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Appointments
Q1. When did you last see a Doctor at the GP Surgery?
Q2. If you haven't seen a doctor in the past 6 months, why is that? Please tick all that apply
Q3. How do you normally book your appointments to see a doctor or nurse at the surgery. Please tick all that apply.
Q4. Which of the following methods would you prefer to use to book an appointment at the Surgery
Q5. How easy is it for you to get an appointment with a doctor or practice nurse at the surgery
Q6. Would you like to be reminded about your appointment? How?
TELEPHONE ACCESS
Q7. In the past 6 months how easy have you found the following? Please put a tick in one box for each row
Getting through on the phone
Speaking to a Nurse on the phone
Obtaining test results by phone
Q8. Have you ever had a telephone consultation with a doctor
Q9. Was the consultation for?
Q10. Was the GP able to deal with your problem by phone?
Q11. Would you use a telephone consultation again?
BOOKING AHEAD
Q12. In the past 6 months, have you tried to book ahead for an appointment with a DR? By 'booking ahead' we mean booking an appointment more than two weekdays in advance?
Q13. Last time you tried, were you able to get an appointment with a Dr more than 2 weekdays in advance?
Q 14 How far ahead would you like to be able to book a non urgent appointment?
Q 15. How easy do you find getting into the building at the surgery?
Q16. How clean is the GP surgery?
OVERALL SATISFACTION
Q17.The next questions are about the things which may or may not happen when you contact the surgery or see a GP. When answering, please think about the GP you see most often. For each question, please put a tick in the box which shows how often it happens. please answer all questions by ticking one box on each line
Does your GP take your opinions seriously?
Does your GP listen to you no matter how busy they are?
Does your GP treat you with courtesy and respect?
Are the Receptionists as helpful as you think they should be?
Does your GP treat you as you would wish when giving you a physical examination?
Q18. In general, how satisfied are you with the care you get at the Surgery?
Q19. Would you recommend the surgery to someone who has just moved to your local area?
FINALLY - INFORMATION ABOUT YOU
Q20.Are you
Q21.How old are you?
Q22. Which of these best describes what you are doing at present? If more than one of these applies to you,tick the main one only
Q23. In general, how long does your journey take from home to work (door to door)?
Q24. If you need to see a doctor at your GP surgery or health centre during you typical working hours, can you take time away from work to do this?
Q25. In general, would you say that your health is...
Q26. Do you have any of the following conditions? Please include problems due to old age. Please tick all the boxes that apply to you.
Q27. Are you a deaf person who uses sign language.
Q28. Are you a parent or a legal guardian of any children aged under 16 years
Q29. Do you have carer responsibilities for anyone in your household with a long-standing health problem or disability?
The following questions will help us to see how experiences vary between different groups of the population. We will keep your answers completely confidential.
Q30. 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
D. Black or Black British
E. Chinese or other ethnic group
Q31. Which of the following best describes how you think of yourself?
Q32. Which of the following best describes your religion?
OTHER COMMENTS
If there is anything else you would like to tell us about your experience in or at the practice please do so here
Was there anything particularly good about your practice Visit?
Was there anything that could be improved?
Any other comments/