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Name

Gender

Male

Female

Age

18-25

26-40

41-55

56-65

66-75

over 75

Mobile number

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Confidence in the overall service offered by the practice

Overall service confidence

I feel very confident in the practice

I'm mostly confident in the practice

No opinion

I sometimes doubt the ability of the practice

I strongly doubt the ability of the practice

Being called for your appointment by the clinician

Are you aware when it is your turn?

I never have a problem

I sometimes get a problem

I occasionally have a problem

I often have a problem

I always have a problem

Waiting room times

The waiting time

All my appointments have been on time

The majority of my appointments are on time

Generally fine - some on time

The majority of my appointments are on delayed by you

All my appointments have been delayed by you

Appointment delays When a clinician is running late, was the reason for the delay explained to you?

Delays and reasons

They explain the reason every time

They've explained the reasons most of the time

Sometimes they haven't explained

They have never explained the delays

I've never had a delay

Waiting for an appointment Are you satisfied with the typical length of time you have to wait to be given a suitable appointment to see a doctor or nurse?

Time it takes to get an appointment

Appointments are usually available very quickly

The majority of appointments are available quickly

Sometimes I wait

The majority of appointments are NOT available in a timely manner

The delays for an appointment are unacceptable

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Telephone calls to reception Are you satisfied with the typical length of time it takes you to get through to reception on the telephone?

Telephone delays (reception)

I never have to wait

I sometimes have to wait

I don't notice

I mostly have to wait

The wait is unacceptable

Waiting in person at reception Are you satisfied with the typical length of time you are kept waiting to speak to a receptionist if you have come into the surgery with a query?

Delays in person at reception

I never have a delay

I sometimes have a delay

I don't notice

I often have a delay

I always have a delay

Prescription requests Are you satisfied with the typical time it takes the practice to turn around a prescription request?

Prescription timings

I get all prescriptions quickly

I get most prescriptions quickly

It varies

There's often a delay with the prescription

There's always a delay with the prescription

Clear advice Are you satisfied with the clarity of medical information given to you by health care professionals at the practice?

Health advice

The advice is always clear

The advice is mostly clear

It depends on the doctor and the problem

The advice is sometimes confusing

The advice is always confusing

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Respect Do you feel in general that the clinicians at the practice treat you with respect?

Respect

I'm treated respectfully every time

I'm treated respectfully most of the time

I'm treated respectfully some of the time

I'm treated with disrespect most of the time

I'm treated with disrespect every time

Doctors' attire Do you feel that the way the doctors' dress is appropriate?

Doctors' attire

My doctor dresses appropriately all the time

My doctor dresses appropriately most of the time

I don't care what the doctor wears

I sometimes think my doctor dresses inappropriately

The clothing is totally inappropriate

Services Tick all the services that you were aware that we offer

Services offered

different ways of ordering your prescription

telephone consultations online appointments

online appointments

pre-bookable GP appointments in the early morning/ late evening

pre-bookable GP appointments on the weekend

Disability-related healthcare Are you satisfied with our commitment to disability-related access to healthcare?

Disability-related healthcare

I'm really happy with you commitment to disability-related healthcare

I think you're on your way to being fully committed to disability-related healthcare

I have no opinion on disability-related healthcare

I think you can improve your commitment to disability-related healthcare

I don't feel you're committed disability-related healthcare

Diversity and inclusivity Are you satisfied with the mix of genders and ethnicity of the practice employees?

Diversity and inclusivity

Strongly yes

Yes

Generally

Sometimes

Strongly No

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What areas do you feel the practice needs to concentrate on to improve the patient experience?

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