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Dear Patient,

We would be grateful if you would complete this short survey, which has been devised by our Patient Reference Group.

Our goal is to provide you with a positive patient experience, the best medical service available and the highest standard of care. Your comments are therefore invaluable and will help us to ensure that we are truly responsive to your needs.

Please answer all of the questions that apply to you. All responses to this survey are anonymous and our staff will not be able to identify your individual responses. (Submissions via our website are subject to our privacy policy)

We would be most grateful if you could complete the survey by return. The results of the survey will be published on our website and will also be available for viewing at the Practice before the end of March

Q1. Hospital Referrals - If you have ever needed a referral to see a consultant at Hospital, how satisfied were you with your GP's explanation for each of the following?

Explaining about your choice of hospital(s)

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Were you given enough time to make a decision about where you would like to be referred, offered any literature or information on website to view? How satisfied were you with the decision time allowed and information given?

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Following your referral, how satisfied were you with your actual choice of Hospital/Consultant?

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Q2. Scans - These are currently performed at either Oxley Clinic, Probert Road, Wolverhampton or New Cross Hospital, Wolverhampton. Do you feel you would benefit if the facility was made more available more locally in the community, closer to the surgery, as opposed to travelling across the city?

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Did your GP make you aware that scans can be done privately if you so wished?

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Q3. Blood Test Results - If you have ever needed a blood test, how good was each GP at the following?

Did your GP clearly explain to you why you needed to have a blood test? How would you rate your GP's explanation?

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If you required a Fasting Blood test, did the GP explain what this was and why it was needed? How would you rate your GP's explanation?

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Did you understand / feel your GP / Nurse clearly explained the process for obtaining your blood result information from the surgery? How would you rate your GP's / Nurse's explantion?

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Q4. Out-Patient Follow Up (for example, Dermatology, Diabetes, X-Ray) Do you feel you would benefit if such a facility was made available locally in the community or within your own surgery, as opposed to travelling to be seen again at a Hospital appointment?

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Q5. Chronic Disease/Long Term Condition Management

Which, if any of the following medical conditions do you have?

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How great is your understanding of your condition?

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When first diagnosed with your condition, do you feel you were given enough support via your GP, Pharmacist, Social Services? How would you rate the support given?

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Did your GP ask how this diagnosis would impact on your family, your work, or your finances?

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If you have a long standing health condition, how confident are you that you can manage your own health to ensure you take ownership in terms of booking / having regular checks at the Surgery?

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Has your GP encourgaed you in self-management skills?

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Do you feel you would benefit from Expert Patient Programmes if you were given details / made aware of these?

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To help us analyse your answers please tell us a few things about yourself:

Are you male or female?

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What age are you?

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What is the ethnic background with which you most identify?

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Which of the following best describes your smoking habits?

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Many thanks for taking the time to complete our survey

Kind Regards,

Your Practice Team