Q1 How easy do you find getting through to the surgery on the telephone?
o Very easy
o Fairly easy
o Not very easy
o Not at all easy
Q2 How helpful do you find the reception staff at
the Practice?
o Very helpful
o Fairly helpful
o Not very helpful
o Not helpful at all
Q3 How easy do you find making an appointment
to see a nurse or doctor urgently / same day?
o Very easy
o Fairly easy
o Not very easy
o Not at all easy
o Don’t know
Q4 How easy do you find making an appointment
to see a nurse or doctor in advance?
o Very easy
o Fairly easy
o Not very easy
o Not at all easy
o Don’t know
Q5 How important is it to you to be able to make
an appointment to see a nurse or doctor in advance?
o Important
o Not important
Q6 How do you prefer to book appointments at the practice (please tick all that apply)?
o In person
o On the telephone
o Online
Q7 Did you know that you were able to book an appointment or order a repeat prescription online?
o Yes
o No
Q8 When you want to make an appointment with a particular doctor, how quickly do you usually get seen?
o The same day
o The next day
o 2 – 5 days
o 5 days or more
o Don’t know / have not tried
Q9 How do you rate this?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q10 When you want to make an appointment with
any doctor at the practice, how quickly do
you usually get seen?
o The same day
o The next day
o 2 – 5 days
o 5 days or more
o Don’t know / have not tried
Q11 How do you rate this?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q12 If you need to speak someone at the Practice for advice how easy do you usually find this?
o Very easy
o Fairly easy
o Not very easy
o Not at all easy
o Don’t know
Q13 When you were at your last consultation with a doctor, how long did you wait for your consultation to start?
o Within 5 minutes
o 6 – 10 minutes
o 11 – 20 minutes
o 21 – 30 minutes
o 30 minutes or more
Q14 How do you rate this?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q15 The last time you saw a doctor, how would you rate the amount of time you had at your appointment?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q16 The last time you saw a doctor, how would you rate how good they were at listening?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q17 The last time you saw a doctor, how would you rate how good they were at explaining tests and treatment?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q18 The last time you saw a doctor, how would you rate how good they were at involving you in decisions about your care?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q19 The last time you saw a doctor, how would you rate how good they were at treating you with dignity and respect?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q20 Did you have confidence and trust in the doctor you saw or spoke to?
o Yes definitely
o Yes, mostly
o Yes, somewhat
o Yes, a little
o No, none at all
o Don’t know / cant say
Q21 When you were at your last consultation with a nurse, how long did you wait for your consultation to start?
o Within 5 minutes
o 6 – 10 minutes
o 11 – 20 minutes
o 21 – 30 minutes
o 30 minutes or more
Q22 How do you rate this?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q23 The last time you saw a nurse, how would you
rate the amount of time you had at your appointment?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q24 The last time you saw a nurse, how would you
rate how good they were at listening?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q25 The last time you saw a nurse, how would you
rate how good they were at explaining tests and treatment?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q26 The last time you saw a nurse, how would you
rate how good they were at involving you in decisions about your care?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q27 The last time you saw a nurse, how would you
rate how good they were at treating you with dignity and respect?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q28 Did you have confidence and trust in the nurse you saw or spoke to?
o Yes definitely
o Yes, mostly
o Yes, somewhat
o Yes, a little
o No, none at all
o Don’t know / cant say
Q29 Is the practice currently open at times that are convenient to you??
o Yes (Go to Q31)
o No
o Don’t know
Q30 Which of the following times would be helpful to you?
o Before 8am
o At lunchtime
o After 6.30pm
o On a Saturday
o On a Sunday
Q31 How easy do you find accessing the building?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q32 Did you know that we offer the following In-house services? (Please tick Yes or No)
Yes No
o o GP
o o Nurse Practitioner
o o Practice Nurse
o o Health Care Assistant
o o Physiotherapist
o o Counsellor
o o Midwife
o o Practice Pharmacist
Q33 How would you like us to communicate to you about new services? (Please tick all that apply)
o Newsletter
o E mail
o Posters in Surgery
o Local press
o Flyer
o Notes on Prescriptions
o Website
o Other (please specify below)
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Q34 How do you rate the cleanliness of the Practice?
o Excellent
o Very good
o Good
o Fair
o Poor
o Not applicable
Q35 Would you recommend the Practice to someone that has just moved into your local area?
o Definitely
o Probably
o Probably not
o Definitely not
o Don’t know
Finally it would help us if you could tell us a little about yourself, all answers are anonymous.
Q36 Are you?
o Male
o Female
Q37 How old are you?
o Under 15
o 16 – 44
o 45 to 64
o 65 to 74
o 75 or over
Q38 Do you have a long-term health condition?
o Yes
o No
o Don’t know
Q39 What is your ethnic group?
o White
o Black / Black British
o Asian / Asian British
o Mixed
o Chinese
o Other Ethnic group (please state below)
______
Q40 Which of the following best describes you?
o Employed (full or part time including self employed)
o Unemployed / looking for work
o At school or in full time education
o Unable to work due to long term sickness
o Looking after home / family
o Retired from paid work
o Other (please state below)
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