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Firstly please tell us the name of your usual doctor
1. In past 12 months how many times have you seen a doctor?
2.How do you rate the way you are treated by receptionists?
3a.How do you rate the hours open for appointments?
3b.What additional hours would you like practice to be open? (tick all that apply)
4.Thinking of times you want to see a particular doctor. How quickly do you get to see that doctor?
5.Thinking of times you are willing to see any doctor. How quickly do you usually get seen?
6.If you need to be seen urgently can you normally get seen on same day?
7.Thinking of times you have ‘phoned the practice,how do you rate the following?
a) Ability to get through
b) Ability to speak to doctor on ‘phone when you have a question or need medical advice?
8. In general how often do you see your usual doctor?
9. On your last visit to the surgery did you see the doctor or the emergency practitioner?
10.Thinking about that particular visit, how doyou rate the following?
a)How well they listened to what you had to say
b)How well they put you at ease during your physical examination
c)How much they involved you in decisions about your care.
d)How well they explained your problems or any treatment you need.
11)Have you seen a nurse in the past 12 months?
12) Thinking about the nurse(s) you have seen, how do you rate the following?
a)How well they listened to what you say
b)The quality of care they provide
c)How well they explained your health problems or any treatment.
Finally it would help us to understand your answers if you could tell us a little about yourself.
13. What is your gender?
14. What is your Age?
15)Do you have any long-standing illness,disability or infirmity? By long-standing we mean anything that has troubled you or is likely to affect you over a period of time.
16) What is the ethnic background with which you most identify?
17) Is your accommodation?
18.Which of the following best describes you?
19.We are interested in any other comments you may have.Please enter them below.