; Neither good nor poor; Poor; Very poor; Don't know.
Before April 2020, FFT instead asked: "How likely are you to recommend our [service] to friends and family if they needed similar care or treatment?" The response scale: Extremely likely; Likely; Neither likely nor unlikely; Unlikely; Extremely unlikely; Don't know.
The change moved FFT from a hypothetical recommendation question to a direct overall-experience question. NHS Friends and Family Test Guidance (2014)
Timing and actionability
This is FFT's defining strength. Patients are able to respond at any time: while receiving care, at discharge, after an appointment, or afterwards. Providers choose whether and how to invite feedback - for example, through a QR code, form, tablet, web page, or SMS link - and do not have to ask every patient after every episode. There is no national rule requiring a standard post-discharge send.
Responses are submitted nationally as monthly counts, but staff should receive feedback as soon as possible, making feedback part of a local improvement loop rather than an annual report. NHS England guidance on using the Friends and Family Test to improve patient experience
Digital and technology
FFT makes monthly aggregate data publicly available through national publications and a public analysis tool. Providers can also use NHS England's local Excel dashboard template to record and review their monthly returns. These are simple tools for reviewing numeric patterns by time, response method, organisation, site, or ward - not a complete experience-intelligence platform.
The national FFT offer does not provide free-text analytics or theme classification, real-time service-recovery workflows, action tracking, or integrated operational, clinical, and experience data. Providers can build those capabilities in their own BI or feedback systems, but they are not part of FFT itself.
Development and validation
FFT was launched in April 2013 as a simple national feedback mechanism and was rolled out to most NHS-funded services in England over the following two years. FFT was developed as a practical, accessible route for local improvement rather than a controlled, psychometrically-validated comparative measure. NHS England Friends and Family Test and NHS Friends and Family Test Guidance (2014)
Evolution and modernisation
The 2018/19 FFT development project gathered input from patients, patient-experience leads, clinical staff, commissioners, and others. Its revised guidance also drew on cognitively tested free-text prompts.
From April 2020, the original recommendation question was replaced by the current overall-experience question, alongside revised guidance and a stronger emphasis on free text. NHS England Friends and Family Test and NHS England guidance on using the Friends and Family Test to improve patient experience
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