Dear Patient

We would be grateful if you would take some time to complete this patient survey. Your Doctors and Nurses want to provide the highest standard of care. Feedback from this survey will help them to identify areas that may need improvement. Your opinions are very valuable.

Please answer ALL the questions that apply to you by putting an X in one box unless more than one answer is allowed. There are no right or wrong answers and your doctor will not be able to identify your individual answers.

Thank you.

About You:

1: Are you: Male Female 

2: How old are you?

3: What is your ethnic group? (Please tick the relevant box.)

A: White B: Mixed C: Asian or Asian British

British White and Black Caribbean Indian

 Irish White and Black African Pakistani

White and Asian Bangladeshi

Any other White background Any other Mixed background Any other Asian background

(Please detail) (Please detail) (Please detail)

D: Black or Black British E: Chinese/Other Ethnic Group F: Not Stated

Caribbean Chinese

African Any other Ethnic Group

Any other Black background (Please detail)

4: Which of the following best describes you?

Employed Unemployed Full time education

(full, part time, including (includes looking for work)

self-employed)

Unable to work Looking after Retired from paid work

due to long term sickness family and home.

Other

Attendance at the Surgery

5. How frequently do you attend the surgery?

Rarely Occasionally Regularly

Practice Opening Hours

6. Are you happy with our opening hours?

Yes No

7: What additional hours would you like the surgery to be open?

Before 8am? At lunchtime? After 6.30pm? Other times, please state below:

Additional Opening Hours

8: Do you find it useful that we offer pre bookable appointments on Saturday mornings 8.00 – 11.00 a.m.?

Yes No

9: Are you aware we offer a text messaging service notifying you that your prescription is ready to be picked

up?

Yes No

If you are interested in the service please speak to reception.

Appointments

10: How long do you have to wait for your ROUTINE appointment?(Please only tick one please)

More than 2 weeks Less than 2 weeks Less than 1 week

11: If you required an urgent appointment and you were not able to be seen, was it because?

(Please tick more than one answer)

Times offered did not suit Appointment was with No appointments

a clinician you did not want to see

12: Did you know that nurse triage is offered between 11.00 am-12 noon?

Yes No

13: Did you know that GP triage is available between 8.15 am-9.00 a.m.?

Yes No

14: Have you registered for online appointment booking?

Yes No

Please speak to reception

Confidentiality

15: Can you overhear conversations with the receptionists?

Yes but I don’t mind Yes, and I am not happy about itNo, other patients can’t hear

16: Did you know that you can speak to reception privately?

Yes No

17: Did you know that you could ask to speak to a doctor or nurse on the telephone if you have a medical questionat the end of morning surgery?

Yes No

Patient Experience

18: How helpful have you found the following non-clinical staff?

Receptionists: Very helpfulFairly helpfulNot helpful

Dispensers: Very helpfulFairly helpfulNot helpful

Secretaries: Very helpfulFairly helpfulNot helpful

Admin Staff Very helpfulFairly helpfulNot helpful

Dispensary

19: Does the practice dispense your medication?

Yes No

If yes and you have regular repeat medication, are you aware there is a managed repeat system available?

Yes No

Please speak to a member of dispensary staff for more information.

GP Consultations

20: How long have you had to wait after your pre-booked appointment time to be seen?

5 minutes or less6-10 minutes11-20 minutes Over 20 min

21: How do you consider your experience with your GP?

A: Care & Concern

Very GoodGood SatisfactoryPoor Does Not apply

B: Involving you

Very GoodGood SatisfactoryPoor Does Not apply

C:Explaining tests and treatments

Very GoodGood SatisfactoryPoor Does Not apply

D:Listening

Very GoodGood SatisfactoryPoor Does Not apply

E: Asking about symptoms

Very GoodGood SatisfactoryPoor Does Not apply

F:Taking problems seriously

Very GoodGood SatisfactoryPoor Does Not apply

H: Giving enough time

Very GoodGood SatisfactoryPoor Does Not apply

22: Do you agree with this statement ‘I have confidence and trust in my GP’ ?

Strongly agree Agree  Neutral  Disagree

Nurse Consultations

23: How happy are you with the Nurses at the practice?

A:Do you agree-‘I have confidence in the Practice Nurses’

Strongly agree Agree  Neutral  Disagree Does Not apply

B: Showing care and consideration

Very GoodGood SatisfactoryPoor Does Not apply

Patient Choice

24: Did you know that you have a choice of secondary care providers if applicable? For example if you need

a referral to a consultant, you are able to specify which consultant and hospital you would like to attend.

Yes No

Overall Satisfaction

25: How satisfied are you with the overall patient care at the Practice?

Very Satisfied SatisfiedNot Satisfied

We are interested in any other comments you may have about your experience?

Do you have a suggestion as to how your future experience could be improved?

Thank you for taking time to complete this questionnaire.

1 EQUIP 2013