Patient Survey Please tell us the name of your usual doctorPlease select a doctorDr Jonathan GriffinDr Helen MorrisDr Gordon GibbonsDr Stuart VasDr Gavin RhodesDr Matthew TeesdaleDr Katherine RivettDr Lisa RoscoeDr Abbie MorleyDr Rachel LangleyDr Laura PopeDr Jonathan BreezeDr Elizabeth HargraveDr Kate RankineDr Rachael TibbitsDr Pramod Gubbi1. In the past 12 months, how many times have you seen a doctor from your practice? None Once or twice Three or four times Five or six times Seven times or more 2. How do you rate the way you are treated by receptionists at your practice? Very poor Poor Fair Good Very good Excellent 3. a) How do you rate the hours that your practice is open for appointments? Very Poor Poor Fair Good Very good Excellent b) What additional hours would you like the practice to be open? Early morning Lunch times Evenings Weekends None, I am satisfied 4. Thinking of times when you want to see a particular doctor: a) How quickly do you usually get to see that doctor? Same day Next working day Within two working days Within three working days Within four working days Five or more working days Does not apply b) How do you rate this? Very poor Poor Fair Good Very good Excellent Does not apply 5.Thinking of times when you are willing to see any doctor: a) How quickly do you usually get seen? Same day Next working day Within two working days Within three working days Within four working days Five or more working days Does not apply b) How do you rate this? Very poor Poor Fair Good Very good Excellent Does not apply 6. If you need to see a GP urgently, can you normally get seen on the same day [this is with any GP]? Yes No Don’t know/I have never needed to 7. a) How long do you usually have to wait at the practice for your consultations to begin? 5 minutes or less 6 – 10 minutes 11 – 20 minutes 21 – 30 minutes More than 30 minutes b) How do rate this? Very poor Poor Fair Good Very good Excellent 8. Thinking of times you have phoned the practice, how do you rate the following: a) Ability to get through to the practice on the phone? Very poor Poor Fair Good Very good Excellent Don’t know/never tried b) Ability to speak to a doctor on the phone when you have a question or need medical advice? Very poor Poor Fair Good Very good Excellent Don’t know/never tried These next questions ask about your usual doctor. If you don’t have a ‘usual doctor’, answer about the one doctor at your practice who you know best. If you don’t know any of the doctors, go straight to question.9. a) In general, how often do you see your usual doctor? Always Almost always A lot of the time Some of the time Almost never Never b) How do you rate this? Very Poor Poor Fair Good Very good Excellent 10. Thinking about when you consult your doctor, how do you rate the following: a) How thoroughly the doctor asked about your symptoms and how you are feeling? Very Poor Poor Fair Good Very good Excellent Does not apply b) How well the doctor listens to what you had to say? Very poor Poor Fair Good Very good Excellent Does not apply c) How well the doctor puts you at ease during your physical examination? Very poor Poor Fair Good Very good Excellent Does not apply d) How much the doctor involves you in decisions about your care? Very poor Poor Fair Good Very good Excellent Does not apply e) How well the doctor explains your problems or any treatment that you need? Very poor Poor Fair Good Very good Excellent Does not apply f) The amount of time your doctor spends with you? Very poor Poor Fair Good Very good Excellent Does not apply g) The doctor's patience with your questions or worries? Very poor Poor Fair Good Very good Excellent Does not apply h) The doctor's caring and concern for you? Very poor Poor Fair Good Very good Excellent Does not apply 11. Have you seen a nurse from your practice in the past 12 months? Yes – go to question 12 No – go to question 13 12. Thinking about the nurse(s) you have seen, how do you rate the following: a) How well they listen to what you say? Very poor Optional Poor Optional Fair Optional Good Optional Very good Optional Excellent Optional b) The quality of care they provide? Very poor Optional Poor Optional Fair Optional Good Optional Very good Optional Excellent Optional c) How well they explain your health problems or any treatment that you need? Very poor Optional Poor Optional Fair Optional Good Optional Very good Optional Excellent Optional Finally, it will help us to understand your answers if you could tell us a little about yourself: 13. Are you: Male Optional Female Optional Other Optional 14. How old are you? 0-15 16-24 24-35 36-50 50-65 65 and over 15. Do you have any long-standing illness, disability or infirmity? By long-standing we mean anything that has troubled you over a period of time or that is likely to affect you over a period of time. Yes No 16. Which ethnic group do you belong to? White Black or Black British Asian or Asian British Mixed Chinese Other Ethnic Group 17. Is your accommodation? Owner-occupied/mortgaged Rented or other arrangements 18. Which of the following best describes you? Employed (full or part time, inc. self employed) Unemployed and looking for work At school or in full time education Unable to work due to long term illness Looking after your home/family Retired Other
