Q1. When did you last see a doctor at the GP Surgery?
Q2. How do you normally book your appointments to see a doctor or nurse at the Surgery?
Please tick all that apply
Q3. Which of the following methods would you prefer to use to book an appointment at the Surgery?
Please tick all that apply
Q4. In the past 6 months have you tried to see a doctor fairly quickly?
By fairly quickly we mean on the same day or in the next two weekdays that the GP or Surgery was open.
Q5. Thinking about the last time you tried to see a doctor fairly quickly - were you able to see a doctor on the same day or in the next two weekdays that the GP or Surgery was open ?
Please tick the blank box that applies
Q6. If you weren’t able to be seen during the next 2 weekdays that the GP or Surgery was open, why was that?
Please tick all that apply
Q7. Do you know that you can have a telephone triage appointment by which the Doctor will contact you on the day?
Q8 Advance appointments
How far in advance would you like to be able to book an appointment?
Q9 Missed appointments
Have you ever missed an appointment because?
Missed appointments are a problem for the practice. Can you easily contact the practice when you wish to cancel an appointment?
Q10. How helpful do you find the receptionists at the Surgery?
Q11. How long after your appointment time do you normally wait to be seen?
Q12. How often do you see the doctor you prefer?
Q13. How satisfied are you with the opening hours at the surgery?
Q14. As far as you know is the surgery open …
Before 8am
At lunchtime
After 6:30pm
On Saturdays
On Sundays
Q15. Would you like the surgery open at additional times?
Q16. The last time you saw a doctor at the surgery how good was the doctor at each of the following?
Giving you enough time
Asking about your symptoms
Listening
Explaining tests and treatments
Involving you in decisions about your care
Treating you with care and concern
Taking your problems seriously
Q17. Did you have confidence and trust in the doctor you saw?
Q18. How easy is it for you get an appointment with a practice nurse at the surgery?
Q19. Last time you saw a practice nurse at the Surgery, how good did you find the practice nurse at each of the following?
Giving you enough time
Asking about your symptoms
Listening
Explaining tests and treatments
Involving you in decisions about your care
Treating you with care and concern
Taking your problems seriously
Q20. In general, how satisfied are you with the care you get at the Surgery?
Q21. Would you recommend the Surgery to someone who has just moved to your local area?
Q22. Do you have any long-standing health problem, disability or infirmity? Please include anything that has troubled you over a period of time or that is likely to affect you over a period of time?
Q23. Have you had discussions in the past 12 months with a doctor or nurse about how best to deal with your health problems?
Q24. In these discussions…..
Did the doctor or nurse take notice of your views about how to deal with your health problem?
Did the doctor or nurse give you information about the things you might do to deal with your health problem?
Did you and the doctor or nurse agree how best to manage your health problem?
Did the doctor or nurse give you a written document about the discussions you had about managing your health problem?
Would you have liked a written plan summarising your discussion with the doctor or nurse?
Did the doctor or nurse ever mention that you had something called a care plan?
Q25. Do you think that having these discussions with your doctor or nurse has helped improve how you manage your health problems?
Q26. In the past 6 months have you had enough support from local services or organisations to help you manage your long-term health condition(s) Please think about all services and organisations, not just health services.
Q27. Are you male or female?
Q28. How old are you?
Q29. Which of these best describes what you are doing at present?
If more than one of these applies to you, please indicate the main one
Q30. How do you get to the surgery?
Please tick the box or boxes which apply
Q31. If you are a car driver do you have difficulty finding parking facilities?
Q32. Do you have any of the following conditions? Please include problems due to old age.
Please tick all the boxes that apply to you
Q33. Do you have carer responsibilities for anyone in your household with a long-standing health problem or disability?
Q34. What is your ethnic group?
(Choose one section from A to E below then select the appropriate option to indicate your ethnic group)
A. White
B. Mixed
C. Asian or Asian British
B. Black or Black British
C. Chinese or other ethnic group
Please add any further comments in the box below. Thank you for completing the survey. Your comments will be used to improve the service which the surgery provides.