This survey is now closed
PATIENT SERVICE IMPROVEMENT QUESTIONNAIRE 2011
Please place a tick in the box that best relates to your answer.
All the information that you give is used to monitor and improve our services and will be held in
confidence in accordance with the data protection act.
The questions relate only to Sullivan Way Doctors and the practice NOT to any trainee doctors or any
locum doctors you may have seen.
Please answer as accurately and as honestly as possible.
You can complete he form via our website - www.sullivansurgery.co.uk
1. When did you last see a doctor at your GP surgery?
2. If you haven’t seen a doctor in the past 6 months, why is that? Please tick all that apply.
3. Which of the following methods would you prefer to use to book appointments at the surgery?
Please tick all the boxes that apply to you
4.
. Which of the following methods would you prefer for ordering repeat prescriptions?Please tick all the boxes that apply to you
5. In the past 6 months how easy have you found the following?
Getting through on the phone
Obtaining test results by phone
Speaking to a Nurse by phone
Obtaining test results by phone
6. In the past 6 months have you successfully tried
To see a Doctor fairly quickly?
. To make an appointment more than two weeks in advance
If no to one or both of the above please give brief details
7. How easy or difficult do you find it to get into the building at the surgery?
If you have answered difficult or very difficult please give a brief explanation.
7a. How do you get TO Sullivan Way surgery?
7b. If you have had to attend a clinic outside of Sullivan Way which Clinic did you attend?
If yes, please tell us how you found it to:
Make an Appointment
Travel to and from the clinic
Please comment on your experiences
8. In the reception area, can other patients overhear what you say to the receptionist?
9. How helpful do you find the receptionists at your GP surgery?
10. How long after your appointment time do you normally wait to be seen?
Do you wait?
If more than 30 minutes please say:-
11. Is there a particular Doctor you prefer to see at the Surgery?
Do you get to see your preferred doctor:-
12. Last time you saw Doctor at your surgery how good was the doctor at each of the following?
Giving you enough time Listening to you
Explaining tests and treatments
Involving you in decisions about your care
Taking your problems seriously
13. 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.
Discussing symptoms
Listening
Explaining tests/treatments
Involving you in your care
Taking you seriously
14. Do you feel that you are always treated with care and concern?
By the receptionists
By the Doctors
By the Practice Nurses
15. Do you find the waiting room at you GP’s surgery suitable for your needs?
(if no please say briefly why not)Other please give a brief comment:
16. Do you know the opening times of the surgery:
17. Do you know what the Health Trainers do?
18. Do you use the surgery web site?
If Yes have you used it for the following?
Book appointments
Order repeat prescriptions
Just for information purposes
Do you rate the site as
19. 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. (Please do not give us specific information)
20. Have you had discussions in the past 12 months with a doctor or nurse about how best to deal with your health problem?
21. If help and information were available to help you manage your long term condition would you be interested?
22. Are you aware of any of the following services being provided by your GP’s surgery?
23. Have you been referred to a Consultant or Specialist Doctor in the last 12 months?
(a) If yes, were you given a choice of hospitals to attend?
(b) If yes, did you have enough information on which to base your choice?
(c) If no, what information would you need to make an informed choice?
(d) How would you like to have received that information?
If other please give brief details
24. Have you had to used the Choose & Book System? If yes have you.
Please say which you prefer
20. Are you familiar with the complaints procedure at the surgery?
THANK YOU FOR YOUR HELP.
ABOUT YOU
The following questions will help us to see how experiences vary between different groups of the population. We will keep your answers completely confidential.
Are you male or female?
How old are you?